Scleral Lens Frequently Asked Questions: Your FAQs answered

Hi I’m Dr.Laura and welcome to my scleral lens answer page! I’ve been working with these amazing lenses for almost a decade and this is a list of common questions I frequently get from my patients about their lenses. They are in no particular order. Don’t see an answer to burning scleral lens question? Send me an email at eyecareLS@eyecareLS.com with your question and I’ll do my best to get it answered. 🙂

See my intro to scleral lenses here and info about cleaning solutions here.

Do scleral lenses hurt?

If they are fit correctly, they should not hurt. In fact, if your lens is fit appropriately, you’ll find you can keep your eyes open for much longer due to the fluid hydrating the tissue, you’ll never lose a staring contest again. (I don’t really recommend this, but have many patients who report they do this to freak out their friends.)

The most common reason a well-fitting lens does actually hurt is due to a bubble. If you knock too much fluid out of the lens when you put it in (by say, tapping it against your eye lid… we’ve all been there) the lens goes on the eye with a lot of air between it and your eye. This is equivalent to your eye not blinking for however long your lens is on your eye, and it can be very painful.

So, rule number 1 of these lenses that I always teach my patient: if it hurts, take it out, clean it and put it back in like normal. If the lens feels better now, you’re good to go. If it still is uncomfortable, there could be crack in the lens or its REALLY dirty; both of these cases its usually just uncomfortable but not painful or dry feeling. Even a poorly fitting lens shouldn’t be painful, they are usually just uncomfortable.

If the lens is on your eye with a bubble for a long period of time, it will be very uncomfortable even after the lens is removed because the cornea is dehydrated and it needs to heal itself. Frequent use of non-preserved artificial tears (the ones in little individual vials) will help lubricate the tissue and reduce the friction of the upper lid when you blink. Some people just keep that eye closed for a few hours while it heals. And in my experience, it always heals back to normal in a few days.

Can these lenses be stored dry?

Yes, in fact I recommend it for long term storage in most cases. Since these lenses can be used for years, it’s best for a back up set to be cleaned and dried before storing it in a case. (Label it with a year or when they were last worn, so you don’t end up with a drawer full of old mystery lenses). If you aren’t using it for a while, the solution will dry out and leave a chalky film on the lens. Remove the film by rehydrating it. Need them quickly? Scrubbing will get the film off. If they have been in dry storage, I recommend soaking them in a conditioning solution overnight, to make them more comfortable when you put them in again.

Exception: Lenses coated in Hydra-Peg can NOT be stored dry. This coating, which allows for better surface wettability, is destroyed and will no longer feel as comfortable.

To store the lenses for less than a few weeks, keep the lens in a conditioning solution to improve wettability; good wettability means the tear film coats the lens more evenly when you blink and keeps the tear film from evaporating as quickly, making your vision more stable and comfort better. Less friction from the eyelid makes a comfortable lens.

What are they most commonly used for?

Scleral lenses may be used to improve vision and reduce pain and light sensitivity for people suffering from growing number of disorders or injuries to the eye, such as ocular graft vs. host disease, microphthalmia, keratoconus, corneal ectasia, Stevens-Johnson syndrome, Sjögren’s syndrome, aniridia, neurotrophic keratitis (aneasthetic corneas), complications post-LASIK, complications post-corneal transplant and pellucid degeneration. Injuries to the eye such as surgical complications, distorted corneal implants, as well as chemical and burn injuries also may be treated by the use of scleral lenses.

What is the difference between a miniscleral and a scleral lens?

Mini-scleral designs rest partially on the outer edge of the cornea due to their smaller design. Larger lenses are generally just referred to as scleral lenses, are usually at least 16 mm in diameter. There are many reasons to use different sizes including protecting more of the ocular surface benefits from a larger lens, while an eye with lots of asymmetry on the sclera (steeper in some areas and flatter in others) does better with a lens landing just off the cornea where the tissue is more symmetrical.

Can they fall out like the smaller ones?

No. Because scleral lenses rest under the lid, they don’t come out unless you are actively trying to remove them. They also don’t easily get debris underneath them. The cornea can make proteins and that can be released into the fluid under the lens, but I’ve not heard of anyone getting something from outside of the eye like dust under the lens.

Will they cut my eye if I don’t take them out correctly?

Not that I’ve ever seen. The edges of the lens are rounded so they don’t scratch the eye when you’re taking them out.

