Dr Dylan Joseph, an Ophthalmologist and Eye Specialist, discusses everything you need to know about Scleral Lenses, the causes, symptoms, risk factors and treatment options. Keep reading to find out how early diagnosis and management can help.
Scleral Lenses are rigid lenses designed to improve the quality of your vision and are ideal for a variety of eye conditions, high prescriptions, and some forms of dry eye disease.
These lenses rest on the white of the eye or sclera and are remarkably comfortable. Just like other rigid lenses, they provide a clearer, higher quality of vision, but have lower infection rates than soft contact lenses.
Why should I use a Scleral Contact Lens?
If we look at history, Scleral lenses were the first type of contact lenses invented. Back then it was designed to be used as glass moulds for a person’s eye, but as technology advanced, it ultimately evolved into a rigid contact lens.
Vision issues that can be corrected with Scleral Lenses
Eye diseases that are managed with RGP (rigid gas permeable) and particularly scleral RGP contact lenses include:
This is the most common condition treated by Scleral Lenses. Keratoconus is a condition where your cornea has a more cone-like shape (not round). This irregular shape means that glasses and normal soft contact lenses are not providing you with the best quality of vision.
Pellucid Marginal Degeneration
Corneal Scarring from Injury
Dry Eye Disease
Altered eye surfaces following corneal refractive surgery
Similar benefits are achieved for the irregular corneal surfaces present in all the corneal diseases mentioned above.
Dry Eye Disease
If you’re suffering from debilitating dry eye conditions such as Sjogren’s syndrome, scleral lenses can provide significant relief from corneal dryness.
Each lens includes artificial tears that are retained between the lens and eye during wear.
This includes refractive errors such as astigmatism, myopia or hyperopia.
If spectacles, soft contact lenses or smaller diameter corneal RGP lenses are not reaching the level of vision or comfort you require, scleral lenses are an excellent alternative.
Stability and Comfort
Who else can benefit from the stability and quality of vision scleral lenses offer?
An active person/ sports player.
Someone who has stopped wearing small diameter rigid lenses due to discomfort from environmental factors.
Someone who works in a dusty environment.
Current contact lens wearers that are experiencing difficulties with their lenses.
How do Scleral lenses work?
Scleral lenses range from 15.00 mm to 20.00 mm in diameter, much larger than soft contacts or rigid corneal lenses.
What makes these lenses different is the way it fits your eye. Each lens covers your entire cornea and rests on the sclera (white of the eye). Your lids do not touch the edge of the lens, which make them extremely comfortable. Each lens is also filled with saline or artificial tears to soothe the cornea.
At first, you will be madly aware of the Scleral Lenses, but within a month your eyes will be accustomed to them. Most patients wear these lenses for long periods, but it is advisable that you remove them in the evenings if your eyes are feeling tired.
Scleral Lens Fitting Process
Your initial examination will establish whether your eyes are suitable for scleral lens wear. We look at your eye health, vision and corneal shape.
If you qualify for scleral lenses, we will gather the needed data.
Step 1: We take a range of measurements from each eye. Step 2: The data gets imported into EyeSpace (a lens simulation software). Step 3: Eyespace uses the data to customise and order your lenses.
EyeSpace is now used by contact lens practitioners across the world including Australia, the USA, New Zealand and South Africa.
During the fitting appointment, we will examine the design and fit of your customised EyeSpace scleral lenses, and you will be taught how to insert, remove, clean and care for your lenses.
One Week Follow-Up Visit
After 1 week we will examine:
Your insertion and removal technique
Your vision quality in the lenses
The fit of the lenses on the eye
The health of the eye surface
If needed, a few adjustments will be made to the design.
Ongoing Follow Up
After your one-week follow-up visit, we will schedule 2 ongoing follow up appointments:
At your three-month follow-up examination, we assess the success of your contact lenses. Some ocular health complications may be present without any discomfort or vision trouble.
At your six-monthly follow-up examination, we ensure your lenses are clean, you are seeing well and your eye health is uncompromised.
What are the Risks?
Lens complications, though minimal if instructions are followed correctly, can include:
Mild redness after lens removal.
Slight fogging of vision as the day progresses.
Reaction to lens solutions, requiring a change to a different type of solution.
What are the Benefits?
The intended benefit of these lenses is to ultimately improve vision, but there are a few specific benefits that are unique to Scleral Contact Lenses:
Comfortable to wear
Scleral lenses are custom-made to fit a patient’s requirements.
