Who Is a Good Candidate for Scleral Lenses
Conditions That Make You a Strong Candidate
Scleral lenses were originally developed for irregular corneas, but their applications have expanded significantly. Today they are a well-established option for several distinct conditions, and many patients qualify based on more than one of the following categories.
Keratoconus is the most common reason patients pursue scleral lens fitting. It is a condition in which the cornea gradually thins and takes on a cone-like shape, creating irregular astigmatism that glasses and soft lenses cannot fully correct. Scleral lenses vault over the cone and create a smooth, uniform optical surface in front of the eye, which often produces the clearest vision a keratoconus patient has ever experienced.
- Keratoconus at any stage, from mild to advanced, may benefit from a scleral lens trial
- Pellucid marginal degeneration, a related condition affecting the lower cornea, responds similarly
- Post-surgical ectasia that develops after LASIK or PRK is a well-recognized scleral lens indication
Our cornea specialists work closely with our optometry team to evaluate ectasia patients thoroughly before recommending a fitting approach.
Scleral lenses are recommended for moderate to severe dry eye cases that have not responded adequately to eye drops, anti-inflammatory medications, or punctal plugs, which are tiny devices placed in the tear drainage ducts. The lens holds a reservoir of sterile saline solution directly against the corneal surface, providing continuous hydration throughout the day.
- Sjogren's syndrome, which damages moisture-producing glands throughout the body, is a common cause of severe dry eye
- Graft-versus-host disease following bone marrow transplant can severely damage the ocular surface
- Stevens-Johnson syndrome causes eyelid and conjunctival scarring that worsens dryness over time
For patients whose natural tear glands produce very little moisture, the scleral lens fluid reservoir effectively replaces what the tear film can no longer provide on its own.
Surgeries including corneal transplant, LASIK, PRK, and older procedures like radial keratotomy can leave irregular surfaces that scatter light and reduce sharpness of vision. Corneal scarring from trauma, infection, or chemical injury can do the same. Scleral lenses vault over these altered surfaces and provide optical correction that neither glasses nor soft lenses can replicate.
An eye doctor evaluates the health and stability of the cornea before recommending scleral lens fitting in these situations, since the underlying surface must be stable enough to support safe lens wear.
Patients who have tried soft contact lenses or rigid gas-permeable (RGP) lenses without achieving good vision or comfortable wear are strong candidates for scleral lenses. Common reasons for prior lens failure include poor fit on irregular corneas, lens dislodgement, inadequate vision correction, and discomfort related to dry eye. Scleral lenses address all of these issues through their vaulting design, built-in fluid layer, and stable landing zone on the sclera.
If you gave up on contact lenses years ago because of discomfort or blurry vision, advances in scleral lens materials, design software, and three-dimensional eye mapping may produce a very different result today. A trial fitting can help determine whether modern scleral lenses overcome the issues that caused your earlier difficulty.
How an Eye Doctor Evaluates Your Candidacy
Determining whether you are a good candidate for scleral lenses involves a thorough evaluation, not just a single measurement. Your eye doctor gathers information from multiple sources to understand both your visual needs and the health of your eye surface before recommending a fitting strategy.
A comprehensive candidacy evaluation typically includes corneal topography to map the shape and curvature of your cornea, a slit-lamp examination to assess the health of the cornea and surrounding tissue, and tear film testing to measure dry eye severity. Your eye doctor also reviews your full eye health history, including any prior surgeries, contact lens experience, and treatments you have already tried.
- Corneal topography reveals the type and degree of surface irregularity
- Tear assessment guides decisions about whether scleral lenses are an appropriate dry eye treatment
- Slit-lamp examination checks for active inflammation, scarring, and conjunctival health
- A review of prior treatment history clarifies what approaches have already been attempted
Active eye infections, uncontrolled inflammation, and certain eyelid abnormalities generally need to be treated before scleral lens fitting can safely begin. Your eye doctor identifies and manages these issues as a first step. Patients with glaucoma require careful intraocular pressure monitoring during scleral lens wear, since the lens can affect how pressure readings are interpreted.
Very young children may need additional support with the handling routine. In those cases, a parent or caregiver is trained alongside the patient to assist with insertion, removal, and daily lens care.
Scleral lens fitting typically involves two to four visits with your eye doctor. The process begins with detailed eye surface mapping, followed by selection of initial lens parameters, a trial fitting, and refinement of the lens design based on how the lens sits and how clearly it corrects your vision. Three-dimensional profilometry technology, which creates a precise digital map of the eye's surface, can reduce the number of trial lenses needed by allowing data-driven design before the first lens is even placed.
