Scleral lenses and rigid gas permeable (RGP) lenses offer unique benefits designed to correct vision for patients with irregular corneas and specific ocular surface challenges. These two types of specialty lenses are crucial for people who cannot achieve optimal comfort or vision with standard soft contact lenses. Our eye doctors take pride in individualized fittings that significantly improve both vision clarity and daily comfort.

Understanding the Basics

Before comparing these lens types side-by-side, it helps to understand how each works. Scleral lenses are larger and are designed to vault over the cornea, resting on the sclera (the white part of the eye). In contrast, RGP lenses are smaller, contacting the cornea directly to create a smooth refractive surface.

Patient Profiles: Scleral vs RGP Lenses Comparison

Dry Eye Patients

Patients with dry eye need lenses that maintain hydration and protect the ocular surface from irritation.

Scleral Lenses: Vault over the cornea to create a fluid reservoir that continuously bathes the eye in preservative-free saline, reducing dryness and irritation.
RGP Lenses: Depend on the natural tear film for lubrication; may not provide enough moisture and can exacerbate dry eye symptoms in some cases.

Athletes

Active individuals require lenses that stay stable during physical activities and provide reliable vision.

Scleral Lenses: Offer superior stability and centration due to their larger diameter, making them ideal for sports and vigorous activities.
RGP Lenses: Smaller and may shift with rapid eye movements or blinking, which could potentially affect vision during intense activities.

Eye Allergy Sufferers

Patients prone to eye allergies need lenses that minimize irritation and reduce the likelihood of allergen buildup.

Scleral Lenses: Vault over the cornea and create a barrier that minimizes direct exposure to allergens; the fluid reservoir can also help flush out irritants.
RGP Lenses: Directly contact the cornea, which may trigger irritation or discomfort when allergens are present.

Patients with High Astigmatism

High astigmatism requires lenses that offer precise correction and stable vision.

Scleral Lenses: Provide a smooth optical surface and excellent stability, often reducing residual astigmatism even in highly irregular corneas.
RGP Lenses: Their rigid design masks corneal irregularities well, delivering sharp vision; however, slight movement may occasionally affect correction in cases of extreme astigmatism.

Keratoconus

Keratoconus patients benefit from lenses that can manage corneal irregularities and improve visual acuity.

Scleral Lenses: Vault over the cone, creating a new refractive surface and maintaining consistent vision even in advanced cases of keratoconus.
RGP Lenses: Also effective at masking corneal distortions, but may be more sensitive to decentration, particularly in rapidly progressing cases.

Corneal Dystrophies

Patients with corneal dystrophies require lenses that protect and mask irregularities while providing comfort.

Scleral Lenses: Offer a smooth optical surface by vaulting over the irregular cornea, which can enhance visual clarity and comfort.
RGP Lenses: Can effectively mask surface irregularities; however, direct contact with the diseased cornea may sometimes lead to discomfort.

Sjogren’s Syndrome

For patients with Sjogren’s, maintaining a well-lubricated ocular surface is essential.

Scleral Lenses: The continuous fluid reservoir provides ongoing lubrication, alleviating the severe dryness associated with Sjogren’s syndrome.
RGP Lenses: Rely on the natural tear film, which may be insufficient in Sjogren’s patients, potentially leading to increased discomfort and irritation.

Post-LASIK Patients

Patients who have undergone LASIK may experience residual refractive errors or dry eye, and their lens choice should enhance vision without further disrupting the corneal surface.

Scleral Lenses: Provide excellent stability and can correct residual irregularities while protecting the cornea with a cushioning fluid reservoir.
RGP Lenses: Can offer sharp vision correction for residual errors, but direct corneal contact might not be ideal for post-LASIK eyes that are still healing or experiencing dryness.

Post-Corneal Transplant Patients

After a corneal transplant, maintaining a stable and protective lens environment is critical for healing and long-term visual quality.

Scleral Lenses: Provide a protective vault over the healing cornea, minimizing direct contact and reducing the risk of mechanical trauma.
RGP Lenses: May offer precise vision correction but can irritate the sensitive, post-transplant corneal surface due to direct contact.

Pediatric Patients

In younger patients, lens comfort, ease of handling, and visual stability are essential for successful adaptation.

