Scleral lenses are large-diameter, gas-permeable lenses that vault over the entire cornea and rest gently on the white part of the eye, known as the sclera. This design creates a tear-filled reservoir between the lens and the cornea, which not only enhances visual clarity by creating a smooth optical surface but also offers continuous hydration and protection to sensitive corneas.

Scleral lenses are particularly useful for patients with conditions like keratoconus, pellucid marginal degeneration, and post-surgical corneal irregularities, as they can mask corneal surface irregularities and provide stable, high-quality vision. Because scleral lenses do not touch the sensitive corneal surface, they can provide significant relief for individuals suffering from dry eye or discomfort associated with traditional lens wear.

Their custom-fit design addresses the unique contours of each eye, ensuring that the lens drapes over the irregular surface consistently while ensuring a secure and stable fit. However, the fitting process for scleral lenses is more complex and specialized, requiring advanced imaging technology such as corneal topography and OCT to measure the ocular sagittal height and horizontal visible iris diameter (HVID). These lenses are carefully tailored to each patient’s ocular anatomy, ensuring that they extend adequately beyond the limbus for complete corneal coverage without causing excessive debatable pressure on the sclera. This highly individualized approach, while requiring more time initially, often results in superior long-term comfort and vision quality for those who need it.

Both scleral lenses and soft contact lenses aim to correct refractive errors, but their performance can differ significantly based on the patient’s specific eye condition. Soft lens wearers generally enjoy excellent visual acuity in eyes with smooth, regular corneas. The design of soft lenses allows them to correct for common vision issues such as nearsightedness, farsightedness, astigmatism, and presbyopia, offering a versatile approach to vision correction.

However, in patients with irregular corneas, especially where aberrations from conditions like keratoconus are present, standard soft lens designs might not provide optimal clarity. In these cases, the superior optics of scleral lenses become apparent. By vaulting over the cornea, scleral lenses help create a uniform optical surface that minimizes the visual disturbances caused by corneal irregularities. This smoothing effect typically results in improved visual acuity and more stable vision, even in cases where soft lenses have failed.

Moreover, customized soft contact lenses have made strides in handling mild to moderate irregular astigmatism by tailoring the lens parameters—such as power, base curve, and thickness—to the individual’s needs. Despite these advancements, scleral lenses remain the go-to option for patients requiring correction for more severe corneal irregularities. They ensure that even when faced with challenging optical aberrations, vision quality remains consistently high.

One of the challenges in managing irregular corneas is determining whether a standard soft contact lens design will suffice or if a custom soft lens is needed. Standard soft lenses are manufactured with a set range of base curves, diameters, and powers that fit the majority (roughly 77%) of patients with average ocular dimensions. For those whose corneal profiles and horizontal visible iris diameter (HVID) fall within this common range, standard soft lenses can be an effective, convenient, and budget-friendly option.

However, almost a quarter of patients have ocular dimensions that fall outside these standard parameters. In these cases, custom soft lenses offer essential benefits. They can be manufactured with tailored parameters such as specific diameter, modified base curves, increased center thickness, or an adjusted optic zone to better handle high degrees of corneal irregularity. The customization process allows our eye doctors to work closely with each patient, ensuring that the lens fit is optimized for comfort, centration, and visual performance.

When deciding on lens selection, our eye doctors consider key factors such as the corneal profile (whether the cornea is prolate or oblate), the severity of the irregular astigmatism as shown by topography, and the patient’s visual acuity with new refractions. These elements work together in determining whether a standard lens will provide sufficient quality of vision or if a more finely tuned custom lens is required.

The fitting of soft contact lenses is generally straightforward, with most eye care practitioners having ample experience due to the simplicity of the design. Soft lenses come in various disposables and power ranges, and their standardized design often simplifies the fitting process.

Scleral lens fitting, however, demands a more detailed evaluation. Our eye doctors use advanced diagnostic tools like corneal topography and anterior segment OCT to measure the ocular sagittal height and determine the horizontal visible iris diameter. Since scleral lenses are custom-made to achieve proper draping over the ocular surface, it is important that the lens diameter is typically about 3mm larger than the patient’s HVID. This ensures that the lens extends beyond the limbus by approximately 1.0mm to 1.5mm, providing a stable, protective fit.

The fitting process often involves a trial lens and multiple follow-up visits to fine-tune the lens parameters, including adjustments to the peripheral curves to prevent issues like excessive movement or the formation of air bubbles. Although this process may require more time initially compared to soft lens fittings, the end result is a highly personalized lens that provides superior comfort, visual clarity, and long-term ocular health benefits.

Cost is an important factor when choosing between scleral and soft contact lenses. Soft contact lenses are typically less expensive, largely because they are mass-produced and widely available in standard designs. For many, the affordability of soft lenses makes them a practical everyday solution for managing common refractive errors.

In contrast, scleral lenses come with a higher initial cost due to their specialized fitting process and custom manufacturing. While this may seem like a daunting investment, it is important to note that scleral lenses are designed to last from one to three years when properly cared for, which can offset the higher upfront cost over time. Additionally, for individuals with complex corneal issues or dry eye conditions, the long-term benefits of scleral lenses – such as improved comfort, reduced dependency on frequent lubricant use, and enhanced quality of life – may justify the extra expense.