Before you take your lenses home, you receive hands-on training for insertion, removal, and daily care. Most patients develop confidence with the handling routine within one to two weeks of regular practice.
Our Scleral Lens Specialists
Scleral lens fitting requires clinical expertise that goes well beyond standard contact lens fitting. Our optometry team includes specialists with extensive experience in complex and specialty lens applications, and we have the diagnostic technology to support precise, individualized fitting.
Dr. Paul Zerbinopoulos has been fitting scleral lenses since 2008 and has served as past president of the Rhode Island Optometric Association, bringing deep expertise in complex contact lens cases including keratoconus and severe dry eye. Dr. Earle Scharff brings more than 40 years of experience fitting specialty lenses, including RGP, multifocal, toric, and scleral designs. Dr. Mishley brings a comprehensive approach to specialty contact lens care, drawing on training from the Pennsylvania College of Optometry at Salus University. Her clinical focus spans specialty contacts, low vision, binocular vision, and pediatric eye care, and she is known for thorough exams and treatment plans tailored to each patient's unique needs. Dr. Lori Boivin specializes in complex lens fittings and draws on her background training at a major academic eye center.
Together, our team has experience fitting the full range of specialty lens types for conditions that standard lenses cannot address.
Our practice fits a wide range of contact lens options, and our eye doctors recommend the specific design that best matches each patient's condition and goals.
- Scleral lenses for irregular corneas, dry eye, and post-surgical eyes
- Rigid gas-permeable (RGP) lenses for patients who are good candidates for corneal lens designs
- Toric and multifocal lenses for astigmatism and presbyopia
- Orthokeratology lenses worn overnight to temporarily reshape the cornea
- Myopia control lenses designed to slow progression of nearsightedness in children
- Daily and monthly soft lenses for patients with straightforward prescriptions
Our team has experience fitting patients across a wide spectrum of diagnoses that benefit from specialty contact lenses. We routinely work with patients who have keratoconus, post-surgical ectasia, severe dry eye, irregular corneas from scarring or transplant, high prescriptions that are difficult to correct with standard lenses, and pediatric aphakia, which is the absence of the natural lens in a child's eye following surgery.
Frequently Asked Questions
These questions address common points of uncertainty that come up when patients are exploring whether scleral lenses are right for them.
Yes. Even mild keratoconus can produce irregular astigmatism that glasses and soft lenses do not fully correct. The key question is whether a scleral lens trial produces meaningfully better vision than your current correction. Your eye doctor compares results directly and uses that comparison to guide the recommendation, rather than relying on disease stage alone.
Scleral lenses are effective for moderate to severe dry eye even when the corneal surface is perfectly regular. If you have worked through drops, anti-inflammatory treatments, and punctal plugs without adequate relief, and your symptoms are affecting your daily life, a scleral lens evaluation is a reasonable next step to discuss with your eye doctor.
There is no defined age cutoff. Teenagers with keratoconus and adults in their seventies or eighties with post-surgical complications can both be successful scleral lens wearers. Your eye doctor evaluates your ability to handle and maintain the lenses safely, along with the health of your eyes, rather than applying any age-based restriction.
Having both conditions at once actually makes scleral lenses particularly well suited to your situation. The rigid surface corrects the irregular astigmatism from keratoconus, and the fluid reservoir inside the lens provides the hydration that dry eyes need throughout the day. Many patients with keratoconus also have some degree of dry eye, and scleral lenses address both simultaneously rather than requiring separate treatments.
Active eye infection, uncontrolled inflammation, certain severe eyelid deformities, and an inability to safely handle lenses may prevent fitting from going forward. Importantly, most of these are temporary situations that can be resolved with appropriate treatment before proceeding. Permanent disqualification is rare, and your eye doctor will clearly explain what needs to be addressed if any barriers are identified during your evaluation.
Most patients adapt to the physical sensation of scleral lenses fairly quickly, often within the first week of wear. The handling routine, including filling the lens with saline and inserting it correctly, takes a bit longer to master. Our team provides step-by-step training during your fitting visits, and most patients feel confident with the process within one to two weeks of daily practice at home.
Schedule Your Scleral Lens Evaluation
If you have keratoconus, severe dry eye, a history of eye surgery affecting your vision, or previous contact lens failure, a scleral lens evaluation may open options you did not know were available to you. Rhode Island Eye Institute brings together fellowship-trained cornea specialists and experienced specialty lens optometrists under one roof, supported by advanced diagnostic technology and more than 1,800 patient reviews averaging 4.6 stars. We invite you to schedule a consultation with our team and find out whether scleral lenses are the right solution for your vision and comfort.