If your cornea has an irregular shape due to eye disease (keratoconus), surgery (e.g. corneal transplant) or injury, your vision will not be clear, even with glasses. Hard contact lenses provide a smooth and regular surface so your eyes can see clearly, but they are not always well-tolerated.

Scleral contact lenses are much larger than other hard lenses (RGPs) and vault the cornea to rest on the white of the eye (or sclera). The hard surface creates a stable, regular ocular surface, which means crisp vision. They are used to provide comfortable, functional vision in corneal disease and patients with dry eyes.

Scleral lens diagram.

Scleral contact lenses after corneal transplant

Many patients who undergo corneal graft mistakenly feel this procedure will ‘fix’ their eyes. The truth is that many patients struggle with their vision after corneal transplant and one of the best solutions if spectacles are unsatisfactory, is a scleral contact lens that vaults the entire area of the graft.

This is important information for those considering a transplant rather than managing their keratoconus with hard or scleral contact lenses. Transplant will not necessarily bypass this strategy.

Please note that once you’ve had a corneal transplant, 50% of grafts fail within 15 years, which makes another transplant inevitable. The longer you can push out the necessity for the first graft, the better.

Keratoconus: Are scleral lenses the answer?

There was a time when scleral contact lenses were only fitted as a last resort before corneal transplant surgery. The skill required to fit these lenses as well as the sheer size of them compared to other lenses was off-putting for both practitioner and patient.

What we have found at The Eye Practice is that with the right technology and experience that these lenses can be a fantastic option for many patients with keratoconus and in some cases sclerals are our lens of choice for these patients.

If you have failed in contact lenses for keratoconus in the past, sclerals may be the solution for you.

Scleral contact lenses for dry eyes

At our dry eye clinic, we see patients who have suffered for years with severe and debilitating dry eyes and tried every treatment going. Their eyes are just so sensitive to air that they cannot bear to have them open, even to watch TV.

If this sounds like you, scleral contact lenses can be life-changing. By providing a physical barrier that holds a layer of tears in place and prevents evaporation, these lenses can provide comfort like nothing else. They require expert fitting from a practitioner who is a contact lens expert (and ideally a dry eye expert too).