Are scleral lenses made of glass?

No. There aren’t any lens made of glass, although the first scleral lenses were made that way. Glass doesn’t let oxygen pass through and the cornea will swell after a short period. The plastics used in these lenses allow for lots of Oxygen to get to the cornea. We can go as large as we need in these lenses without harming the tissue.

If they break, plastic lenses usually snap in half, verses glass shattering. (And no, this does NOT happen in the eye when taking them out. In fact, the break most often while you’re cleaning them; if you’re pressing too hard, try using your pinky or ring finger instead). If they were made of glass, a small break or crack on the edge could injure the eye significantly as it’s much harder than the plastics we use.

Do they come in colors?

They do, but we don’t fit these frequently. They are used in movies all the time to give actors different looks including colored scleral, unique patterns like a cat iris shape or no pupil at all. Currently, we don’t fit these lenses, mostly due to lack of demand.

Who makes scleral lenses?

There are a few large labs in the US and Canada where we get our lenses from. We also get some lenses from a company in Holland. They are all custom order and designed specifically for each patient.

How long do scleral lenses last, how do I know if I should replace them?

All RGP material lenses can last many years if you take good care of them. You can replace them when your prescription changes, when they get scratched or your eye shape changes. Many patients replace them when they break or crack; this almost always happens due to pressing too hard of the lens when you’re cleaning it. Clean the lens with your picky or ring finger. If your scratching your lenses, you should clean your hands more thoroughly before cleaning the lens; the material is softer than most debris that gets on your hands including metal, glass and rocks (i.e. dirt).

Why do scleral lenses cost so much?

I’m not going to lie to you, these lenses are an investment, but they can also last for many years. Part of the cost lies in the lens technology itself. Because they use 4-6 times more material than smaller RGP lenses, the material cost is 4-6 times as much; additionally, the software to lathe these lenses can only make one at a time. These computers aren’t cheap. There is a fee to the lab to use the math to create the lens with parameters we specify; this happens each time they make the lens. It is very common to make a few lenses when we go through the fitting process the first time as we fine tune the shape to best fit your eye.

Additionally, we are expecting to see you multiple times before the process is complete. We bill our scleral lenses using global fees, this means the professional service fee and the scleral lens cost are both billed at the time of the fitting and generally cover the services for a specific period of time, usually 90 days. Your visit with me usually takes 60 to 90 minutes for initial consultation, although follow ups are typically much quicker. Part of this fee also helps pay for my staff to train you on how to care for the lens as well as ensure you can comfortably take the lenses in and out. We won’t dispense your lenses until we know you can do this.

How much do they cost at Eyecare Associates?

They can range from $500 to well over $1000 per lens and $250+ for my time. If we are just replacing a lens that is working well, the cost is less than creating a new design. Many vision plans and health insurance plans help pay for scleral lenses when you have a medical reason to wear them.

What is our office’s return policy and warranty?

Scleral lenses aren’t for everyone and sometimes they don’t work. Usually, the portion of the cost that covered my time (professional service fee) isn’t refundable, as I haven’t figured out how to go back in time and not fit someone, but if the lenses are returned, part of that can be returned. Thankfully this is rare. In some cases, we are successful using a different contact lens design (like a custom soft lens, hybrid lens or smaller RGP design).

The material is usually warranted against breakage (from defective material) for 3 to 6 months depending on the material and the fitting period for making changes is usually 90 days.

How do you remove and insert them without a plunger?

There are some techniques where you use your eyelids to get them out. Videos show it much better than I ever could explain here. For me, it is much easier to remove with a plunger and insert using a stand (large plunger with a hole in the bottom so there isn’t any suction.

Can I rinse scleral lenses with tap water?

I have a controversial answer to this… it depends on your overall health and risk tolerance. Do you have a strong immune system and no ocular health issues? Then it’s probably safe to rinse the lenses in tap water. Do you have a compromised immune system or an ocular condition with inflammation or an open wound? Then I strongly recommend against tap water making contact with the lens. Use saline to clean off solutions and rinsing.

Here’s what I usually recommend. Wash off any cleaner with tap water, then rinse the lens with saline. Fill with your favorite solution and insert.  Some tap water has lots of sediment (aka the water is “hard” and it leaves a white film on faucets and drains) and it can deposit on the lens. Rinsing with saline removes this and keeps the lens surface smooth.