What are scleral contact lenses?
Scleral contact lenses are specialized contact lenses made out of gas permeable material.
This material helps to create a smooth surface, which can greatly improve visual quality – for patients suffering from keratoconus, corneal scarring. Post RK or LASIK surgery, and many other eye conditions, or help protect the ocular surface – for patients suffering from dry eye, graft-vs-host-disease, Sjogren’s syndrome, Stevens-Johnson, and other debilitating eye issues.
These highly customized lenses are unique to each patient’s eye.
How are scleral contact lenses different from a regular contact lens?
Scleral contact lenses are an extra-large type of rigid gas permeable lenses. Unlike traditional contacts, scleral lenses vault over the entire cornea, leaving a layer of liquid between the lens and the corneal surface. This layer of liquid masks the irregularities of the corneal shape, resulting in clear, comfortable vision. These larger lenses rest on the white part of your eye (your sclera).
Their unique design makes scleral lenses among the most comfortable contacts available, providing excellent vision for people of all ages.
The fitting process is much more complex, and the equipment necessary to fit this lens is much different than a regular contact lens, as these lenses are custom to each patient’s eye.
There is also behind the scenes work involved in which the doctors and the laboratory work together to design, fabricate, and adjust your scleral lenses throughout the fitting process to perfect your lenses.
Why do I need a scleral lens?
There are many different eye conditions that may warrant a scleral lens including, but not limited to: keratoconus, astigmatism, high myopia, high hyperopia, corneal scarring, post refractive surgery (LASIK, PRK, RK, etc) problems, corneal ectasias, irregular corneal surface, extreme dry eye, non-resolving epithelial defects, graft-vs-host disease, Sjogrens syndrome, Stevens-Johnson, eyelid malformations or anatomy issues, trauma to the eye, iris defects, and other ocular surface diseases.
If you were referred to our office by another doctor, it is very likely you have one of these conditions or similar which prevents you from being successful in other modalities such as glasses and soft contact lenses.
How long do scleral lenses last?
Most scleral lenses will last 1-3 years.
This depends on a variety of factors including how well you take care of the lenses and if the shape of your eye or prescription changes. This will be determined by our doctors at your yearly exam.
How do you take care of scleral lenses?
Scleral lenses should be removed every night, cleaned, and undergo a disinfection process.
There are many different scleral lens care systems, and our office will recommend one based on your specific situation.
Will I be able to insert and remove my scleral lenses?
While scleral lenses can seem intimidating due to their size, most patients (98%) are able to effectively insert and remove their lenses.
You will have an in-depth training session at our clinic and a variety of devices can be trialed to help you properly insert and remove your lenses.
While a majority of patients are successful, there is always a chance that you will not be able to insert or remove the lenses.
While there is no way to predict who will and won’t be successful, practice and repetition greatly improves your chances of success.
What happens if I break my scleral lens?
If your lens breaks, chips or becomes damaged within the first 90 days of your fitting, you can bring back the damaged lens or any remaining pieces and we will issue a new lens at no charge.
Please keep in mind that you must bring in the lens or the pieces in order for the lab to issue a credit.
What happens if I lose my scleral lens?
If you lose your scleral lens, you will be responsible for the fee to pay for a new lens.
Can’t I just get LASIK instead of scleral lenses?
Most patients that require scleral lenses have medical eye conditions or complicated prescriptions that cannot be corrected with refractive surgery such as LASIK.
In fact, having a surgical procedure may worsen your vision or eye condition permanently.
Common Financial Questions:
Why are scleral lenses so expensive?
Scleral contact lenses are fit by trained eye care professionals who are proficient in this type of lens.
Many doctors must complete a cornea/contact lens residency or other extensive training to be able to effectively fit and manage scleral lens patients. There is also a significant amount of equipment that is necessary to fit your eyes successfully into scleral lenses.
After your diagnostic fitting in the office, the doctor must then analyze the information and consult with the laboratory to design and fabricate your unique scleral lens. Sometimes there are multiple remakes of your lenses, as well as multiple follow-up visits to perfect your lenses. The amount of cost and time involved with scleral lenses leads to a higher service and material fee compared to any other contact lens type.
Is there insurance on scleral lenses?
No laboratory currently offers scleral lens insurance.
As an alternative, you can contact your homeowner’s insurance company and add the scleral lenses on, usually for a small fee. This would fall into the category of personal property such as household furniture, jewelry, etc.
If you lose your scleral lens, you would contact the insurance company directly for reimbursement. Many of our patients have used their homeowner’s insurance for scleral lens coverage with success.
Do I have to pay the same fee all over again when I come in next year for my next scleral lens visit?
If your scleral lenses are performing well for you, we will see you in 1 year after the original scleral lenses are finalized. At that visit, we will assess the scleral lenses for chips, scratches, warpage, and other defects. We will also evaluate the lens fit, prescription, and determine if any changes to the lens are necessary.
If no changes are needed, you will only be charged for a comprehensive scleral lens evaluation, and we will schedule you for another annual lens check-up.
If changes need to be made, the doctor will discuss the recommended lens modifications, and our staff will review program pricing with you.
