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Scleral Lenses: Uses, Fitting, Benefits and Care
Scleral lenses are custom, large-diameter gas-permeable contact lenses used when glasses or conventional contacts do not provide adequate vision or comfort. Because they vault the cornea and rest on the sclera, they can create a smoother optical surface and hold a fluid reservoir over the cornea. Dr. Edward Boshnick evaluates patients with keratoconus, severe dry eye, irregular corneas, and post-surgical vision problems to determine whether a scleral lens is appropriate for their eyes and daily visual needs.
Understanding Scleral Lenses
A scleral lens rests on the tissue over the sclera, the white part of the eye, while vaulting the cornea. Before application, the bowl of the lens is filled with sterile, preservative-free saline, creating a fluid reservoir between the lens and the cornea. For an irregular cornea, the front surface of the lens may provide a more regular optical surface. For selected patients with ocular surface disease, the reservoir may also help protect and hydrate the cornea during wear.
Every fit is individualized. Corneal clearance, the landing zone, lens stability, oxygen transmission, comfort, and vision must be evaluated together, and results vary by diagnosis and eye health.
Who May Be Evaluated for Scleral Lenses?
A specialty evaluation may be considered for people with:
- Keratoconus or corneal ectasia: a scleral lens may provide a smoother refractive surface over an irregular cornea.
- Severe dry eye or ocular surface disease: the fluid reservoir may support comfort and corneal protection for appropriately selected patients.
- Post-surgical corneal irregularity: custom lenses may be evaluated after LASIK, radial keratotomy, PRK, or corneal transplantation when the corneal shape limits vision with glasses.
- Corneal scarring, degeneration, or dystrophy: candidacy depends on the location and severity of the condition and the health of the ocular surface.
Scleral lenses are not the right choice for every patient. A comprehensive examination is needed before a recommendation can be made.
The Scleral Lens Fitting Process
- Eye-health and vision evaluation: Dr. Boshnick reviews symptoms, prior treatments and surgeries, ocular surface health, and visual goals.
- Corneal mapping and diagnostic measurements: imaging helps document corneal shape and guide lens selection.
- Diagnostic lens assessment: a lens is evaluated on the eye for clearance, landing, stability, comfort, and visual performance.
- Custom design and refinement: lens parameters may be adjusted over one or more visits based on clinical findings and the patient’s response.
- Application, removal, and care training: patients receive hands-on instruction and return for follow-up so fit, eye health, and vision can be monitored.
Caring for Scleral Lenses
Contact lenses are medical devices and must be handled as directed. Wash and dry your hands before touching a lens, use only the cleaning and disinfecting products recommended for your lens system, and keep lenses and cases away from tap water. Use the prescribed sterile, preservative-free solution to fill the lens before application. Remove the lens and contact the practice promptly if you develop pain, marked redness, light sensitivity, discharge, or an unexpected change in vision.
Follow Dr. Boshnick’s instructions for wear time, storage, case replacement, follow-up visits, and lens replacement. General safety guidance is also available from the CDC’s Healthy Contact Lens Wear and Care program.
Potential Benefits and Limitations
Depending on the condition and the fit, scleral lenses may improve visual clarity and stability, reduce lens movement, or provide a protected fluid environment over the cornea. Some patients report meaningful improvements in comfort or daily visual function, but a specific result cannot be guaranteed.
Scleral lenses also require training and ongoing care. Possible challenges include application and removal, lens awareness, midday fogging, deposits, solution sensitivity, or the need for design adjustments. Eye health, tear quality, eyelid anatomy, handling ability, and prior surgery all influence whether the benefits are likely to outweigh these limitations.
Advanced Scleral Lens Technologies
Dr. Boshnick uses diagnostic measurements and specialty lens technologies to individualize the fitting process. These may include computerized corneal topography, WaveDyn vision analysis, wavefront-guided scleral lens designs, and EyePrintPRO for selected complex eyes. The technology used depends on the diagnosis, measurements, and clinical findings; not every patient needs every system.
