A scleral lens fitting is a process of evaluating eye health, measuring corneal and scleral shape, testing a diagnostic lens, designing customized optics, teaching lens handling, and refining the fit during follow-up. It is more involved than ordering a standard soft contact lens because each lens must vault the cornea and land appropriately on the sclera while supporting vision, comfort, and ocular health.
Dr. Edward Boshnick evaluates patients with keratoconus, severe dry eye, irregular corneas, corneal scarring, post-LASIK or post-RK vision problems, corneal transplants, ocular surface disease, and prior contact lens intolerance. A diagnostic examination is required to determine whether a scleral lens is reasonable for a particular eye.
What Does “Fitting” a Scleral Lens Mean?
Scleral lenses are not selected from a single standard shape. The central portion must clear the cornea and limbus, while the landing zone must align with the sclera without excessive pressure, edge lift, rocking, or instability. The optical power must then be refined for the patient’s visual needs.
The initial lens may provide useful information without being the final design. Scleral lenses settle after application, and some fitting characteristics become clearer after the lens has been worn for a period of time. Follow-up is therefore part of the fitting rather than an optional extra.
The Scleral Lens Fitting Process
1. Define the Diagnosis, Symptoms, and Goals
The visit begins with a review of the diagnosis, prior procedures, current correction, medications, ocular-surface treatments, lens history, and the situations in which vision or comfort breaks down. A person seeking better night vision after surgery may require a different evaluation from someone needing ocular-surface protection for severe dry eye.
Bring current and previous lenses, recent prescriptions, corneal imaging, surgical records, and the names of lens solutions or eye drops when available.
2. Examine the Eye and Ocular Surface
Dr. Boshnick evaluates the cornea, conjunctiva, eyelids, tear film, and other structures relevant to lens wear. Active inflammation, infection, significant staining, lid disease, or an unstable ocular surface may need attention before or alongside lens fitting.
A scleral lens may be one part of care, but it does not replace diagnosis or management of the underlying condition.
3. Measure Corneal and Scleral Shape
Corneal topography maps corneal curvature. Tomography and anterior-segment optical coherence tomography can provide additional information about corneal shape, thickness, and the relationship between a diagnostic lens and the eye. Other measurement or impression-based systems may be considered for selected complex surfaces.
Not every patient requires every technology. Measurements should answer a specific fitting or optical question rather than being used simply because they are available.
4. Apply a Diagnostic Scleral Lens
A diagnostic lens is filled with preservative-free saline and applied without trapping an air bubble. Initial vision and comfort are checked, but the lens also needs time to settle before final observations are made.
The examination considers central and peripheral corneal clearance, limbal clearance, scleral landing, edge relationship, centration, stability, movement, surface wettability, and signs of localized compression or impingement.
5. Evaluate Vision Through the Lens
Refraction over the diagnostic lens helps estimate the required optical power. Dr. Boshnick also considers whether residual blur, ghosting, glare, or double images arise from ordinary refractive error, lens position, corneal irregularity, tear-film quality, or higher-order aberrations.
Standard optics are appropriate for many patients. Wavefront-guided scleral lens optics may be evaluated for selected eyes when measurable residual aberrations remain after the physical fit is stable.
6. Design and Dispense the Custom Lens
The collected findings guide lens diameter, sagittal depth, peripheral geometry, material, power, and other design features. When the manufactured lens arrives, its fit and vision are checked on the eye rather than assumed from the order.
Patients receive instruction in application, removal, filling, cleaning, disinfection, storage, and recognition of air bubbles. Handling competence is important for both lens performance and eye safety.
7. Refine the Fit During Follow-Up
Follow-up evaluates how the lens behaves during real wear. Symptoms such as redness after removal, pressure, edge awareness, variable vision, front-surface drying, midday fogging, or reduced wearing time can provide useful clues.
Some patients obtain an appropriate fit quickly; complex eyes may require multiple design changes. The number and timing of visits depend on anatomy, diagnosis, prior surgery, ocular-surface health, optical goals, and the response to each lens.
What Makes a Scleral Lens Fit Acceptable?
An acceptable fit is not defined by one measurement. The overall assessment includes:
- adequate corneal and limbal clearance after settling;
- a stable landing relationship without harmful localized pressure;
- appropriate edge alignment and minimal unwanted movement;
- clear and stable vision for the intended tasks;
- acceptable comfort and wearing time;
- healthy tissue appearance during wear and after removal; and
- a care routine the patient can perform safely.
A more expensive or technologically advanced design is not automatically better. The appropriate design is the one that addresses the patient’s measurable fitting and optical needs.