In most cases, the cost is significantly less than your very first visit with us due to the fact that the laboratory has your lens information in their system and changes can be made quite easily with less fees.
What happens if scleral lenses do not work for me?
While our success rate is very high (over 95%), there is always a chance that scleral lenses will not work for you. This could be due to a variety of reasons, none of which can be predicted beforehand.
In the event that you do not succeed with scleral lenses, you will be refunded a portion of your program fee. Please see your specific contract for details.
Why is there only a 90 day warranty on my scleral fitting?
The warranty is dictated by the laboratory that fabricates your scleral lenses.
Returns and exchanges are available for 90 days, but beyond this point, the laboratory will not refund or credit any money to your lens account.
We are bound by the rules and regulations of each laboratory.
Can I submit an out of network claim to my medical or vision insurance?
Yes, while we do not accept insurance, we will provide you with any necessary documents needed so that you may submit a claim to your insurance company.
Reimbursement varies drastically and depends on your insurance company, your out of network benefits, your deductible, and your specific diagnosis.
Other common questions:
Will the Contact Lens Institute replace my regular eye doctor?
No, while we love taking care of our patients and our doctors are fully qualified to perform comprehensive eye exams, the Contact Lens Institute is equipped for fitting and managing the contact lens portion of your exam only. You will still need to see your normal optometrists and ophthalmologists as directed for all comprehensive eye care, dilated fundus exams, glasses, eye emergencies, and any other eye issues. If you do not have a primary eye care practitioner, we are happy to recommend several excellent eye doctors in your area.
Can I use eye drops with scleral lenses?
Yes, you can use certain eye drops with scleral lenses. If you are using medicated eye drops, you will still continue to use them as directed.
For best results, apply your eye drops, then wait 10 minutes, and then apply your scleral lens.
If you use eye drops at night, remove your scleral lens first, then apply your eye drops. This will maximize the absorption of the eye drop. If you are using eye drops during scleral lens wear, a preservative free option such as Systane preservative free, Refresh Optive, iVizia, Optase, Blink, or Oasis preservative free tears will be recommended to you. Check out our storefront for Dr. Woo and Dr. Wong’s recommendations.
Will I be able to see far and near with scleral lenses?
If you are over 40 years of age or have an eye condition that disrupts your near vision, your near vision may be affected with scleral lenses.
Typically, we fit your scleral lenses for maximum distance clarity. This may result in the need for glasses to see intermediate and up close. Some patients may be a good candidate for a scleral multifocal or monovision, which can improve your up close vision and reduce your need for reading glasses. Our doctors will determine what you are the best candidate for, based on your specific eye condition and vision goals.
How many visits will it take to finalize my scleral lens prescription?
A typical scleral lens program consists of the following:
- Your journey begins with an initial consultation where special measurements are taken of your eyes, and a diagnostic scleral lens fitting to determine your best possible visual acuity.
- Once your lenses arrive, you will return to the office for a dispense visit where we apply the scleral lenses onto your eyes and evaluate your vision and the fit of the lenses. Typically, patients will leave with the lenses on. It can take up to two weeks for your eyes to adjust to the comfort and vision of these lenses.
- If you are new to scleral lens wear, we will include an in-depth training session to work with you on how to successfully insert, remove and care for your scleral lenses. This is typically conducted at your dispense visit.
- You will then return for a 1-2 week follow-up to check the fit and vision of your scleral lenses. Changes to the lenses may be needed and adjustments may be made.
- If lens changes were made, you will return for another dispense appointment, or pick up your lenses without an appointment (determined by your doctor).
- Typically, another 1-2 week follow-up may be scheduled to check the fit and vision of your scleral lenses.
- Other follow up visits and dispense visits may be scheduled if changes are needed to further improve your fit and vision. Most patients require the consultation, fitting, dispense, training, and 2-3 follow-up visits. Depending on your specific case, you may need more or less visits.
- Once the lenses are finalized, you will be released back to your primary care eye doctor. We will see you annually to evaluate the fit and vision of your lenses.
Please remember scleral lenses are a process and it takes a tremendous amount of time to design an accurate and healthy lens.
Why did scleral lenses not work for me in the past or with another eye doctor?
There are many different brands of scleral lenses on the market and also different fitting techniques from each specific doctor.
If you did not do well with scleral lenses in the past, it could be that you need a more customized option. Many of our patients have highly complex eye issues which require a custom fit scleral lens using specialized 3D technology.
Even if you did not succeed with scleral lenses in the past, it may be worth exploring some of the newer technologies available to improve your success rate.
Why do I need to come in every year?
Scleral lenses are considered medical devices. It is important that you see your scleral lens practitioner every year to evaluate the overall fit of your scleral lens as well as the health of your eye.
Even if your scleral lens is providing good comfort and vision, there may be microscopic issues leading to a slow decrease in eye health.
It is important to address these issues right away and make adjustments to your scleral lens to prevent long term damage to your eye.
The Nevada Board of Optometry requires all contact lens patients to be seen annually in order to renew their contact lenses (this applies to all contact lenses, including but not limited to soft lenses, scleral lenses, gas permeable lenses, and hybrid lenses).
