Scleral Contact Lenses: What They Are and How They Can Help You
What Are Scleral Lenses?
Scleral lenses are a type of rigid contact lens designed for eyes that standard lenses cannot adequately correct. They work differently from regular contacts, which is why they are so effective for certain conditions.
Scleral lenses are large-diameter rigid lenses made from a gas permeable material that allows oxygen to pass through to your cornea. Unlike soft lenses, which flex and conform to the eye's surface, scleral lenses hold a precise, firm optical shape. This rigid form is what makes them so effective at delivering clear, stable vision.
The key difference with scleral lenses is where they rest. Instead of sitting on the cornea (the clear front surface of the eye), scleral lenses vault completely over the cornea and land gently on the sclera, which is the white part of your eye. The space between the lens and your cornea is filled with preservative-free saline solution before you insert the lens each morning.
This creates a fluid reservoir that continuously bathes your cornea, smooths out any irregularities on the surface, and protects it throughout the day.
Traditional rigid lenses rest directly on the cornea, which is packed with sensitive nerve endings. Scleral lenses avoid this by resting on the much less sensitive scleral tissue. Combined with the cushioning fluid layer, this design makes scleral lenses far more comfortable than smaller rigid lens types, even for first-time contact lens wearers.
Who Can Benefit from Scleral Lenses?
Scleral lenses are a specialty tool, and they are especially valuable for patients whose eyes present challenges that other lens types simply cannot overcome. Our team evaluates each patient individually to determine whether scleral lenses are the right fit.
Keratoconus is a condition where the cornea gradually thins and bulges forward into a cone shape, distorting vision in ways that glasses cannot correct. The fluid reservoir in a scleral lens fills in the uneven surface and presents a smooth, uniform optical front to incoming light. The same benefit applies to post-surgical irregular astigmatism and corneal scarring, where the cornea's surface has become unpredictable.
For patients with chronic dry eye, the saline reservoir in a scleral lens acts as an all-day moisture chamber. The lens seals against the sclera and maintains a constant layer of hydration over the cornea, which can reduce discomfort, blurred vision, and irritation that standard lenses make worse.
Patients who have had LASIK, corneal transplants, or other eye surgeries sometimes develop irregular corneal surfaces that are difficult to fit with standard lenses. Scleral lenses accommodate these changes well because they do not rest on the cornea at all.
Some patients have prescriptions or corneal shapes that soft lenses cannot match precisely. Scleral lenses can be made to exact custom specifications, making them a strong option when other contact lens types have failed to provide adequate vision correction.
Children who have had a lens removed due to congenital cataracts (a condition called aphakia) often need specialized optical correction. Scleral lenses are one tool our team uses to help these young patients achieve functional vision during critical developmental years.
How Scleral Lenses Improve Your Vision
The optical benefit of scleral lenses comes from how they interact with the front surface of your eye. Understanding this helps explain why so many patients see dramatically better with them than with any other correction option.
When your cornea is uneven, light entering your eye scatters in irregular patterns. Glasses cannot correct this type of distortion. The saline-filled space inside a scleral lens fills in the cornea's peaks and valleys, replacing the irregular surface with a perfectly smooth optical layer. The rigid lens then adds precise vision correction on top of that.
Eyes affected by dry eye, corneal swelling, or progressive conditions often produce blurry or fluctuating vision that changes from hour to hour. Because the scleral lens maintains a constant fluid layer and a fixed rigid surface, your vision stays consistent from the moment you insert your lenses in the morning until you remove them at night.
The sealed environment created by a scleral lens protects your cornea from wind, dust, and friction from your eyelids. For patients dealing with corneal surface disease, recurrent erosions, or significant dryness, this physical barrier can reduce daily discomfort and support surface healing over time.
The Scleral Lens Fitting Process
Getting scleral lenses is not the same as picking up a standard pair of contacts. It is a careful, personalized process that requires expertise and the right diagnostic tools. Our specialty-trained optometrists guide you through every step.
Your Eye Doctor will use corneal topography and scleral profilometry to create a detailed map of your eye's shape. These measurements are the foundation of a well-fitting scleral lens. Your Eye Doctor also evaluates your tear production, corneal thickness, and overall eye health before designing your lenses.
Your Eye Doctor will place a diagnostic trial lens filled with saline on your eye and let it settle for 20 to 30 minutes. After settling, your Eye Doctor checks how the lens vaults over your cornea, how the edges align with your sclera, and what your vision looks like through the lens. Most patients work through a series of trial lenses across multiple visits before the ideal design is confirmed.
Once your Eye Doctor finalizes the design, your custom lenses are sent to a specialty laboratory for manufacturing. Turnaround time is typically one to three weeks. When your lenses arrive, your Eye Doctor verifies the fit carefully before clearing you to wear them.
Before you take your lenses home, our team walks you through everything you need to know. You will practice filling the lens with preservative-free saline, checking for air bubbles, inserting using either a plunger or tripod method, and removing safely with a small suction tool. We do not send you home until you feel confident.
Your Eye Doctor will schedule follow-up visits at one week, one month, and then every six months. These appointments allow us to monitor your corneal health, check that the lens fit has not shifted, and address any questions as your wearing schedule builds.
Living with Scleral Lenses Day to Day
Most patients adapt to scleral lenses within a few weeks and find them a natural part of their daily routine. Here is what a typical day looks like.
