Scleral Contact Lenses

At Raleigh Contact Lens Institute, it is common for patients to travel from hours away to see us, as our office is truly unique in the capabilities and services we provide. We have scleral lens patients who come to us from Virginia, Tennessee, and Georgia, as well as North Carolina and South Carolina. At our office you can expect a very thorough and detailed initial examination, and you can expect to spend 100% of your time on-one-on with the doctor. Our doctors lecture nationwide on the topic of scleral contact lenses, so rest assured you’re in good hands with doctors who are truly scleral lens specialists.

Another way in which Raleigh Contact Lens Institute is truly unique is with the type of technology which is available to aid in designing the best possible scleral lens.  The Pentacam AXL Wave is a medical device that is currently only available at a dozen or two Optometry offices nationwide. 

This device collects up to 240,000 unique data points, and these 240,000 data points are used to design a truly custom scleral lens that is specific to each patient’s eyes.  For this reason, each scleral contact lens is extremely different for each patient, which allows for the best possible visual outcome.

Scleral contact lenses come in many shapes and sizes. They are large-diameter gas-permeable (“hard”) lenses, which may sound intimidating; however, scleral contact lenses are designed to vault over the cornea (the sensitive part of the eye) and land on the white part of the eye. 

Because of this design, they are very comfortable.  Unlike traditional contact lenses that cover only the cornea, scleral lenses are larger, extending to the sclera’s outer edges.  If scleral lenses are uncomfortable, then either the design needs to be adjusted or the patient may have dry eye syndrome, which is something that will be addressed separately.

• Stability and Comfort – Scleral lenses offer a stable fit, reducing the likelihood of movement on the eye and enhancing overall comfort
• Corneal Protection – Scleral contact lenses provide a protective barrier, shielding the cornea from environmental factors and reducing the risk of abrasions

• Visual Correction – Scleral lenses are particularly effective in correcting complex vision issues, such as irregular corneas or high prescriptions, leading to improved visual acuity
• Dry Eye Management – The fluid reservoir helps maintain a stable tear film, making scleral lenses a valuable option for individuals with dry eye syndrome
• Versatility – Scleral lenses can be customized to fit various eye shapes and conditions, offering a versatile solution for a wide range of visual challenges

There are two different typical approaches to designing a scleral lens.  Raleigh Contact Lens Institute primarily uses a different method, but first we are going to explain the standard approach, which is using a “fit set”. 

A fit set is comprised of 12-40 standard designs of scleral lenses which are provided by contact lens manufacturers, and this serves as a starting point for Optometrists to customize lenses for individual patients. A lens is selected that is close to the patient’s eye shape. From there, the doctor will determine modifications by observations of the “fit” lens on the eye. While effective for straightforward cases, traditional scleral lenses may fall short in providing the best fit, vision, or comfort compared to more advanced options like freeform lens designs or those created from scleral topography.

The traditional fitting process can be both time-consuming and expensive, often necessitating multiple visits. However, with technological advancements, the trend is moving towards more customized solutions, such as freeform lenses. These are crafted using advanced imaging and lens design software, allowing for a fit that precisely matches the unique contours of each patient’s eye, potentially surpassing the results achievable with standard fit sets. At the Raleigh Contact Lens Institute, our doctors primarily employ scleral topography-based, freeform lenses, focusing on maximizing comfort and vision quality for patients using scleral contact lenses.

Most patients want the best fit, vision, and comfort possible, and that is why at Raleigh Contact Lens Institute we do NOT use “fit sets” except for in rare circumstances. Instead, we use an advanced medical device called thePentacam AXL Wave which is only found in a few doctor’s offices nationwide!!

The Pentacam AXL Wave collects up to 240,000 unique data points, and these 240,000 data points are used to design a truly custom scleral lens specific to each patient’s eyes.  It is this extreme amount of data that our doctors use to design truly custom lenses that include customizations that would not be possible with a fit set.  Not only does this technology result in a much more customized design, it also minimizes the number of “re-fits” / adjustments to the lens that have to be made, which allows the patient to avoid unnecessary trips to the doctor’s office.

Scleral contact lenses are versatile and can be beneficial for various vision and eye health conditions. Some of the primary applications for scleral lenses include:

1. Keratoconus – Scleral lenses are frequently used to provide visual correction for individuals with keratoconus, a condition where the cornea takes on a cone-like shape. More info 
2. Irregular Astigmatism – Individuals with irregular astigmatism, often caused by corneal irregularities or post-surgical complications, may benefit from the customized optics of scleral lenses.
3. Dry Eye Syndrome – Scleral lenses are known for their ability to create a fluid reservoir between the lens and the cornea, providing continuous moisture.
4. Ocular Surface Diseases – Conditions such as Stevens-Johnson syndrome, Sjögren’s syndrome, and graft-versus-host disease can cause significant discomfort and vision issues. Scleral contact lenses can provide protection and comfort for these conditions.
5. Post-Corneal Transplant – After corneal transplant surgery, the cornea may have irregularities that affect vision, and scleral lenses can help compensate for these irregularities
6. High Refractive Errors – Scleral lenses are effective in correcting high levels of nearsightedness, farsightedness, and astigmatism that may be challenging to address with traditional lenses
7. Post-Refractive Surgery Complications – Some individuals may experience complications or unsatisfactory outcomes after refractive surgeries like LASIK or PRK, and scleral lenses can help
8. Photophobia and Light Sensitivity – Scleral lenses can provide relief for individuals with conditions causing heightened light sensitivity, such as migraines or photophobia
9. Corneal Trauma – Individuals recovering from corneal injuries or trauma may benefit from the protective and stabilizing features of scleral lenses during the healing process
10. Complex Prescriptions – Scleral lenses are suitable for individuals with complex prescriptions that may not be adequately addressed by traditional contact lenses or glasses
11. Sports and Outdoor Activities – Scleral lenses provide stable vision and reduce the risk of dislodgement during physical activities, making them suitable for sports or outdoor pursuits
12. Cosmetic and Prosthetic Use – Scleral lenses can be customized for cosmetic or prosthetic purposes, such as changing eye color or concealing disfigurements

While scleral lenses offer numerous advantages, they are not without certain disadvantages. It is essential to consider both the benefits and limitations when deciding on the most suitable vision correction option, and our doctors are well-versed in explaining all available options.

Potential disadvantages of scleral lenses include:

• Cost – Scleral lenses can be more expensive than traditional contact lenses. The initial fitting process, customization, and the cost of the lenses themselves may be higher
• Complex Fitting Process – Fitting scleral lenses requires more time and expertise from eye care professionals. Finding the right fit may take multiple appointments. Our technology reduces the number of needed appointments and typically a suitable lens is designed within 2 to 3 visits.
• Limited Availability – Scleral lenses may not be readily available at all eye care practices. Finding an experienced practitioner with expertise in fitting scleral lenses may be challenging in certain locations
• Initial Difficulty Putting in the Lenses – For those who are not used to putting in contacts, it may take time to get used to putting in scleral contact lenses.

Many people wonder what scleral lenses cost.  Scleral contact lenses cost more than other types of contact lenses, due to the level of technology offered, combined with the involved fitting process. 

For someone who would be a NEW scleral lens wearer, the cost varies, but often times the initial fit typically ranges around $2500 – 3000 for scleral lenses.  This price range includes a 1.5-2 hr comprehensive exam with the doctor, necessary adjustments to the lens, a set (of 2) lenses, and all follow-up visits.

In addition to a paid-in-full option, Raleigh Contact Lens Institute offers an affordable monthly payment program that breaks this up into payments of ~ $160-200/month.  Additional financing options such as CareCredit TM may be available.