Some Questions and Answers on Scleral Contact Lenses from Dr. Folman
What are scleral contact lenses?
Scleral lenses are a type of rigid gas permeable contact lens specially designed for eyes that are otherwise difficult to fit in traditional soft contact lenses. The lens material is harder than traditional soft contacts, which allows for a more customized fit, and the most superior optics of any lens available. The wide diameter of the lens allows it to sit on the white part of the eye, rather than drape over the more sensitive cornea. The lens is filled with a non-preserved saline solution before inserting it onto the eye. In this way, the lens vaults over the cornea, protecting it and keeping it hydrated all day long.
What conditions can be treated with scleral lenses, and who is a good candidate?
While anyone can be fit with a scleral lens, it has become the lens of choice for patients with irregularly shaped corneas, such as patients with keratoconus, corneal graft recipients, corneal dystrophy patients, patient with incomplete eyelid closure, and patients with severe dry eye. If a doctor has ever told you that you cannot be fit in contact lenses, you may be a good candidate for scleral lenses!
How do scleral lenses work?
Vision is a complex neurological process that begins with light entering the eye and being bent (or refracted) to a focal point on the retina. When the front of the eye does not have a smooth spherical shape, light entering the eye scatters, creating optical aberrations, and defocus on the retina. We see this in many ocular conditions that produce an irregularly shaped cornea.
The scattered light is interpreted by the brain as a blurry image, glare, halos, or distortion. Scleral lenses vault over the cornea, creating an artificially smooth front surface of the eye. The space between the contact lens and the cornea is filled with non-preserved saline, creating an optical system that masks any irregularities to the front surface of the eye. Light is then free to enter the eye and come to a crisp focal point on the retina. As an additional benefit, the saline keeps the eye hydrated throughout the day for added comfort.
What types of scleral lenses are there?
There are multiple manufacturers that produce scleral lenses. The difference between them are the fitting philosophies and the available curvatures and parameters. Our doctors will select the best lens for your eyes based on your corneal topography and the underlying condition being treated.
Are scleral lenses typically covered by medical or vision insurance?
In the vast majority of cases, scleral lenses are used to treat an underlying ocular condition. A prior authorization may need to be submitted to your medical insurance company to be fit in this specialty lens. This is handled by our billing department. Most insurance companies approve and pay for the fitting process and cost of the lenses. In some cases, the patient may be responsible for part of the balance. This is worked out prior to the fitting so that you do not receive any surprise bills.
How long do the lenses last?
Because the lenses are made of a rigid gas permeable material, they have a much longer life than traditional soft contact lenses. Depending on how well you care for the lenses, and your tear film's ability to rewet the lens surface, scleral lenses usually last 1-2 years.
Will scleral lenses eliminate my need for glasses?
For nearly all patients, scleral lenses eliminate the need for distance glasses. However, if patients are over 40 years old, they may still require reading glasses to be worn over their contact lenses to see clearly at all distances.