Start by washing your hands thoroughly. Fill each lens bowl with preservative-free saline, being careful to avoid air bubbles. Insert the lens using your preferred technique while looking into a mirror. The insertion process takes most patients three to five minutes once they are comfortable with it.
Scleral lenses stay centered and stable during most daily activities, including reading, driving, computer work, and physical activity. If debris enters the fluid reservoir and causes fogging, simply remove the lens, rinse it, refill with fresh saline, and reinsert. Many patients keep a small travel kit with them for easy midday maintenance when needed.
Remove your lenses using your suction plunger. Rub each lens gently with a daily surfactant cleaner on both surfaces, then place them in a hydrogen peroxide-based disinfecting solution overnight. Using single-use saline vials rather than multi-use bottles is recommended to reduce the risk of contamination. The entire evening routine takes about five minutes.
How Long Scleral Lenses Last
Scleral lenses are durable, but they do not last forever. Knowing when to replace them and when to reach out to your Eye Doctor is an important part of successful long-term wear.
Most patients replace their scleral lenses every one to two years, though this varies based on how well the lenses are cared for and how the eyes change over time. Your Eye Doctor will examine the lens surface at each visit and recommend replacement when scratches, protein deposits, or changes in fit affect how well the lenses perform.
Remove your lenses and contact your Eye Doctor promptly if you experience persistent pain, redness, sudden changes in vision, or a white spot on your cornea. Persistent fogging that does not clear after reinsertion, a lens that repeatedly decenters, or any discharge around the eye are also reasons to seek care without delay. Pain during wear is never normal and always warrants attention.
Our Specialty Contact Lens Team
Fitting scleral lenses well requires specialized training and years of hands-on experience. Our optometry team includes some of the most experienced specialty lens fitters in the region.
Dr. Zerbinopoulos has been fitting scleral lenses since 2008 and is a past president of the Rhode Island Optometric Association. His depth of experience with complex corneal cases and difficult-to-fit patients makes him one of the most sought-after scleral lens fitters in the area.
With over 40 years of experience in specialty contact lens fitting, Dr. Scharff has expertise across the full range of rigid gas permeable, multifocal, toric, and scleral lens designs. He brings a deep clinical foundation to every fitting, particularly for patients with challenging prescriptions or corneal conditions.
Dr. Boivin trained at Massachusetts Eye and Ear and brings specialty lens fitting expertise to our practice. She works with patients across a wide range of conditions and lens types, offering thorough, thoughtful care for those who need more than standard contact lenses can provide.
Dr. Mishley provides comprehensive eye care for patients of all ages, with particular expertise in specialty contact lenses, low vision, binocular vision, and pediatric eye care. A graduate of the Pennsylvania College of Optometry at Salus University, she combines refractive and medical optometry to deliver thorough, personalized fittings for patients who need more than standard lenses can offer.
Frequently Asked Questions
Here are answers to questions our patients commonly ask about scleral lenses, with guidance to help you understand what to expect and how to make decisions about your care.
The best way to find out is to schedule a specialty contact lens evaluation. Candidates often include people who have tried other lens options without success, or those with conditions like keratoconus, severe dry eye, or irregular corneas. Your Eye Doctor will review your corneal shape, tear production, and visual history to make that determination, since not everyone with these conditions will need or benefit from scleral lenses in the same way.
Coverage depends on your specific plan and the condition being treated. When scleral lenses are documented as medically necessary, such as for keratoconus or severe dry eye, some medical insurance plans will provide benefits. Vision-only plans often do not cover them. Our team can help you understand what documentation may be needed and what your plan is likely to cover before you commit to the fitting process.
Most patients find insertion easier than expected once they practice with guidance. The technique is different from soft lenses because you fill the bowl with saline before placing it on your eye, but our team provides hands-on training during your dispensing appointment. Many patients feel comfortable within one to two weeks of consistent practice. First-time contact lens wearers can also learn successfully with the right support.
Fogging usually means that debris or mucus has entered the fluid reservoir under the lens. The solution is to remove the lens, rinse it with preservative-free saline, refill it with fresh saline, and reinsert. If fogging is frequent or does not resolve with reinsertion, mention it to your Eye Doctor at your next visit, as it can sometimes point to a fit issue or a change in your tear chemistry.
Scleral lenses correct the visual effects of keratoconus but do not stop the underlying progression of the condition. If your keratoconus is still advancing, your Eye Doctor may discuss additional treatment options alongside lens wear. Regular monitoring is especially important in these cases because changes in your corneal shape can affect lens fit and require adjustments over time.
Standard rigid gas permeable lenses are smaller and rest directly on the cornea. They can be effective for mild to moderate corneal irregularities, but they tend to be less comfortable and less stable on severely irregular or dry surfaces. Scleral lenses vault over the cornea entirely and land on the sclera, adding the benefit of a fluid reservoir that standard rigid lenses cannot provide. The choice between the two depends on your specific eye shape, condition, and comfort needs, and your Eye Doctor will help determine which is more appropriate for you.
Schedule Your Scleral Lens Evaluation at Rhode Island Eye Institute
Our specialty contact lens team at Rhode Island Eye Institute is ready to help you find the clearest, most comfortable vision possible. Whether you have been living with an irregular cornea, chronic dry eye, or years of frustrating contact lens failures, we have the expertise, the technology, and the experience to guide you through a specialty fitting. We welcome patients from across Rhode Island and look forward to helping you see the difference the right lens can make.