Scleral Lenses for Keratoconus: What to Expect
Overview
If you have keratoconus and your glasses don't give you sharp vision anymore, there's a good chance someone has mentioned scleral lenses. They're one of the most reliable ways to see clearly with an irregular cornea. Here's what a fitting looks like, how long it takes, and what to expect in the first few weeks.
I was diagnosed with keratoconus myself, so I know how frustrating ghosting and glare can be. Most of the questions below are ones I hear every week.
Why scleral lenses work for keratoconus
Keratoconus makes the cornea thin and bulge into a cone. That uneven shape bends light in the wrong directions, which is why letters look doubled or smeared even with a new prescription.
A scleral lens doesn't try to follow that uneven shape. It's a large, rigid gas permeable lens that vaults over the whole cornea and rests on the white of the eye. You fill it with saline before you put it in, so the cornea sits under a smooth layer of fluid. The lens becomes the new front surface of your eye, and vision is often much clearer.
You can read more about the condition itself in our keratoconus overview.
Scleral lenses vs. RGP lenses
Smaller rigid gas permeable (RGP) lenses also mask an irregular cornea, and they work well for many people with keratoconus. The difference is where the lens sits.
An RGP lens rests directly on the cornea. In more advanced keratoconus, it can rub the tip of the cone or pop out more easily. A scleral lens doesn't touch the cornea at all, so many people find it more comfortable and more stable. We'll talk through both options at your evaluation.
Your first visit
The first appointment is an evaluation. We check your eye health, measure your prescription, and take detailed corneal measurements to see the shape and thickness of each cornea.
If scleral lenses look like a good option, we put a trial lens on your eye. It needs about 20 to 30 minutes to settle. Then we look at how far the lens sits above the cornea and how it lands on the white of the eye, and we check your vision through it.
Plan on a longer visit than a routine eye exam.
Ordering and picking up your lenses
Scleral lenses are made to order. We use what we learned at the first visit to design your lens, and a specialty lab makes it.
When your lenses come in, you'll come back for a dispensing visit. We check the fit and your vision, then teach you how to fill, insert and remove the lenses. Most people use a small suction tool (a plunger) at first. We practice with you until you're comfortable doing it on your own.
Follow-up visits
Most scleral fittings take three to five visits over several weeks. After you've worn the lenses for a while, we check how they've settled and make adjustments. A small change to the curve or the prescription is normal. It's part of getting a custom lens right, not a sign that something went wrong.
Once the fit is set, we see you at regular visits to check the lenses and the health of your corneas.
Your daily routine
Scleral lenses are worn during the day and taken out before bed. Each morning, you fill the lens with fresh preservative-free saline and put it in. At night, you clean and store it the way we show you.
Never use tap water on your lenses or in your case. Tap water can carry organisms that cause serious eye infections.
Comfort and the first few weeks
Most people are surprised by how comfortable scleral lenses feel. The white of the eye is less sensitive than the cornea, and the lens doesn't move much when you blink.
The learning curve is mostly about handling. Insertion gets easier after the first week or two. Some people notice mild fogging later in the day, and that can usually be improved with a fit or routine change.
If a lens causes pain, redness or a sudden drop in vision, take it out and call us.
What scleral lenses don't do
Scleral lenses improve vision, but they don't stop keratoconus from progressing. If your measurements show the cornea is still changing, we'll talk about corneal cross-linking and refer you to a corneal specialist. You can keep wearing scleral lenses before and after cross-linking, with timing guided by your surgeon.
Cost and insurance
There isn't one price for scleral lenses. It depends on your eyes, the lens design and your coverage.
Many vision plans have a medically necessary contact lens benefit for conditions like keratoconus, and some medical plans cover parts of the evaluation. Benefits vary by plan, so call (484) 606-3937 with your insurance details and we'll help you check before your visit. Our scleral lens page lists the plans we accept.
Getting started
If you live in Chester Springs, Exton, Downingtown or anywhere in Chester County and you're curious about scleral lenses, start with an evaluation. Bring your current glasses and any contact lenses you've tried.
Learn more about scleral lenses at Bespoke Eye Care, schedule your visit, or call (484) 606-3937.
Dr. Amrit Singh, OD FAAO
Bespoke Eye Care, 100 Begonia Drive, Suite 160, Chester Springs, PA 19425