Our eye doctors are mindful of both the financial and visual needs of each patient. They carefully evaluate each case to recommend the lens option that offers the best balance between cost, performance, and long-term ocular health, ensuring that patients receive the most suitable solution for their unique circumstances.

Regular cleaning and maintenance are essential aspects of contact lens wear, regardless of the type you choose. Soft contact lenses, especially daily disposables, are relatively low maintenance because each pair is replaced frequently, reducing the risk of protein buildup and contamination. However, for those using reusable soft lenses, proper cleaning and storage routines must be diligently followed to maintain lens integrity and eye health.

Scleral lenses, with their larger size and tear reservoir, require a more detailed cleaning regimen. Since these lenses can be more susceptible to protein deposits and tear debris underneath the lens, meticulous cleaning is necessary to ensure that the tear exchange remains optimal and that the lens continues to deliver the promised comfort and clarity. Patients are advised to use appropriate cleaning solutions and to follow a strict care routine as instructed by our eye doctors, ensuring that the high oxygen permeability and surface integrity of the lens material are maintained.

While both types of lenses demand a commitment to proper maintenance, many patients find that the additional care required for scleral lenses is offset by the significant improvements in comfort and vision they experience, especially if they have previously struggled with soft lens wear in the presence of irregular corneas or dry eye issues.

Choosing between scleral lenses and soft contact lenses involves careful consideration of several key factors that are unique to your eyes and lifestyle. Here are a few aspects to keep in mind when determining the best option for you:

• Corneal Irregularity: Individuals with irregular corneas due to conditions like keratoconus, pellucid marginal degeneration, or post-refractive surgery complications often benefit from the vaulting design of scleral lenses, which creates a uniform optical surface.
• Comfort and Dryness: If you experience chronic dry eye or discomfort with soft lenses, the continuous hydration provided by the tear reservoir in scleral lenses may offer a significant advantage.
• Visual Acuity: For those with high levels of irregular astigmatism or significant visual aberrations, the customized fit and optical correction of scleral lenses can provide markedly better and more stable vision.
• Fitting Complexity: Standard soft lenses are generally easier and quicker to fit, which might be ideal for patients with straightforward prescriptions. In contrast, scleral lenses require advanced imaging and multiple visits to fine-tune the fit.
• Cost and Longevity: While soft lenses are more budget-friendly, scleral lenses, despite their higher initial cost, offer long-term durability and fewer lens replacements over time.

The ultimate goal of any contact lens fitting is to enhance the quality of life by providing clear, comfortable vision. For many patients with challenging corneal conditions, the transition from conventional soft contact lenses to scleral lenses represents a significant improvement in daily functioning.

Enhanced vision can lead to better performance at work, increased confidence in social settings, and an overall higher satisfaction with day-to-day activities. Additionally, the stability of vision provided by scleral lenses can reduce fluctuations in visual clarity that may occur with soft lens wear, especially in eyes with irregular astigmatism where alignment issues can disrupt clear sight.

Whether you are managing a mild refractive error or a more complicated corneal condition, both lens types aim to restore your best possible vision. Our eye doctors are committed to working with you to explore these options and to fine-tune your lens parameters so that you enjoy the benefits of a solution that meets your unique requirements.

• They create a smooth optical surface that compensates for corneal irregularities.
• The tear reservoir not only improves comfort but also protects against dryness and irritation.
• The custom-fit design enhances stability, making them ideal for patients with high prescriptions or severe irregular astigmatism.
• Scleral lenses can provide more consistent and extended wear time owing to reduced lens movement.

• The fitting process is more time-intensive and requires specialized equipment and expertise.
• They are typically more expensive initially due to the custom manufacturing process.
• The larger lens size demands a more thorough cleaning regimen to avoid protein buildup and tear debris.

• Soft lenses are widely available and easy to fit, making them an accessible option for everyday wear.
• They offer a high degree of comfort due to their flexible, water-rich materials that conform naturally to the eye’s surface.
• Standard soft lenses are generally less expensive, with many options available for daily, bi-weekly, and monthly disposable use.
• They are highly versatile, correcting a broad range of refractive errors.

• They may not adequately mask significant corneal irregularities or severe astigmatism.
• For some patients, prolonged wear can lead to discomfort if the lens movement or tear film stability is compromised.
• The standard design may not provide sufficient customization for eyes with atypical corneal dimensions.

Deciding between scleral and soft contact lenses is a highly individualized process. If you have a relatively smooth cornea and are seeking a low-maintenance, budget-friendly option for correcting common refractive errors, soft contact lenses may be ideal. However, if you suffer from irregular corneas, severe dryness, or conditions such as keratoconus, scleral lenses might provide that extra level of comfort and clarity that truly improves your vision and quality of life.

Your eye care professional will evaluate factors like corneal topography, the degree of astigmatism, and your visual demands during a comprehensive eye exam. With this detailed assessment, our eye doctors can recommend a customized treatment approach that best fits your unique medical needs and lifestyle preferences. This might mean trying a diagnostic fitting with a standard soft lens first, followed by a custom soft or scleral lens if needed.