How to Choose a Scleral Lens Fitter
When comparing scleral lens providers, look beyond proximity or a list of lens brands. A thorough fitting process should include an eye-health examination, measurements that relate to the individual cornea and sclera, an on-eye diagnostic lens assessment after settling, vision testing through the lens, handling and care instruction, and planned follow-up.
Ask who will evaluate the fit, how the practice checks the cornea and ocular surface after lens wear, what happens if the first ordered lens needs refinement, and how urgent symptoms are handled. For a complex cornea or ocular-surface condition, experience with that diagnosis and access to appropriate diagnostic technology may be especially relevant. No credential, device, or lens design can guarantee candidacy or a particular result.
For a focused provider-selection checklist, read how to choose a scleral lens specialist.
How to Prepare for a Scleral Lens Evaluation
- Bring all current contact lenses, cases, plungers, and care products.
- Bring prior lens parameters, prescriptions, imaging, and surgical records when available.
- Write down when blur, fogging, discomfort, glare, or redness occurs.
- List current eye drops, medications, allergies, and ocular-surface treatments.
- Follow any lens-removal instructions provided before the appointment. Do not stop prescribed medication or lens wear unless instructed by the treating professional.
Planning an Evaluation When You Live Outside the Area
Eye Freedom evaluates patients who travel from many locations. Scleral lens diagnosis, measurements, diagnostic lens testing, dispensing, and fit assessment require in-person care; they cannot be completed through a remote consultation alone.
Before making travel arrangements, contact the practice to discuss the reason for evaluation and which records may be useful. Prior corneal imaging, surgical reports, current lens parameters, prescriptions, medication lists, and notes from treating eye-care professionals can help Dr. Boshnick understand the history, but they do not replace his examination. The number and timing of visits cannot be determined reliably before the eye and a diagnostic lens are evaluated.
Patients traveling a long distance should also maintain access to a qualified eye-care professional near home for emergencies and care that cannot wait for a return visit.
When to Remove a Lens and Seek Advice
Remove the lens and contact the treating office for new pain, pronounced redness, discharge, sudden light sensitivity, an abrupt reduction in vision, persistent fogging that does not clear after proper removal and reapplication, or a lens that becomes difficult to remove. Urgent symptoms should not wait for a routine follow-up.
Why Customization Matters
Two patients with the same diagnosis may have different corneal geometry, scleral shape, tear-film behavior, eyelid interaction, optical aberrations, and daily visual demands. That is why a diagnosis alone cannot determine the final lens.
For a deeper explanation of clearance, landing, optics, technology, and follow-up decisions, read Why Custom Scleral Lens Fitting Matters. The broader Eye Freedom scleral lens guide explains uses, benefits, limitations, care, and candidacy.
Frequently Asked Questions
How long does a scleral lens fitting take?
The evaluation includes examination, measurements, diagnostic lens application, settling time, fit assessment, and refraction. The total process commonly extends across more than one visit because the manufactured lens must be evaluated and may require refinement. Timing varies by patient and should not be promised before examination.
Will the first diagnostic lens be my final lens?
Usually not. A diagnostic lens helps show how a particular geometry behaves on the eye. Those observations are used to design the ordered lens, which is then checked and adjusted as needed.
Can I tell whether a scleral lens will help before ordering one?
A diagnostic lens trial may provide useful information about potential vision and initial comfort, but it cannot guarantee the final result or predict every issue that may occur during longer wear.
Why might a scleral lens need to be changed after it looks good initially?
The lens settles, and real-world wear can reveal pressure, fogging, surface drying, instability, or optical symptoms that were not apparent during the first observation. Follow-up allows the design or care plan to be refined.
Do all complex eyes need EyePrintPRO or wavefront optics?
No. Many patients do well with conventional custom scleral designs. Impression-based or wavefront-guided options are considered when specific anatomical or optical findings justify them.
How do I find a qualified scleral lens fitter?
Look for a provider who examines eye health, evaluates a diagnostic lens after it settles, checks corneal and scleral relationships, refines vision through the lens, teaches safe handling, and provides follow-up. For complex eyes, ask about experience with your condition and how lens changes or urgent symptoms are managed.
Can I begin the process before traveling for an evaluation?
You can contact the practice and provide relevant records before traveling, but candidacy, measurements, diagnostic lens testing, and the final fitting require an in-person examination. The practice should review your situation before you make travel plans, without promising the number of visits or an outcome in advance.
How can I request a scleral lens evaluation with Dr. Boshnick?
Use the Eye Freedom evaluation form or call 305-271-8206. The practice reviews patients from many locations, but an in-person examination is required for diagnostic fitting and measurements.
Medical Sources
- Cleveland Clinic: Scleral lenses
- BostonSight and Bausch + Lomb: Guide to scleral lens fitting
- Scleral Lens Education Society: Patient information
This article is educational and does not determine candidacy or prescribe a lens design.