Scleral lenses rest on the white part of your eyes and each lens is filled with saline or artificial tears to reduce dryness.
These lenses can last one to two years, but after these periods, we recommend that you replace these lenses to ensure they work optimally and do not cause any adverse effects.
There is no age limit to wearing scleral lenses. However, most conditions that require a scleral lens aren’t present until an older age. If children require scleral lenses, they need to be old enough to insert and remove the lenses themselves or have adult supervision who can insert and remove the scleral lenses on their behalf. Many older adults wear scleral lenses but need the dexterity to be able to insert and remove the lenses safely.
Can The Scleral Contact Lenses Damage My Eyes?
Any contact lens has the potential to cause damage or infection if they are misused. Proper hygiene, lens care and timely replacement can minimise the risks. Long-term wear of poorly fitting lenses may harm your cornea, and progressive conditions such as keratoconus may cause corneal changes which result in a poor fit. Regular reviews are therefore critical to ensure a healthy scleral lens fit.6
How Different Are The Scleral Lenses From Other Rigid Lenses I Have Worn?
Scleral lenses are designed to rest on the white of the eye and are therefore larger than rigid corneal lenses. The larger lens improves comfort, as it never touches the cornea. The insertion and removal techniques are a little different to other contact lens types, but solutions are similar to those used for smaller rigid lenses.
Can I Sleep In My Scleral Lenses?
No! Nightly wear of scleral lenses is not recommended. Scleral lenses reduce the oxygen flow to the cornea when the eyes are closed during sleep, which leads to compromised eye health over time. Your lenses also need to be sterilised and cleaned each day to reduce the risk of infection.
I Am Over The Age Of 45 And Need Multifocals Or Reading Glasses, Can I Still Wear Sclerals?
Absolutely. Your optometrist will discuss with you all the options available to correct both your distance and near vision.
How Often Will I Have To Replace My Scleral Contact Lenses?
We recommend replacing your lenses every one to two years, depending on their condition. Frequent replacement of the scleral lenses decrease the risk of eye infections and ensure the optical surface of the scleral lens remains smooth and clear.
What Ongoing Costs Are Required For Scleral Contact Lens Wear?
You will need regular solutions and insertion drops. We also recommend a spare set of lenses.
How Do I Get Started To Find Out If I Am Suitable For Scleral Lenses?
A full examination is needed, even if you had a recent eye test with another eye care practitioner. During this exam, your eye health, vision and corneal shape are evaluated to establish if your eyes are suitable for scleral lens wear. If you have had a full eye exam with us in the last 12 months, you might just require an additional corneal topography examination and a brief discussion with our optometrists regarding scleral lens wear.
Meet the Expert
“I have been privileged to fit scleral lenses in dr Dylan Joseph’s practice.
To work on the most advanced devices for the analysis of the anterior segment of the eye is an experience that left me without the proper words to describe, except maybe…..I was on a high. I could view and analyze lens fit on the cornea with one glance, giving me an appreciation for futuristic ophthalmic technology.
Scleral lenses are large-diameter rigid lenses that vault the cornea and fits on the white portion of the eye, known as the sclera. This makes them more comfortable than traditional hard lenses, as they don’t rub the cornea with resultant scarring after years of wear.
They offer the best possible vision and comfort for patients, suffering vision loss with conditions known as keratoconus, a bulging of the cornea (or floppy cornea associated with collagen abnormalities and eye rubbing).
They are also useful after corneal grafts, complicated LASIK refractive surgery and RK complications.
Because these lenses vault the entire cornea, they functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by keratoconus and other corneal irregularities.
The contact lens becomes your “ new cornea”, the first smooth surface for light to be focused on, affectively neutralizing corneal aberrations and distortions.
Also, the space between the cornea and back surface of the lens acts as a fluid reservoir to provide comfort for people with severe dry eyes, who otherwise could not tolerate lens wear.
The lenses I fit, is bespoke scleral lenses, where every quadrant of the lens can be customized to fit the irregular shape of your eye, including the landing zones of the lens, which could be fitted with different angles in all four quadrants, to create a snug fit, as close as possible to the shape of your sclera, which is asymmetric in most cases as well.
If technology is your thing, look no further, as dr Dylan Joseph‘s practice caters for the best.”
Dr Sorieta Roos Optometrist & Fraxel Laser Practitioner
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