Occasionally I will be asked questions about scleral lens quality and about what is the best scleral lens. Many patients think about scleral lens technology like many of us think about cars or electronics. Most of us assume that a Mercedes Benz is a superior automobile compared to most other cars. This is not how it works when it comes to specialty contact lenses and specifically to scleral lenses.

Every eye is different and so is every patient. Not only that, every ocular condition comes with its own unique history. In addition to this, the shape and contour of every eye is different just like every face is different. Thankfully, today’s scleral lens technology allows us to create individualized scleral lens designs to better address the vision and comfort needs of every patient.

How Do You Determine The Best Scleral Lens Design For Each Patient?

When patient’s first come to visit our specialty lens practice, there are many things that we need to consider. These include the patient’s medical history, their visual acuity and comfort with their existing eyeglasses or contact lenses.

We also want to know what the patient’s goals are, what kind of work that they do, how they use their eyes. Before getting involved with any lenses, a careful eye health examination is done. Images and photos of all the ocular structures are taken and carefully documented.

Once we decide to fit a patient with a scleral lens, careful measurements are taken of the front surface of the eye. These include corneal topographies, and anterior segment OCT (optical coherence tomography) images. In addition a careful dry eye evaluation is done including images of the patient’s meibomian glands. These are the glands located within our eyelids and are responsible for keeping the ocular surface moist.

There are 3 methods that doctors use to design a scleral lens. These include:

1. Conventional scleral lenses that are designed using a diagnostic scleral lens fitting set.
2. Customized scan based technology using special imaging computers capable of measuring (virtually) every “hill and valley” of the ocular surface of the eye. The images taken are uploaded to a special lab that uses software compatible with our imaging computer to allow them to make a scleral lens with every aspect of the ocular surface embedded into the back surface of the scleral lens. In other words the scleral lens is designed to exactly fit the patient’s eye.
3. Impression based scleral lens technology. This technology involves taking an impression of the front surface of the eye. It is a pain free procedure that takes about 3 minutes to do. The impression taken is sent to a special lab where 3-D printing technology is used to make a scleral lens where every “defect” along the ocular surface is embedded onto the back surface of the scleral lens.

With the scleral lens technologies explained above, almost all of our “hi need” patient population are comfortably wearing scleral lenses created by the last 2 technologies explained above.