Scleral Lenses for Keratoconus: Custom Designs for Unique Needs

When Are Scleral Lenses The Best Option for Keratoconus?

Scleral lenses have become a primary contact lens option for keratoconus. They can be used for mild to moderate cases but are especially effective when keratoconus is advanced or other contact lenses fail. Scleral lenses offer unique advantages over other keratoconus contact lens options. Because they rest on the sclera (the white part of the eye) and vault over the cornea without touching it, they provide greater comfort than traditional corneal RGP, hard, or hybrid lenses. This unique design accommodates even the most severe keratoconus cases, preventing corneal pain and damage caused by lens rubbing and eliminating the risk of lenses popping off. Additionally, scleral lenses act as a barrier, preventing dust and debris from getting under the lens and causing discomfort. When combined with wavefront guided optics, these lenses can potentially provide superior vision compared to other options.

Scleral Lenses: An Option to Avoiding Corneal Transplant

Corneal transplants are used for patients with keratoconus when the cornea is extremely irregular, preventing contact lenses from fitting properly, or when advanced scarring obscures vision. However, in many of these cases, scleral lenses can successfully address vision and comfort issues, potentially eliminating the need for transplantation. While corneal transplantation has become less common due to advancements like scleral lenses, it may still be necessary when vision cannot be improved to functional levels with scleral lenses or other contact lens options. Alternative procedures, such as topography-guided PRK or CTAK, can also improve corneal shape and enhance vision with or without glasses. These procedures may even improve vision with scleral lenses or make other options like soft lenses for keratoconus viable.

Custom Scleral Lenses For Optimal Results

These customized, lathe-cut lenses can be made in a wide variety of shapes, sizes, materials, and refractive powers. To achieve the best possible fit, we utilize all available techniques and technologies, including diagnostic fitting, profilometry scan-driven design, and impression-based design. During your initial scleral lens evaluation, our doctors will determine which approach best suits your individual needs.

Diagnostic and Advanced Scleral Lenses for Complex Cases

If a diagnostic fitting approach is best for you, we will place a series of lenses with varying sizes and shapes on your eye. We then evaluate the fit and make modifications based on our observations. While diagnostic fitting can provide excellent results for many patients, it may not be successful in cases involving complex eye shapes or design limitations. In such instances, our team of experts utilizes advanced software-driven, scan-based, or impression-based scleral lens designs to achieve an improved outcome. Many of these techniques and devices were pioneered, tested, and developed by CLEI’s doctors. As experts in these methods, our team of specialists can determine which approach will best suit your individual needs.

Scan and Impression-Based Scleral Lenses: Precision Options

Scan-based scleral lens design involves using a diagnostic device to scan the entire ocular surface (cornea and sclera). This scan is then used to create a 3D model of your eye, from which our doctor designs a 3D model of your lens for manufacturing. Impression-based scleral lens design is similar, but instead of using a diagnostic device, an ocular impression is taken to model your eye. This process is much like how a dentist takes an impression of your teeth, but it is significantly more comfortable and gentle. The ocular impression is then 3D scanned to create a 3D model. From there, our doctor and a software engineer collaborate to create a 3D model of your lens for manufacturing.

Options for Better Vision in Scleral Lenses

For those not fully satisfied with their scleral lens vision, wavefront-guided optics can be added to improve vision quality, reducing overlap, glare, flare, and other visual disturbances. Those seeking to eliminate reading glasses can utilize multiple types of multifocal options. For patients with diplopia (double vision), optical prism can be incorporated into the lens design, eliminating the need for prism glasses. 

Scleral Lens Expert to Prescribe the Best Scleral Lens

Scleral lenses can address multiple conditions and offer multiple benefits. However, finding a scleral lens expert can be challenging, and results can vary between practitioners. Our doctors at CLEI possess extensive skill, experience, and knowledge, utilizing cutting-edge technology to create optimal scleral lenses that enhance your quality of life. They have achieved numerous fellowships and have been instrumental in the development of multiple scleral lens designs. In fact, CLEI’s doctors pioneered and developed many of these techniques and devices, establishing us as leaders in the field.

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