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Scleral Contact Lenses

Scleral contact lenses are a specialty type of contact lens that provide clear vision when glasses, soft contact lenses, or traditional rigid gas permeable (RGP) or 'hard' lenses cannot. Scleral contact lenses are primarily used for patients with irregular corneas (due to disease or post-surgical changes), dry eyes, or difficult-to-fit eyes that make conventional lenses uncomfortable or unsuccessful. The design of scleral contact lenses allows patients with conditions to achieve sharper vision and improved comfort.

 

DID YOU KNOW? Not all doctors fit scleral contact lenses

 

Because scleral lenses are a specialty type of contact lens used in very specific clinical situations, not all eye care providers prescribe scleral contact lenses. The fit of a scleral contact lens is extremely important, more so than with a soft contact lens. The fit of your contact will affect vision and, more importantly, the health of your eye. It is important to choose an eye doctor who has advanced training, experience with scleral contact lenses, and the technology to properly fit your scleral lens. When fit properly, scleral contact lenses are extremely safe, comfortable and provide a number of benefits for the patient. 

What Is A Scleral Contact Lens?

Scleral lenses are named for the portion of the eye on which they rest when worn by the patient. The cornea is the clear front portion of the eye that is extremely important for clear vision. The cornea is the portion of the eye where soft contact lenses and corneal gas permeable (hard) lenses rest. It is also the portion of the eye where surgeons perform LASIK, PRK, and other refractive procedures. The cornea can be damaged by trauma or disease, such as keratoconus or other degenerative conditions. When the cornea is compromised it is important to use a contact lens that does not rely on the cornea for a healthy fit and clear vision. A scleral lens is larger in diameter than other contact lenses and intended to vault the entire cornea and come to rest on the white portion of the eye called the sclera.

 

By covering the entire cornea the scleral lens essentially replaces the cornea with a new 'refractive surface' for the eye. This means that even with an irregular cornea, patients who wear scleral contact lenses can achieve clear vision. The use of a scleral lens also provides a more stable fit as compared to a corneal contact lens, which means stable vision and improved comfort for the wearer. Scleral contact lenses are designed to provide excellent ocular health for the wearer. The materials used to make scleral contact lenses are very 'breathable', meaning they provide adequate oxygen necessary to maintain a healthy cornea. This material is what allows the lens to cover the entire cornea while providing the environment necessary for eye health.

Types of Scleral Contact Lenses

Scleral contact lenses are primarily categorized by their size and the part of the eye they rest upon (which is affected by their size). It is important to note that even the smallest scleral lenses vault the entire cornea, where corneal gas permeable lenses cover approximately 70% of the cornea and are subject to corneal irregularities.

 

CORNEO-SCLERAL LENSES

This category of scleral lenses is the smallest of the scleral lenses. Corneo-scleral lenses still vault the entire cornea and come to rest near the junction between the cornea and the sclera. This makes these lenses larger than traditional corneal gas permeable lenses and an ideal choice for patients with irregular corneas.

 

MINI-SCLERAL LENSES

This category of scleral lenses are larger than corneo-scleral lenses and rest on the anterior sclera; the white portion of the eye just beyond the cornea/scleral border. This larger lens provides advantages beyond corneal gas permeable lenses as well as improved comfort.

 

FULL SCLERAL LENSES

This category of scleral lenses are the largest and supported exclusively by the sclera. By vaulting the cornea and other critical structures of the front of the eye, these lenses provide better clearance and fluid reservoir that benefits many patients with diseases of the cornea.

 

The type of scleral contact lens that is best for your eye will be determined by the doctor at your scleral contact lens fitting. Her decision is based on the complexity of the case and the advanced measurements obtained during your evaluation. The specific condition and extent to which the cornea has been effected are important factors in the decision making process. At Artisan Optics our doctors use technology that measures the full extent of the cornea and gathers over 9000 data points in less than two seconds. This compares to lesser technology that is commonly used and measures as few as two points isolated to the center of the cornea. Our doctor's knowledge and experience fitting scleral contacts lenses combined with this advanced technology provides and better, healthier and more comfortable fitting scleral lens that fits your specific needs.

When Are Scleral Contact Lenses Prescribed

Any patient who wears contact lenses could potentially benefit from scleral contact lenses. Their unique size and design can provide improved clarity, comfort and stability as compared to other types of contact lenses. For many patients without a significantly eye health history the convenience of a soft disposable contact lens outweighs the benefits of a scleral contact lens. For this reason, scleral contact lenses are often the first choice when prescribing contact lenses for the following groups of patients:

 

IRREGULAR CORNEA DUE TO CORNEAL DISEASE - Keratoconus | Pellucid Marginal Degeneration

Patients with corneal diseases, such as keratoconus or pellucid marginal degeneration have a cornea that is irregular in shape. Rather than being a smooth dome, the cornea will have areas that are steeper or flatter than normal. This abnormal corneal shape means that glasses and traditional contact lenses cannot provide adequate vision. If the disease is mild, a corneal rigid gas permeable lens may be used with moderate success. With moderate to severe cases, as the corneal shape becomes increasingly irregular, a scleral contact lens is necessary to provide clear vision, comfort, and stability (corneal gas permeable lenses move on the eye are are more likely to dislodge from the eye).

 

IRREGULAR CORNEA DUE TO SURGERY – Keratoplasty/Corneal Transplant | Refractive Surgery (LASIK, PRK, RK)

Surgeries such as LASIK, PRK, RK, or a corneal transplant affect the shape of the cornea. Refractive surgery (LASIK, PRK) for example changes the shape of the cornea in order to eliminate a prescription and the need for glasses. Unfortunately this new corneal shape, which may be significantly steeper or flatter, is not ideal for traditional contact lenses. By vaulting the cornea, scleral contact lenses are able to provide clear and comfortable vision for individuals who have had a corneal surgery in the past. This lens design is also ideal for people who have had a corneal transplant as it reduces irritation from interaction with sutures or any scarring that may be present.

 

DRY EYE SYNDROME

Conventional contact lens wear is usually limited by dry eye; negatively affecting both comfort and clarity with wear. For those patients with certain types of dry eye, or systemic conditions such as Sjogren's Syndrome or Stevens Johnson, scleral lenses provide a level of dry eye treatment that other contact lenses cannot. The design of a scleral contact lens creates a tear reservoir, or a supply of tears between the contact lens and the eye. This creates an environment that keeps the eyes moist and ultimately more comfortable. While wearing scleral contact lenses will not eliminate the need for other forms of dry eye treatment prescribed by the doctor, they will assist in the overall management of your dry eye syndrome.

 

DIFFICULT TO FIT PATIENTS

There are many people who have found limited success with traditional contact lenses; whether it is due to comfort, the prescription, the shape of the eye, or the specific activities you wish to perform with your contact lenses. The 100% customizable design of scleral contact lenses can correct a wider range of prescriptions and eye shapes than soft contact lenses. Because they avoid contact with the cornea (a highly sensitive tissue of the eye), many people find improved comfort with these lenses. For athletes and extreme sports enthusiasts, the larger diameter of these lenses decreases the changes that the lens will become dislodged during your activities.

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