Scleral Lenses: Although highly customizable and protective, the handling and longer adaptation process may be challenging for some children.
RGP Lenses: Often preferred for pediatric cases due to quicker adaptation and ease of handling, though they may offer less comfort in cases of corneal irregularity.

Lens Fit Comparison: Scleral vs RGP Lenses

Contact Points

Scleral lenses are designed to vault over the cornea and rest on the sclera, which is far less sensitive. This design minimizes direct contact with the sensitive corneal tissue and can reduce irritation and discomfort. In contrast, RGP lenses are fitted directly on the cornea. Because the cornea is highly sensitive, patients may experience more foreign body sensation and irritation with RGP lenses.

Scleral Lenses: Contact occurs on the sclera, offering increased comfort and reduced risk of irritation.
RGP Lenses: Direct contact with the cornea can lead to discomfort, particularly for patients with sensitive or irregular corneas.

Vaulting

Vaulting refers to the way a lens sits over the cornea, creating a space between the lens and the eye’s surface. Scleral lenses are specifically designed to vault the cornea, forming a fluid reservoir that continuously hydrates the eye and fills in irregularities. This vaulting is especially beneficial for patients with dry eyes or corneal irregularities. In contrast, RGP lenses do not vault over the cornea; they rest directly on its surface, which means they lack the built-in hydration and smoothing benefits provided by the fluid reservoir of scleral lenses.

Scleral Lenses: Vault over the cornea, creating a fluid reservoir for hydration and comfort.
RGP Lenses: Lack vaulting, leading to direct corneal contact that may not address dryness or irregularities as effectively.

Custom Design to Map of Cornea

Scleral lenses are typically custom designed to the unique topography of your eye. This customization involves mapping the cornea and surrounding sclera to create a lens that fits perfectly, addressing any irregularities and ensuring optimal comfort and visual acuity. In contrast, while RGP lenses are also customized to some degree, they are often limited by their smaller size and the fact that they conform directly to the corneal shape. This means that for patients with significant corneal irregularities, RGP lenses may not provide as precise a fit or as high a level of comfort compared to the highly tailored design of scleral lenses.

Scleral Lenses: Highly customizable with precise mapping of both the cornea and sclera, offering an optimal, individualized fit.
RGP Lenses: Customization is generally limited to the corneal surface, which may not fully address irregularities in patients with complex corneal shapes.

Peripheral Vision

The design and larger diameter of scleral lenses contribute to a broader optic zone, which enhances peripheral vision and provides a more natural field of view. This is particularly important for active lifestyles, as patients enjoy a consistent and uninterrupted view of their surroundings. RGP lenses, with their smaller diameter, offer a more limited peripheral zone and may not provide the same level of visual continuity, especially when compared to the expansive design of scleral lenses.

Scleral Lenses: Larger size and design allow for a wider field of view and better peripheral vision.
RGP Lenses: Smaller diameter may restrict peripheral vision and could lead to a tunneled visual effect.

Stability and Centration

Stability and centration are critical for achieving consistent and clear vision. Scleral lenses are known for their excellent stability due to their larger size and unique design. They remain centered on the eye even during active movements or blinking, ensuring that patients consistently see through the optical center of the lens. On the other hand, RGP lenses are more prone to movement because they are smaller and sit directly on the cornea, which can cause fluctuations in vision as the lens shifts during blinking.

Scleral Lenses: Offer superior stability and remain well-centered, providing consistent vision throughout the day.
RGP Lenses: More susceptible to decentration and movement, which may result in less stable vision during rapid eye movements or blinking.

Visual Performance Comparison: Scleral vs RGP Lenses

Visual Clarity and Sharpness

Scleral lenses offer excellent visual clarity by vaulting over the cornea and creating a smooth refractive surface, which can be particularly beneficial for eyes with corneal irregularities. RGP lenses, with their rigid design, also provide sharp vision by masking corneal imperfections, but they rely on direct contact with the cornea for optimal performance.

Scleral Lenses: Deliver clear vision through a fluid reservoir that smooths out irregularities.
RGP Lenses: Provide crisp vision by directly masking corneal distortions, though they may be affected by corneal sensitivity.

