Do scleral lenses work for everyone?
Scleral lenses are becoming a very popular contact lens choice for a variety of patients. Scleral lenses have given us the ability to fit even the most complicated eyes. Scleral lenses are also very comfortable compared to other contact lens modalities. Corneal gas permeable lenses are notorious for their significant discomfort. While the vision is excellent in corneal GP lenses or hard contact lenses, the comfort can sometimes be unbearable, which leads many patients to discontinue wear.
Luckily, scleral contact lenses are much more comfortable, so many doctors select that as a first line approach. In the past, scleral lenses were used as a "last ditch effort." Doctors would usually fit patients into corneal gas permeable lenses, hybrid lenses, and other lenses before reaching for a scleral lens.
While scleral lenses are a great option for many patients, not all patients can wear scleral lenses. Sometimes patients have a very difficult time inserting a scleral lens. They cannot hold their eyelids open far enough or perhaps their eye is too sensitive and blinks the lens right off of the eye. Also, some patients have eye conditions that will not support a scleral lens.
Corneal transplant patients often fall into this high risk category. Patients who've had corneal transplants are at greater risk for corneal edema and graft rejection. For this reason, many patients are unable to wear scleral lenses. Scleral lenses cover the entire cornea, which limits the amount of oxygen that gets to the transplant. The cornea requires oxygen to stay healthy. If the cornea cannot keep up with the oxygen demands, it can start to develop swelling, also known as edema. This swelling causes the transplant to become cloudy and then it causes the vision to become blurry.
Scleral lenses can also cause the corneal transplant to reject, which is very scary. This is why it is so important to follow up with your doctor. They need to assess the health of your eye and the cornea to ensure any contact lens is not causing any damage.
For many transplant patients, a corneal gas permeable lens is the best option. A corneal GP lens does not cover the entire cornea. Every time you blink, the contact lens moves and gets fresh tears underneath the lens to nourish the cornea. Patients who wear corneal GP lenses are at much less risk of corneal edema and transplant rejection compared to patients who wear scleral lenses.
If you have a corneal transplant, be sure to check with your eye doctor to find out what type of specialty contact lens is the best for your eye safety.
Corneal transplant patient with glaucoma wearing a corneal gas permeable contact lens
