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How Do I Get Insurance to Pay for My Scleral Lenses?

How do I get insurance to pay for my scleral lenses?

If you have medical or vision insurance, they may contribute toward the cost of scleral lenses.

Some insurance companies such as VSP or Eyemed will reimburse eye doctors quite well for scleral lenses, and many offices accept this insurance for scleral lenses.

Other insurance plans reimburse eye doctors poorly for scleral lens fittings. Some of them reimburse less than the cost of the lenses! In this case, it is not feasible or realistic to expect your doctor to fit you into scleral lenses.

One way to get your insurance to cover scleral lenses is to have your doctor write you a letter of medical necessity.

This letter should include”

– Patient’s name

– Patient’s date of birth

– Date patient was seen

– Patient diagnosis

– Patient’s vision (uncorrected)

– Patient’s vision (corrected with glasses)

– Patient’s vision (corrected with scleral lenses)

– Abnormal findings

– Recommended treatment and plan

– ICD 10 codes

– CPT codes

– V codes

The letters we write for patients explain to the insurance company why the patient needs scleral lenses. Usually, our patients suffer from a medical eye condition such as keratoconus, corneal scarring, corneal transplants, RK scarring, post LASIK, etc so the reason they need scleral lenses is to improve their vision. Other patients have medical eye conditions such as extreme dry eye, graft-vs-host disease, sjogren’s, stevens-johnson and other disorders related to the ocular surface. Whatever the reason is, we will write a letter explaining to the insurance company the need for scleral lenses.


Our patient who has extreme dry eye. Notice the major difference in her eyes before and after scleral lenses.

You can also have your doctor give you a list of diagnosis codes, ICD-10 codes, CPT codes, and V codes, along with the pricing for each service. This will allow the insurance company to see what is being requested, and the specific dollar amount needed.

Your insurance company may also request to speak with the doctor. In this case, your doctor will set up a meeting with the insurance company to explain your medical eye condition and explain why scleral lenses are necessary.

With some help from your doctor, you may be able to get a portion or the entire scleral lens fitting covered through your insurances.

Stevens-johnson treatment options

Steven’s-Johnson is a rare, but very serious disease. Stevens-Johnson Syndrome (also known as SJS) is unpredictable and can happen to anyone. It is caused by a reaction to a medication or infection. It starts off with flu like symptoms, but then spreads throughout the body in the form of a painful rash and blisters. Mucous membranes are affected, which is why eye doctors become involved.

SJS is a serious condition which requires hospitalization. After being released from the hospital, the patient usually works with a team of doctors to manage different parts of their body.

SJS patients usually have extremely dry eyes, inflamed eyes, and severe eye pain. Many patients wear very dark sunglasses indoors and outdooors. Often times, the pain is so bad, they keep their eyes closed the entire day and night. Their quality of life can be very poor.

We are fortunate to work with some of these special patients.

A 79 year old female arrived at the office last week for a consultation. She had SJS 30 years ago, and still suffers from a variety of issues. Regarding her eyes, she stated her eyes were incredibly painful all the time. She has to put preservative free artificial tears in her eyes every few minutes, around the clock! Her eyes are red, swollen, and highly sensitive to light.

You can see in the photo that her eyes are very swollen. She wears dark sunglasses all the time due to her severe light sensitivity. She keeps her eyes closed majority of the day because they hurt when she opens them.

For these types of patients, I highly recommend the EyePrint Prosthetic. This is due to the fact that we only have a very small eyelid fissure to work with. For SJS patients, they can’t keep their eyes open even for a few seconds, so it makes fitting their eyes very difficult.

By taking an impression of the surface of the entire eye, the lab is able to design a specialized custom lens. This is the best option for SJS patients, in our opinion.

We were able to take multiple impressions of each eye and send those to the lab to be fabricated.

She arrived to our office for the dispense and we inserted the lenses for her. She was thrilled with the vision and the comfort of her eyes. She wore them over the weekend and when we saw her for her follow up, she said, “You’ve given me a new lease on life!”

You can see in the photo that her eyes are much less swollen and much less red when she has the lenses in her eye. This is because the scleral lens is filled with a preservative free saline, that bathes her eye all day. This also forms a protective barrier between her delicate eye and the outside environment. Scleral lenses can be life changing for these patients. We are honored to work with these special patients – we love seeing their eyes heal and get another chance on life!

