Scleral Lenses for Keratoconus

Name: Scleral Lenses for Keratoconus
Creator: Dr. Edward Boshnick

Keratoconus can make vision feel unstable, distorted, and difficult to correct with glasses or standard contact lenses. For many patients with irregular corneas, scleral lenses may provide a more stable optical surface and more comfortable lens wear than smaller corneal lenses.

Dr. Edward Boshnick evaluates keratoconus patients with detailed corneal imaging, visual testing, ocular surface assessment, and specialty lens diagnostics. The goal is not to make broad promises. The goal is to understand the individual eye and design a lens strategy that may improve functional vision, comfort, and day-to-day quality of life.

Why keratoconus can make vision difficult to correct

Keratoconus is a condition in which the cornea becomes thinner and more cone-shaped over time. Because the cornea is responsible for much of the eye’s focusing power, this irregular shape can create blurry vision, ghosting, glare, halos, light sensitivity, and frequent prescription changes.

In mild cases, glasses or soft contact lenses may be enough. When the cornea becomes more irregular, a standard lens may not sit well or may not create clear enough optics. That is where specialty contact lenses, including scleral lenses, are often considered.

How scleral lenses may help keratoconus

A scleral lens is a custom gas-permeable lens that rests on the sclera, the white part of the eye, and vaults over the cornea. This design creates a fluid-filled space between the back of the lens and the corneal surface.

For keratoconus, that design may help in three important ways:

Optical smoothing: the lens can create a smoother front surface for light to pass through.
Reduced corneal bearing: the lens is designed to vault over the cone instead of rubbing directly on the most irregular corneal area.
Improved stability: the larger lens diameter may reduce movement and lens awareness for selected patients.

Scleral lenses do not eliminate keratoconus and do not stop progression. If progression is suspected, patients may also need monitoring and discussion of treatments such as corneal collagen cross-linking with an appropriate eye care provider. Scleral lenses are used to help manage vision and comfort.

Who may be a candidate?

A keratoconus patient may be evaluated for scleral lenses when glasses, soft lenses, or smaller corneal gas-permeable lenses are not providing enough clarity, stability, or comfort. Candidates often describe symptoms such as:

distorted or doubled vision
glare, halos, or starbursts
frequent prescription changes
difficulty driving at night
poor vision with glasses
contact lens discomfort or intolerance
vision that changes throughout the day

The right lens design depends on the shape of the cornea, the shape of the sclera, tear film quality, prior eye surgery, corneal scarring, and the patient’s visual goals.

Dr. Boshnick’s evaluation process

Keratoconus lens fitting is not just choosing a lens size. It is a diagnostic process. Dr. Boshnick evaluates the eye carefully before deciding whether a standard scleral lens, wavefront-guided scleral lens, EyePrintPRO, or another specialty design may be appropriate.

1. Corneal shape and irregularity

Corneal imaging helps identify steepening, thinning patterns, irregular astigmatism, and optical distortion. This matters because two patients with keratoconus can have very different lens needs.

2. Ocular surface health

Dry eye, inflammation, lid disease, and tear film instability can affect lens comfort and wearing time. These issues may need to be addressed as part of the lens plan.

3. Diagnostic lens fitting

Diagnostic lenses help evaluate vault, landing, movement, comfort, and vision. The final lens may require refinements as the eye’s response and visual performance are assessed.

4. Advanced optics when needed

Some keratoconus patients still experience higher-order aberrations even when a scleral lens fits well. In selected cases, wavefront scleral lenses or diagnostic tools such as the WaveDyn Vision Analyzer may be considered to address more complex optical distortion.

Scleral lenses vs. other keratoconus options

Keratoconus care may include several approaches. The right option depends on disease stage, progression, corneal shape, vision needs, and overall eye health.

Option	Role in keratoconus care
Glasses	May help in early or mild keratoconus, but often become less effective as irregular astigmatism increases.
Soft contact lenses	May help selected mild cases but may not mask significant corneal irregularity.
Corneal GP lenses	Can provide sharp optics for some patients but may be difficult to tolerate if the cornea is very irregular or sensitive.
Hybrid lenses	Combine a rigid center with a soft skirt and may help some patients who need improved optics with a different comfort profile.
Scleral lenses	Vault over the cornea and may provide improved stability, comfort, and vision for many irregular cornea patients.
Cross-linking	Used to slow or halt progression in appropriate progressive cases; it is not a vision-correction lens.
Corneal transplant	Reserved for advanced cases when other options are not enough or the cornea is too scarred or compromised.

What results should patients expect?

Many keratoconus patients seek scleral lenses because they want sharper, more stable vision and better lens comfort. Results vary. Vision can be limited by scarring, disease severity, higher-order aberrations, dryness, prior surgery, or other eye conditions.

A successful outcome usually depends on careful fitting, realistic expectations, proper handling, consistent cleaning, and follow-up care. Patients should expect an individualized process rather than a one-visit solution.

Frequently asked questions

Are scleral lenses the best treatment for keratoconus?

They may be an excellent option for many patients with irregular corneas, but there is no single best treatment for every person. The right approach depends on the stage of keratoconus, progression risk, corneal shape, comfort, and visual needs.

Can scleral lenses stop keratoconus from getting worse?

No. Scleral lenses can help manage vision and comfort, but they do not stop keratoconus progression. Progressive keratoconus may require separate evaluation for treatments designed to stabilize the cornea.

Are scleral lenses comfortable for keratoconus?

Many patients find scleral lenses comfortable because the lens lands on the sclera rather than directly on the sensitive corneal cone. Comfort depends on lens design, ocular surface health, handling, and follow-up refinements.

How long does fitting take?

Complex keratoconus fittings may require multiple visits. The process can include diagnostic fitting, custom lens ordering, training, and adjustments based on vision, comfort, and eye health.

Can scleral lenses help avoid surgery?

Scleral lenses may help many keratoconus patients function well without corneal transplant surgery, but every case is different. Advanced scarring, severe disease, or other complications may still require surgical consultation.

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Medical sources

This article is educational and is not a diagnosis or treatment plan. A specialty examination is needed to determine whether scleral lenses are appropriate for your eyes.