What are scleral lenses and how can they help me?
Have you ever been told in the past that contact lenses are not a good fit for you because of an irregular eye shape or other problem? Scleral lenses are a specialized contact lens that may be the solution for you. Scleral contact lenses are larger in diameter than a typical soft contact lens. Due to the large diameter of the lens, it is able to vault over the cornea (front surface of the eye) and rest lightly on the sclera (the white part of the eye). This means that the lens is less reliant on fitting perfectly to the cornea. This is advantageous in cases where the patient has an irregular shaped cornea or trouble with how the lens remains stable on the eye. A scleral lens replaces an irregular corneal surface with a perfectly smooth optical surface in order to correct vision problems. It can avoid irritating the front surface of the eye and further progressing eye conditions. The size of the lens is determined by the severity of the eye condition. Milder conditions are easily managed with smaller sized scleral lenses while larger lenses are reserved for more progressed conditions. Between the scleral lens and the cornea will rest a fluid reservoir which can greatly benefit patients with dry eye as well. The fluid filled chamber promotes surface healing by providing the eye with the moisture and oxygen needed to remain healthy. It protects the cornea from irritants and the external environment. This may be beneficial for patients following a corneal transplant or patients recovering from an eye injury for example. The many positives associated with scleral contact lenses make them a popular and very satisfying option for patients. Schedule your next eye exam to see if scleral contact lenses would be the proper fit for you.
Who benefits from scleral contact lenses?
Although any patient is able to wear a scleral lens, an eye doctor may recommend these lenses for hard-to-fit eyes such as those with corneal dystrophies or disease. A few examples of situations in which scleral contact lenses may be preferred over typical soft contact lenses would be:
- Keratoconus patients
- Post corneal transplant patients
- Severe dry eye in cases of sjogrens syndrome or steven johnson syndrome
- Patients with drier than normal eyes would benefit greatly from these types of lenses due to the liquid reservoir
- that will fill the space between the back surface of the lens and the cornea. It will act as a tear reservoir and keep
- the front of the eye moist throughout the day.
- Irregular corneas
- Hard to fit eyes
- Corneal degenerations and dystrophies
- Corneal ectasia
- Patients with high amounts of astigmatism
- Corneal trauma patients
- Post radial keratology or post LASIK patients
- Patients who play sports since they are less likely to dislodge
- Lasts longer – less often replaced
- Superior performance in windy and dusty environments
What are the benefits of scleral lenses?
The material and process of production of scleral lenses creates several clear advantages over standard soft contact lenses, including:
- Sharper vision due to lens stability and customization
- Greater durability due to more rigid material
- Less risk of microbial (bacterial, fungal, viral) infection
- Easier handling
- Increased comfort
- Less likely to dislodge from the eye
- Lens stability, less rotation
- Increased breathability for the eye
- Delayed surgical intervention for patients who may need a corneal transplant
- Promotion of ocular surface healing
Who should not be fit in scleral contact lenses?
Although scleral lenses are a great option for a lot of patients, some patients may benefit from avoiding these lenses. This includes patients with small eyes or low cornea endothelial cell counts. A patient with a small eye size or a narrowed lid position, it may be difficult for these patients to place the lens in their eye due to the increased diameter. The corneal endothelium is the most posterior layer of the cornea and functions to regulate its health. With the use of scleral lenses, it may put the patient more at risk for corneal edema. Speak to your eye doctor to determine if scleral lenses are the right lenses for you.
What are the disadvantages of scleral lenses?
Scleral contact lenses require some level of adaptation in terms of application and removal. Scleral contact lenses are inserted similar to soft contacts except they are first filled with a gentle preservative free solution. Patients must be taught the proper insertion technique and will have to practice making this process smooth and easy. However, most patients adapt fairly quickly. When you are first getting used to your contacts, you may notice lens awareness. However, this feeling with subside with continued use.
What are some complications of scleral lenses?
Just like with all contact lenses, scleral lenses come with it their share of risks. However, these are no different than the complications associated with your standard soft contact lenses. Some examples of associated risks include:
- Corneal neovascularization or increased new blood vessel growth in the eye.
- Corneal staining
- Corneal edema
Risks are minimized through proper lens hygiene and care. Review your cleaning regime and replacement schedule with your eye doctor to ensure you are taking the right steps to maximize your eye health.
How do I care for my scleral lenses?
Scleral contact lenses require proper contact lens hygiene and care. Your scleral lenses will have a life span of about 1 year. Therefore, they are not replaced as often as a standard soft lens. The lenses need to be cleaned regularly and stored properly to ensure good overall eye health. Scleral lenses are not suitable to wear overnight and should be removed before sleep. They should also be removed prior to partaking in any water sports or wear goggles over your lenses. It is recommended never to wear your contacts while swimming in fresh water due to risk of infection. Always wash your hands prior to handling your contact lenses and before touching your eyes. Cleaning your scleral lenses requires proper cleaning tools. Biotrue and AOSept Hydrogen Peroxide disinfection system are both approved solutions for cleaning. Never use saline, saliva, or tap water on your lenses. These sources may contain bacteria and viruses that can cause eye infections.
To insert the scleral lenses:
- Remove the lenses from the case
- Place the lens on a suction holder (provided to you by your eye doctor) or hold the lenses with 2-3 fingers.
- Fill the lens to the brim with doctor approved saline solution or eye gel. If the lens is not filled to the top, it may leave air bubbles in the lens once placed on the eye
- Lean over until your face is parallel to the floor.
- Keep both eyes open and look straight ahead.
- Pull back the upper lid with your left forefinger. Hold the lashes out of the way.
- Pull the lower lid out of the way with your left middle finger or fourth finger.
- Hold the suction plunger in your right hand
- Bring the plunger straight towards the middle of your eye and touch the lens to your eye.
- Once you feel the liquid on your eye and the lens is properly touching your eye, squeeze the barrel of the plunger.
- Release your lower lid first then slowly let go of your upper lid. Blink
- If there are any air bubbles in the lens or are uncomfortable after insertion, remove the lenses and repeat the process.
How much do scleral lenses cost?
Scleral contact lenses require a greater skill set, expertise, and is more time consuming than fitting a standard soft or a gas permeable lens. Maps of the entire cornea are used to help with lens design and fitting. Several trial lenses and office visits may be required to get the lens to fit perfectly for you. Parameters of the scleral lens itself may need to be altered over the course of follow up exams and require new fittings. Teaching application and removal of the scleral lenses requires more time as well. For all these reasons, scleral lenses can cost more than standard contact lenses. However, due to the longer life span of theses lenses, the costs are typically offset by not having to replace the lenses often. Each office has their own pricing list for their services so speak to your eye doctor today to determine your costs for this treatment.