Contrast Sensitivity

Both lens types enhance contrast sensitivity by creating a stable optical surface. Scleral lenses maintain a consistent tear film that enhances contrast, while RGP lenses provide improved contrast by eliminating the effects of a distorted cornea. However, the overall performance may vary based on the individual’s corneal shape and eye condition.

Scleral Lenses: Benefit from a fluid reservoir that preserves a uniform optical surface, improving contrast.
RGP Lenses: Enhance contrast by directly correcting corneal irregularities, though they may be sensitive to movement.

Customization for Optimal Vision Correction

Both scleral and RGP lenses can be custom designed to fit your unique eye shape, but scleral lenses offer more versatility when correcting complex vision issues. Advanced mapping and custom fabrication techniques allow scleral lenses to address irregular astigmatism and higher-order aberrations more precisely. While RGP lenses are effective for many patients, they may not fully accommodate severe corneal irregularities.

Scleral Lenses: Customizable to a high degree, ensuring optimal correction for irregular corneas and complex aberrations.
RGP Lenses: Customized primarily to the corneal surface, which may be less effective in cases of significant irregularity.

Higher-Order Aberration Correction

Scleral lenses are often paired with advanced custom designs that correct higher-order aberrations (HOAs), significantly improving the overall quality of vision. RGP lenses also reduce many aberrations due to their rigid nature; however, they sometimes leave residual irregularities uncorrected, especially in cases of severe corneal distortion.

Scleral Lenses: Frequently incorporate HOA correction for a smoother, more natural vision experience.
RGP Lenses: Effectively correct many aberrations but may not address all higher-order issues in complex cases.

Stability of Vision

Stability is key to consistent visual performance. Scleral lenses are designed to remain centered on the eye, reducing fluctuations in vision and maintaining a constant quality of sight. In contrast, RGP lenses can shift slightly with blinking or rapid eye movements, which may momentarily affect visual clarity.

Scleral Lenses: Provide stable vision due to their larger size and secure fit.
RGP Lenses: May experience slight decentration, leading to occasional shifts in the field of view.

Comfort Comparison: Scleral vs RGP Lenses

Initial Comfort

Scleral lenses are designed to vault over the cornea and rest on the sclera, which is less sensitive, offering a gentle introduction to contact lens wear. In contrast, RGP lenses touch the cornea directly, which can cause a more noticeable foreign body sensation when you first start wearing them.

Scleral Lenses: Minimize contact with the sensitive cornea for an initially comfortable experience.
RGP Lenses: Direct corneal contact may lead to initial discomfort and a stronger sensation of having a lens in your eye.

Long-Term Wear Comfort

With scleral lenses, a built-in fluid reservoir continuously hydrates the eye, enhancing comfort throughout the day, especially for those with dry eye issues. RGP lenses, while offering clear vision, may become less comfortable over extended wear due to reduced moisture retention.

Scleral Lenses: Provide sustained hydration and comfort during long hours of wear.
RGP Lenses: Can lead to dryness and irritation after prolonged use due to direct corneal contact.

Tactile Sensation and Foreign Body Feel

The design of scleral lenses minimizes the tactile awareness of the lens because they do not touch the sensitive corneal surface. RGP lenses, however, may be more noticeable on the eye, potentially causing irritation or a constant feeling of a foreign body.

Scleral Lenses: Reduced sensation on the eye, contributing to a more comfortable and natural feel.
RGP Lenses: Direct corneal contact can increase the awareness of the lens, sometimes leading to discomfort.

Adaptation and Handling

While scleral lenses might require a longer adjustment period due to their unique fit and handling techniques, most patients eventually experience superior comfort. RGP lenses often have a shorter adaptation phase, but the ongoing contact with the cornea may result in persistent discomfort for some wearers.

Scleral Lenses: May take longer to master handling but deliver enhanced comfort once adapted.
RGP Lenses: Easier to handle initially but can be less forgiving over time due to direct corneal interaction.

Moisture Retention and Dry Eye Management

How Scleral Lenses Tackle Dryness

The design of scleral lenses creates a sealed reservoir of saline solution between the lens and the cornea. This constant supply of moisture helps to protect the ocular surface from desiccation and environmental irritants. For patients dealing with chronic dryness, the cushion of saline not only lubricates the eye but also supports healing and reduces discomfort throughout the day.