What to Expect After Lens Dispensing
Adaptation and follow-up differ from person to person. Early visits allow Dr. Boshnick to check the ocular surface, review wearing time and handling, measure vision, and look for areas where the lens design may need refinement. Bring your lenses, case, and care products to follow-up visits and report any change in comfort, redness, or vision rather than waiting for the next scheduled appointment.
Common Questions About Scleral Lenses
These patient-focused guides answer common questions that arise before and during a specialty lens evaluation:
- Why should I consider scleral lenses? Review candidacy, realistic benefits, limitations, and questions to bring to an evaluation.
- Are scleral lenses comfortable? Learn what normal lens awareness may feel like, what affects comfort, and when symptoms need attention.
- Why does custom scleral lens fitting matter? See how clearance, landing, optics, measurements, and follow-up shape an individualized lens.
- What if glasses and regular contacts are not enough? Understand why irregular corneas, ocular surface disease, or unstable optics may require a different correction strategy.
Is a Scleral Lens Evaluation Right for You?
If you have keratoconus, severe dry eye, corneal scarring, an irregular cornea, post-surgical vision problems, or intolerance to conventional contacts, a specialty evaluation can help clarify your options. Dr. Boshnick evaluates each eye individually and explains whether a custom scleral lens, another specialty lens, or a different approach is most appropriate.
Request an evaluation with Eye Freedom.
Medical sources
- American Academy of Ophthalmology EyeWiki: Contact Lenses
- Peer-reviewed review: Contact lenses in dry eye disease and associated ocular surface disorders
- CDC: Cleaning, disinfecting, and storing contact lenses
This page is educational and does not replace an eye examination, diagnosis, or individualized treatment plan.
Frequently Asked Questions
Scleral lenses are large-diameter gas-permeable lenses that rest on the tissue over the sclera and vault the cornea. A fluid reservoir fills the space between the lens and cornea. The design can create a smoother optical surface for an irregular cornea and may protect the ocular surface for selected patients.
There is no single ideal candidate. Scleral lenses may be evaluated for keratoconus, corneal ectasia or scarring, severe dry eye or ocular surface disease, post-surgical corneal irregularity, and intolerance to conventional lenses. Candidacy depends on examination findings, eye health, handling ability, and visual needs.
Yes. Scleral lenses require measurements and an on-eye assessment of corneal clearance, the lens landing zone, stability, comfort, and vision. The design may be refined over follow-up visits based on clinical findings and the patient’s experience.
Many patients find a well-fitted scleral lens comfortable because it vaults the cornea, but comfort varies. Lens design, ocular surface health, tear quality, wearing time, and handling can all affect the experience. Persistent discomfort should be evaluated rather than accepted as normal.
Dr. Boshnick’s clinical focus is the evaluation and fitting of specialty contact lenses for complex corneal and ocular surface conditions. That experience helps him interpret diagnostic findings, select an appropriate design, and refine the lens while monitoring eye health and patient-reported comfort and vision.
Scleral lenses may help selected patients whose post-LASIK symptoms are associated with corneal irregularity, ectasia, or higher-order optical aberrations. They do not reverse LASIK, and the likely benefit depends on the cause of the symptoms and the health of the eye.
There is no universal replacement interval. Lens condition, prescription changes, surface deposits or scratches, fit, comfort, and eye health all matter. Dr. Boshnick will examine the lenses and advise when replacement is appropriate.
Follow the care system prescribed for your specific lenses. Wash and dry your hands first, clean and disinfect lenses with the recommended products, use fresh solution, and keep lenses and the storage case away from tap water. Use the prescribed sterile, preservative-free solution when filling a scleral lens for application.
Schedule Your Consultation with
Dr. Boshnick
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7800 Sw 87 Ave Suite B-270
Miami, Florida 33173
