Understanding Scleral Lenses as a Treatment for Keratoconus

Keratoconus is a progressive condition where the normally round cornea thins and bulges into a cone-like shape, distorting vision. While early stages may be managed with glasses or soft contact lenses, many patients with moderate to advanced keratoconus find those options ineffective.

That’s where scleral lenses come in. These large-diameter gas-permeable lenses rest on the white of the eye (sclera) and vault over the cornea, creating a tear-filled chamber that improves vision and comfort for keratoconus patients.

Learn More: What is Keratoconus?

What Are Scleral Lenses?

Scleral lenses are specially designed rigid gas permeable (RGP) lenses that:

Vault over the irregular cornea.
Rest on the less sensitive sclera.
Create a smooth refractive surface.
Trap a tear reservoir beneath for comfort.

Unlike standard contacts, they don’t sit directly on the cornea, making them more comfortable for people with corneal irregularities.

Key Features:

Large diameter (typically 14.5mm – 24mm).
Gas permeable (oxygen flows to cornea).
Custom-made for each eye.
Stable, centered fit for better vision.

How Do Scleral Lenses Help with Keratoconus?

Scleral lenses are particularly effective in keratoconus because they compensate for the misshapen cornea. Here’s how they help:

Visual Correction: By vaulting over the cone-shaped cornea, they provide a smooth optical surface.
Comfort: The fluid reservoir cushions the cornea and reduces dryness or irritation.
Protection: They act as a barrier against environmental exposure and rubbing.

Scleral Lenses vs Other Contact Lens Options

Feature	Scleral Lenses	Soft Lenses	Rigid Gas Permeable (RGP)
Fit Stability	Excellent	Poor for KC	Moderate
Comfort	High	Moderate	Low
Vision Correction for KC	Very Effective	Often Inadequate	Moderate to Good
Dry Eye Relief	Yes (tear chamber)	No	No
Requires Custom Fitting	Yes	No	Sometimes

What to Expect During Scleral Lens Fitting

A proper scleral lens fitting is critical to success. Here’s the general process:

Initial Consultation: Eye measurements, corneal mapping, and visual needs are assessed.
Trial Lens Fitting: Several trial lenses are tested for comfort and fit.
Custom Lens Design: Based on corneal shape, tear film, and patient comfort.
Training & Dispensing: You’ll be taught how to insert, remove, and clean the lenses.

Tip: Fitting appointments may take longer than routine contact lens fittings.

Pros and Cons of Scleral Lenses for Keratoconus

Pros:

Superior vision correction.
Comfort even with advanced KC.
Improved ocular hydration.
Fewer lens dislocations vs smaller RGPs.

Considerations:

Requires more time and expertise to fit.
Higher cost vs regular contacts.
Cleaning and storage are essential.
Initial adaptation period (for some users).

When are Scleral Lenses Recommended?

Scleral lenses are often recommended when:

Glasses or soft contacts no longer provide adequate vision.
Intolerance to smaller RGP lenses.
The cornea has become too steep or irregular.
Dry eye symptoms interfere with other lens types.

In some cases, scleral lenses are used before surgical options like corneal cross-linking or transplant are considered.

Do’s and Don’ts When Using Scleral Lenses

Do's	Don'ts
Use preservative-free saline to fill lenses	Don’t use tap water to clean lenses
Wash hands thoroughly before handling	Don’t wear lenses longer than advised
Follow your care provider’s wearing schedule	Don’t ignore signs of discomfort
Clean lenses with approved solutions	Don’t store lenses dry or uncleaned
Use a plunger for easier removal	Don’t skip follow-up fitting checkups

Final Thoughts

Scleral lenses are an advanced, reliable option for managing keratoconus when glasses or soft lenses fall short. Their ability to restore vision while protecting the cornea makes them an essential tool in keratoconus care, especially for those in moderate to advanced stages of the disease.

If you’ve struggled with contact lens discomfort or poor vision due to keratoconus, scleral lenses may offer the clarity and comfort you need.