Scleral Lens Applications and Resources

When should I consider a scleral lens, and how can my consultant help me with these cases?

“Scleral lenses are a great option for many patients. I would consider using them on almost anyone with the motivation to wear them. From irregular cornea patients to dry eye patients and previous soft lens wearers who are looking for something to give them better comfort and vision, scleral lenses can be beneficial. A consultant can help from start to finish. We can provide you with a fitting set and fitting guide to help with the initial fitting, as well as explain what you are looking for in a good scleral lens fit. Once the initial fitting is done, a consultant can help take your findings and make the appropriate adjustments to the lens to order.” (Kelsey Roberts, Valley Contax)

“The recent development of scleral lenses has enabled practitioners to fit a wide range of difficult corneal issues successfully, including but not limited to keratoconus, PMD, corneal grafts, corneal scars, and post-surgical problems. These large GP lenses provide excellent patient comfort and acuity and are an excellent alternative to corneal lenses for these difficult-to-fit patients.” (Ann Shackelford, ABB Optical Group)

“When other options are obviously not working and you decide that it is better to get off the cornea entirely, the scleral lens is your best option. Our consultants have been fitting thousands and thousands of sclerals since 2006 and know all the ins and outs of changing the designs when necessary to provide you with the perfect fit. The uniqueness of the eyes being fit dictates that many times it will take a unique fit to do the best job possible. The scleral lens chosen needs to have the ability to change the heights over all of the different areas of the cornea at will and control all of the heights separately for your best success with sclerals. As with all other types of lenses, there is no ‘one size fits all’ in the scleral arena.” (Jeff Birk, Essilor)

“When you’re faced with highly irregular corneas, that’s usually a good time to consider scleral lenses, as corneal GPs and soft lenses can be difficult to fit and may not give the expected comfort and visual acuity.” (Eric Marshall, Visionary Optics)

“Scleral lenses are quickly becoming the go-to modality for irregular corneas and dry eye patients, due to the exceptional comfort and vision they provide. While corneal GP lenses remain a viable option for various irregularities, scleral lenses are particularly a good option to consider for patients that are unable to adapt to corneal GPs, patients who work outdoors or in dusty environments, and patients with recurring epithelial defects. Due to the unique fitting characteristics of each scleral lens design, your lab’s fitting consultants will be an invaluable asset. The consultants can assist in the selection of the initial trial lens, assessment of OCT, scleral topography, or photos, and adjustments of parameters to provide optimal clearance and scleral landing.” (Bethany Peebles, Art Optical)

“The advancement of scleral lens designs has created a wide range of patient possibilities. Not only can they be used for any irregular cornea but also they are being fit on regular cornea patients. Over the last nine years we have fit scleral lenses on former corneal GP wearers, dry eye patients, soft lens dropouts, and many athletes. The consultant is the design expert and can guide the practitioner through the fitting process. The consultant will help with choosing the best initial lens and adjusting the customizable parameters for the best possible fit outcome.” (Derrell James, X-Cel)

“Sclerals have a growing number of applications. They are probably best known for their ability to correct vision for severely shaped corneas. You might recommend sclerals to a patient that can’t adapt to the sensation of cornea lenses. I made myself a pair to wear while I play sports, to cut down on glare and wind effects. We find the best way to help a practitioner fit sclerals is to start with a fitting set. There needs to be some kind of baseline before we start adjusting the parameters of the scleral lens. (John Belliveau, Visionary Contact Lens)

What resources can help increase my knowledge about scleral lens designs?

“You can check the website of your CLMA member laboratory. Here are organizations I recommend:

Great meetings where you can obtain experience include:

“Utilizing the CLMA laboratories’ websites and educational material available in the resource pages, practitioners can educate themselves on several different products and designs. Some companies offer additional training through webinars and meetings. Close contact with the laboratory consultants can give practitioners more of a hands-on training experience through virtual fitting and virtual training.” (Dede Reyes, FCLSA, ABB Optical Group)

“Along with the lab’s fitting consultants, the lab’s website will likely have various fitting tools, resources, and webinars available for their specific designs. Two resources that provide a more general but thorough look at scleral lens fitting are the “Clinical Guide for Scleral Lens Success” published by Contamac and “A Guide to Scleral Lens Fitting” by Eef van der Worp.” (Bethany Peebles, Art Optical)

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