Scleral Contact Lenses
What are scleral lenses?
Scleral lenses are large-diameter gas permeable contact lenses. They are designed to rest on the white part of the eye (the conjunctiva or sclera) rather than the clear front tissue of the eye (the cornea). Since the sclera is much less sensitive than the cornea, this allows scleral lenses to be much more comfortable than traditional gas permeable (“hard”) contact lenses.
The fact that scleral lenses “vault” over the cornea also allows them to correct vision problems that other contact lenses can not correct. If the cornea is not perfectly spherical, it will cause vision to be out of focus. The scleral lens effectively serves as a perfectly spherical artificial cornea, thereby focusing vision in nearly all cases.
There are different subtypes of scleral lenses. True scleral lenses completely vault the cornea and rest on the sclera. Corneo-scleral lenses partially rest on the cornea. Both types are useful in certain situations.
Why are scleral lenses used?
There are three main scenarios in which scleral lenses are useful:
1. Vision correction
This is most common indication for scleral lenses. In a variety of ocular conditions, vision can not be adequately corrected with eyeglasses, traditional contact lenses, or surgery. This is most commonly due to “corneal irregularity.” Since the cornea is analogous to the lens of the camera, the absence of a perfectly spherical cornea makes clear vision impossible. Eyeglasses and traditional contact lenses often can not fix this problem. A scleral lens may be the definitive treatment.
Examples of disorders that cause corneal irregularity include keratoconus, pellucid marginal degeneration, and corneal damage due to scarring or injury. In addition, previous eye surgery such as LASIK, PRK, radial keratotomy, or keratoplasty (“corneal transplant”) can result in corneal irregularity.
2. Ocular surface healing
Since scleral lenses vault the cornea, there is a small space between the contact lens and the cornea. This space is filled with fluid, creating a fluid reservoir that bathes the eye. This allow scleral lenses to treat various types of Dry Eye Syndrome. If your eyes are dry even after trying artificial tears, prescription therapy, and/or punctal plugs, you may be a candidate for scleral lenses. More severe forms of Dry Eye Syndrome caused by conditions such as Sjogren’s syndrome, Stevens-Johnson syndrome, and graft-versus-host disease are also effectively treated with scleral lenses.
3. Discomfort with other contact lenses
Scleral lenses are quite comfortable, due to the fact that they do not touch the cornea. If you have been unable to wear soft contact lenses or gas permeable lenses, you may find better success with scleral lenses.
What else should I know?
Since scleral contact lenses are custom made for your eye, they are complex to design and produce. Because of this, they are typically more expensive than traditional contact lenses. At Louisville Eye Center, we will work with your vision and/or medical insurance carrier to attempt to obtain a benefit for scleral contact lenses. This can help significantly with the cost of lenses.
Scleral lenses are a relatively new technology, and they present a number of challenges for the examining optometrist or ophthalmologist. Because of this, there are relatively few eye doctors nationally who use this technology. In fact, Dr. McNulty is one of only a handful of eye doctors in the region with training in this area.
If you think you may be a candidate for scleral lenses, contact our office and we can help you find out.
“Since finding Dr. McNulty my life has changed. Since 12 years old I have been told about my vision problems. After many years and Doctor’s visits my vision had reached the point that I could not live a normal life. One visit to Dr. McNulty changed all of that for me, now I literally see life in a different way. I thought there was no remedy and I was going to lose my vision. Dr. McNulty gave me my life back, and for that I am eternally grateful.”
“Dr. McNulty and his staff fit me for Scleral Lens in November 2015. Simply put these lenses have changed my life. Prior to my new lens my best corrected vision was approximately 20/40. I was able to function, but wasn’t really able to live. I had to stop playing golf, the game that I have loved since childhood, because I could literally no longer see my ball from the tee. I struggled to travel because I could not see road signs well. I had come to accept the fact that I just was not going to be able to see nearly as well as most people. That was all before my scleral lenses. Now I see 20/20+ and am a much happier person. Life is no longer a challenge because I couldn’t see well. It is impossible to explain how much of a difference that they have made in nearly everything that I do. The professionalism, personal attention, kindness and availability of Dr. McNulty and his staff is as wonderful as the lenses themselves. For what it’s worth, I asked Dr. McNulty if I could share my story – my goal is to help others benefit from my incredible experience.”