This feature is a distinct advantage over RGP lenses, which, due to their smaller size, rely solely on the natural tear film for lubrication. While RGP lenses do allow for oxygen permeability, they often do not provide the same level of hydration, making them less suitable for people with severe dry eye symptoms.

Role in Ocular Surface Protection

Beyond simply managing dryness, scleral lenses can also offer protective benefits. For patients young and old, or for anyone involved in activities that expose the eyes to dust, smoke, or other irritants, scleral lenses shield the ocular surface effectively. The design minimizes the chance of foreign particles coming into contact with the sensitive corneal tissue, reducing the risk of abrasions or infections.

This dual-action—merging vision correction with surface protection—positions scleral lenses as an attractive option for those who demand both exceptional clarity and robust ocular defense.

Lifestyle and Activity Considerations

Wearing Lenses During Sports and Physical Activities

Many patients who lead active lives find that scleral lenses provide a much higher level of stability and security during sports. The larger diameter and stable fit ensure that the lens remains centered, reducing the chances of it dislodging during vigorous activities. With scleral lenses, there’s no nerve-wracking moment of suddenly noticing the lens out of place during an intense game or a brisk jog.

RGP lenses, although offering excellent optical correction, may be more susceptible to movement during fast-paced activities. These movements can cause discomfort and potentially lead to the lens shifting or even popping out from the eye. This can be especially problematic when precision and concentration are required, such as on the sports field or during recreational activities with children.

Everyday Comfort and Convenience

For many users, everyday comfort is paramount. Scleral lenses, when properly fitted, offer the sensation of wearing soft contact lenses while delivering the robust optical performance of a hard lens. Their ability to maintain a stable position means that you can count on consistent vision whether you’re reading a book or navigating a busy workday.

In contrast, RGP lenses may require an adjustment period before they become comfortable enough for long hours of wear. Patients who have previously experienced discomfort with any type of hard lens might find the switch to a scleral lens more appealing.

Advantages of Scleral Lenses over RGP Lenses

Superior Comfort

Because scleral lenses vault over the sensitive cornea and rest on the less-innervated sclera, many patients experience a significant reduction in the foreign body sensation.

Enhanced Stability

Their larger diameter ensures that scleral lenses remain securely in place during sports and other dynamic activities, reducing the risk of lens displacement.

Moisture Retention

The fluid reservoir between the lens and the cornea offers continuous hydration, making them ideal for patients with severe dry eye or corneal surface issues.

Protection Against Irritants

The design minimizes the chance of dust, debris, or allergens getting trapped under the lens, providing additional defense for your eyes.

Improved Vision Consistency

With less lens movement, patients often experience stable, consistent vision without the residual astigmatism that sometimes occurs with RGP lenses.

Advantages of RGP Lenses Compared to Scleral Lenses

Proven Optical Correction

RGP lenses have been used since the late 1970s and are highly effective at creating a smooth refractive surface, reducing irregular corneal aberrations.

Simpler Fitting Process

Their smaller diameter typically means that the fitting process is more straightforward and may require fewer follow-up visits.

Durability and Cost-Effectiveness

RGP lenses are known for their durability and, in some cases, can be less expensive than scleral lenses, particularly for patients without severe ocular surface issues.

Enhanced Tear Exchange

The direct contact with the cornea can promote tear exchange, which may be beneficial in maintaining a healthy corneal environment in select cases.

Making the Right Choice for Your Lifestyle, Comfort & Visual Needs

Scleral and RGP lenses both offer excellent vision correction with unique benefits; consult our eye doctors to choose the right option for enhanced vision and comfort. Our eye doctors carefully analyze your ocular measurements, visual needs, and daily activities to recommend the lens that will maximize both your vision and your comfort. In some cases, the unique advantages of each lens may complement one another, underscoring the importance of a personalized approach to contact lens fitting.

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At Insight Vision Center Optometry, we’re proud to serve the diverse communities of Orange County and even patients who travel from abroad for expert specialty contact lens care. Conveniently located in Costa Mesa, our clinic is easily accessible from Newport Beach, Huntington Beach, Irvine, Santa Ana, and beyond.

Our world-class team of specialists has extensive experience fitting contact lenses for even the most challenging cases. With cutting-edge technology and a true passion for improving lives, we deliver the highest level of care from early diagnosis to advanced treatment options.

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