Scleral Lenses After LASIK and RK

Name: Scleral Lenses After LASIK and RK
Creator: Dr. Edward Boshnick

Some patients continue to struggle with blurry vision, glare, halos, ghosting, dry eye, or contact lens intolerance after LASIK, RK, PRK, or other corneal refractive surgery. When the cornea has become irregular or the ocular surface is unstable, scleral lenses may be considered as part of a specialty vision rehabilitation plan.

Dr. Edward Boshnick evaluates post-surgical vision problems with advanced corneal imaging, tear film assessment, visual testing, and diagnostic specialty lens fitting. The purpose is to understand why vision or comfort remains difficult and whether a custom scleral lens, wavefront-guided design, EyePrintPRO, or another approach may help.

Why vision can remain difficult after LASIK or RK

LASIK and RK reshape the cornea. Most patients are satisfied with refractive surgery outcomes, but some experience persistent symptoms or develop complications. These may include dry eye, glare, halos, starbursts, ghosting, fluctuating vision, irregular astigmatism, corneal ectasia, or unstable vision throughout the day.

Post-RK eyes can be especially complex because radial incisions may contribute to irregular corneal shape, fluctuating vision, and difficulty fitting standard contact lenses. Post-LASIK eyes can also have dryness, higher-order aberrations, decentered ablation patterns, or ectasia in selected cases.

How scleral lenses may help after refractive surgery

Scleral lenses are custom gas-permeable lenses that rest on the sclera, the white part of the eye, and vault over the cornea. This design can be useful when the corneal surface is irregular or sensitive.

Irregular optics: the front surface of the lens may create a smoother optical system than the post-surgical cornea alone.
Dryness and ocular surface protection: the fluid reservoir beneath the lens may help selected patients with post-surgical dry eye during lens wear.
Lens stability: larger scleral designs may be more stable than smaller corneal lenses on complex corneal shapes.
Advanced customization: some patients may need wavefront-guided optics or impression-based designs for more complex visual distortion.

Scleral lenses do not undo LASIK, RK, or other surgery. They may help manage vision and comfort for selected patients after a complete evaluation.

Post-LASIK symptoms that may lead to a scleral lens evaluation

dry eye symptoms that affect comfort or vision
glare, halos, starbursts, or night driving difficulty
ghosting or double images
fluctuating vision
irregular astigmatism
reduced quality of vision despite 20/20 acuity
post-LASIK ectasia
difficulty wearing standard contact lenses

Post-RK symptoms that may lead to a scleral lens evaluation

unstable vision that changes during the day
irregular astigmatism from radial incisions
glare, halos, or starbursts
difficulty with glasses or soft lenses
corneal scarring or incision-related irregularity
contact lens intolerance
dryness or ocular surface sensitivity

Dr. Boshnick’s post-surgical evaluation process

1. Surgical and symptom history

The evaluation begins with the type of surgery performed, timing, prior enhancements, symptoms, previous lens attempts, dry eye history, and the patient’s visual goals.

2. Corneal shape analysis

Corneal topography or tomography helps identify irregular astigmatism, ectasia, decentration, scarring, flattening, steepening, or other patterns that may explain visual distortion.

3. Ocular surface assessment

Dry eye can make post-surgical vision worse by destabilizing the tear film. Lid disease, inflammation, tear quality, and corneal staining may need to be addressed alongside lens fitting.

4. Specialty lens diagnostics

Diagnostic lenses help evaluate comfort, vault, landing, stability, and visual improvement. Complex post-surgical eyes often require custom refinements rather than a standard lens design.

5. Advanced optics when needed

Some post-surgical patients still experience glare, halos, or ghosting even when the lens fits well. In selected cases, wavefront scleral lenses and the WaveDyn Vision Analyzer may be used to evaluate and address more complex optical distortion.

Scleral lenses after LASIK vs. after RK

Situation	Common challenges	How scleral lenses may help
After LASIK	Dry eye, glare, halos, decentered ablation, ectasia, irregular astigmatism, fluctuating vision	May create a smoother optical surface and protect the ocular surface during wear.
After RK	Irregular incisions, diurnal fluctuation, glare, unstable refraction, contact lens fitting difficulty	May vault over corneal irregularity and provide a more stable optical surface.
After PRK or other corneal surgery	Scarring, irregular astigmatism, dry eye, visual fluctuation	May improve optical regularity and lens stability for selected patients.

What results should patients expect?

Many post-surgical patients seek scleral lenses because glasses do not fully correct their visual symptoms. Scleral lenses may improve clarity, comfort, and visual stability, but results vary. Vision may still be limited by corneal scarring, retinal disease, nerve-related symptoms, severe dry eye, or higher-order aberrations.

A realistic fitting process may include multiple visits, diagnostic lenses, custom manufacturing, insertion and removal training, and refinements based on comfort and vision.

Frequently asked questions

Can scleral lenses help LASIK complications?

They may help selected patients with post-LASIK dry eye, irregular astigmatism, ectasia, glare, halos, or fluctuating vision. A diagnostic evaluation is needed to understand the cause of the symptoms.

Can scleral lenses help after RK?

They may help some post-RK patients by vaulting over irregular corneal shape and creating a more stable optical surface. Post-RK eyes can be complex and often require customized fitting.

Will scleral lenses eliminate glare and halos?

Not always. Scleral lenses may reduce visual distortion for selected patients, but glare and halos can have multiple causes. Some patients may need advanced optics, ocular surface treatment, or additional medical evaluation.

Are scleral lenses safe after refractive surgery?

Scleral lenses are medical devices and should be fit and monitored carefully, especially after corneal surgery. Proper hygiene, handling, lens care, and follow-up visits are essential.

Do scleral lenses replace dry eye treatment after LASIK?

No. Scleral lenses may help protect the ocular surface during wear, but post-LASIK dry eye may still need diagnosis and treatment of inflammation, tear film instability, eyelid disease, or other causes.

Related Eye Freedom resources

Medical sources

This page is educational and is not a diagnosis or treatment plan. A specialty examination is needed to determine whether scleral lenses are appropriate after LASIK, RK, PRK, or another corneal surgery.