Stevens johnson treatment options 1

Stevens johnson treatment options 2

Stevens johnson treatment options 3


Sjogren’s patient fit into scleral lenses

A 47 year old female was referred for contact lens evaluation. She was diagnosed with ocular cicatricial pemphigoid and Sjogren’s. These two conditions cause the eyes to be incredible red, irritated and dry. She suffers frm extreme dry eye.Her habitual scleral lenses are several years old and feel that they are getting dirty and fogging. She reports poor night vision with glare and halos. She reports only using preservative free sodium chloride solution to rewet her eyes throughout the day. Her lenses are about 2 years old, per patient.

She was 20/40 right eye and left eye with her current lenses. The front surface of the lenses had poor non-wetting surface and protein deposits. You can see in some of the images how deposited the surface of her lenses were. Both eyes exhibited poor tear film stability, inflamed bulbar conjunctiva, and formation of symblepharon. Symblepharon is a condition in which the under part of the eyelid starts to fuse with the white part of the eye. This can happen with patients that suffer from extreme dry eye. Due to her signs and symptoms, we felt that a custom Latitude lens would provide her the best comfort and vision.

The Latitude is a custom scleral lens that uses 3D imaging technology. The patient looks straight ahead, then up, then down, and the machine captures 3 D images in each gaze. Then, the software stitches the images together. This give the laboratory an incredible amount of information, so that a custom scleral lens can be designed and fabricated.

We worked with the lab to help design her new scleral lenses.

We dispensed her new lenses and she reported noticing immediate improvement in comfort and vision. You can see how well the new lenses fit her eye in the images below. Due to the instability of her tear film, we started her on Cequa as well as recommending preservative free artificial tears to replace the sodium chloride solution for the additional lubricating agents. Cequa is an eye drop intended to help with dry eye syndrome. We are very happy with how the new scleral lenses look and feel on this patient’s eyes!

Financial disclosures: I have no financial interest in any of the companies or products mentioned in this case report.

Sjogren’s Patient Fit Into Custom Scleral Lenses

old lens new lens scleral

We had a very nice patient arrives for her scleral lens follow up this week!

This patient was kindly referred by Dr. Stafeeva from New Eyes for a scleral lens refit. This patient has ocular pemphigoid and severe dry eyes. She also suffers from a condition called Sjögren’s syndrome. Patients with Sjögren’s have incredibly dry eyes, and many patients require the use of scleral lenses to function. Scleral lenses hold a layer of liquid onto the eye surface all day, creating a barrier between the eye and the outside world. This results in eye relief and reduced redness, pain, and dry eye symptoms. Many patients must insert their scleral lenses first thing in the morning to even be able to function.

Her habitual scleral lenses were fit elsewhere about 2 years ago. She has done very well over the past 2 years, but as the lenses have worn down, there are some scratches and multiple deposits.

You can see that the edges of the lenses are also a bit compressed, so we felt there could be an improvement to the lens fit as well. In the photo of her old scleral contact lens, you can see there is a bit of white color near the edge of the lens landing. This is called compression and it means the edge of the lens is squishing the conjunctiva or sclera. This compression can cause the eyes to become red after a few hours of wear. It can also cause a compression ring around the sclera when the lens is removed. Many patients will complain that there is a large ring around their eye when the lens is removed.

The photos also show that her old lens had a very large amount of deposits. Deposits can be from excess protein, lipids, and mucous in the tear film on the ocular surface. These can stick onto the lens, creating a blurry image. Deposits on the contact lenses can also cause discomfort. When traditional remedies do not work, it is often times necessary to change the material of the scleral lens or add a special coating.

After reviewing all of the options, we decided to proceed with the Latitude custom scleral lens. The Latitude is very custom lens because we take 3 D images of the entire eye surface, and then the lab is able to fabricate a very custom scleral lens. We felt this was the best option for her.

She had some symblepharon on the upper conjunctiva on each eye, which made some of the images difficult to capture, but we did our best and took multiple images.

The laboratory fabricated the lenses based on the images sent and the diagnostic lens fitting information.

The Latitude custom scleral lenses are fitting much better than her habitual lenses, and we added Hydrapeg coating to help with deposit resistance and to improve wettability. Hydrapeg coating helps with dry eye issues and also helps resist deposits on the lenses. Hopefully by adding this coating, the patient will not have an many deposits on this pair of lenses. Patients with ocular surface disease such as dry eye syndrome, Sjögren’s, Stephen Johnson, ocular pemphigoid or graft vs host disease may always suffer from deposits on the lenses, no matter what changes we make. This is because the tear film and the ocular surface are abnormal, creating a non wetting surface or deposits on the lenses. For these patients, it is important to manage their dry eye disease at the highest level.

Thanks again to Dr. Stafeeva for thinking of us to help with this fun case!