Scleral Lens Basics
Scleral contact lenses are advanced specialty contact lenses designed to provide good vision correction and comfort, especially in people with irregular corneas, dry eye syndrome, and other ocular surface diseases. Traditional contact lenses rest on the cornea whereas, scleral lenses form a vault over the cornea and rest on the sclera. This ensures stable positioning and better hydration. This guide help you explore the benefits, applications, and considerations of scleral lenses which will help understand their suitability and advantages.
What Are Scleral Contact Lenses?
Scleral contact lenses are large-diameter gas-permeable lenses that create a tear- filled reservoir between the lens and the cornea. This design ensures adequate hydration and eliminates corneal irregularities by providing a smooth optical surface.
These lenses are customized for each patient, providing exceptional vision correction and comfort. Depending upon their size and design, scleral lenses are categorized into three main types:
1. Semi Scleral Lenses: Diameter range 13.6 mm to 14.9 mm, these lenses bridge the gap between corneal and scleral lenses, providing both stability and comfort.
2. Mini-Scleral Lenses: Diameter range 15mm to 18mm, these lenses are suited for moderate corneal irregularities.
3. Full-Scleral Lenses: Diameter range 18.1 mm to 24mm, these lenses are beneficial for severe ocular surface diseases and in irregular corneas.
Scleral Contact Lens Benefits:
1. Crisp Clear Vision: Scleral lenses correct aberrations due to irregular corneas, providing clear vision.
2.Increased Comfort: The fluid reservoir prevents lens from touching the cornea, this reduces irritation and discomfort.
3.Stable Fit: The large diameter makes sure the lens stays in place, making them ideal for active individuals.
4.Enhanced Eye Hydration: The tear layer beneath the lens provides continuous hydration, preventing dryness.
5.Extended Wearing Time: Patients can wear scleral lenses comfortably for longer durations when compared to traditional contact lenses.
How to use scleral lens:
Handling of scleral lens can be overwhelming at first but it becomes easy with practice. Before handling the lens always wash your hands thoroughly using soap and wipe your hands with a lint free towel. Never use sanitizer as the alcohol present in the sanitizer can lead to burning, redness or irritation in the eyes.
Scleral lens insertion:
Inspect the lens for damage and clean it using a multipurpose solution.
Hold the lens on plunger and fill the lens bowl completely using preservative- free saline.
Now position your head parallel to the surface or use a mirror on the floor.
Open eye widely using one hand, while looking on the ground.
Gently place the lens on the sclera while keeping eyes wide open.
Now check for any trapped air bubbles. If bubbles are present than, remove and reinsert.
Scleral lens removal:
Place the removal plunger on the lower edge of the lens and gently pull the lens.
This helps to release the suction caused by the lens.
Now lift the lens away from the eye carefully. You have successfully removed the lens
Rinse the lens with solution prescribed by your practitioner and store it in a clean lens case.
Scleral lens care and maintenance:
Always wash and dry hands before handling lenses.
Use a recommended lens cleaner to clean the lens on daily basis.
Rinse lenses the lenses with preservative-free saline before insertion.
Store lenses in a multipurpose or hydrogen peroxide-based solution overnight.
Never reuse old disinfecting solution change the solution daily.
Keep the lens clean and airdry after every use.
Never rinse or store lenses in tap water, this may lead to infections.
Inspect lenses for scratches or warping regularly.
Replace lenses as per your eye care provider’s recommendation.
Schedule periodic check-ups to ensure proper fit and eye health.
Scleral Lenses vs. Other Contact Lenses:
Scleral Lenses vs. Regular Contact lens:
In terms of size, fit and function scleral lens is different from regular contact lens. Regular lenses sit on the cornea whereas, scleral lens sits on sclera forming a vault over the cornea creating a fluid filled reservoir. This reservoir provides hydration to the cornea which makes them ideal lens for irregular corneal conditions like keratoconus, post LASIK ectasia etc.
Regular contact lenses are useful in correcting primary refractive errors like myopia, hyperopia and astigmatism.
Scleral Lenses vs. Corneal Lenses:
Scleral lenses are larger in diameter and rests on sclera whereas corneal lenses are smaller in diameter and rests on the cornea. Corneal lenses are the first choice for selection in irregular corneal cases whereas scleral lenses are an advanced option. People who cannot tolerate corneal lenses, advanced ectasia cases, dry eye conditions scleral lenses are the best suited as it provides comfort and stability. Although corneal lenses require less effort while inserting and removing the lenses on the other hand vision clarity with scleral lens is unmatchable.
Scleral Lenses vs. Hybrid Lenses:
Hybrid lenses are a combination of rigid gas-permeable lens in the center with a soft skirt in the periphery. Hybrid lenses offer clear vision with comfort in wear whereas scleral lens offer more stability and protection in irregular corneal cases. Hybrid lenses are not as effective in advanced cases when compared with scleral lenses.
Scleral Lens Comparison Guide:
The average adult human corneal diameter is 11.67 mm horizontally and 10.63 mm vertically. This corneal diameter varies based on ethnicity, gender and age.
Conditions Treated with Scleral Lenses:
Scleral Lenses for Keratoconus:
Scleral lenses form a vault over the cornea and creates a smooth optical surface. Due to this vision clarity is improved, visual distortions are reduced and corneal protection is achieved. As these lenses are customized it offers long-term vision solution for patients with keratoconus.
Scleral Lenses for Dry Eye Syndrome:
The vault created by scleral lenses acts as a moisture locking system and prevents cornea from drying. This vault provides continuous hydration, reduces irritation and discomfort. These lenses prevent tear evaporation and protect the eye from environmental irritants along with improving vision, providing comfort and improving overall ocular surface health. This makes scleral lens ideal for severe dry eye conditions like Sjogren’s syndrome and neurotrophic keratitis.
Scleral Lenses for Corneal Ectasia:
Corneal ectasia can happen post refractive surgery causing progressive corneal thinning and irregularity. Scleral lens helps in restoring vision by creating a smooth optical surface and also hydrates the eye. Thus, one can achieve comfortable and clear vision in such cases by using scleral lenses.
Scleral Lenses for Corneal Scarring:
Corneal scarring can happen because of infections, trauma or surgery. Scarred cornea leads to surface irregularities which deteriorates vision and causes glares and haloes. Scleral lens help in providing stable vision as it does not touches the cornea and promotes healing.
Scleral Lenses for Graft-Versus-Host Disease (GVHD):
GVHD causes severe inflammation of the ocular surface which leads to dryness, irritation and corneal damage. Scleral lens not only provide hydration and comfortable vision but it acts as a barrier from external irritants. These lenses improve comfort by providing continuous hydration, reducing pain and stabilizing vision. Thus, scleral lens serve as a highly effective treatment option in GVHD related ocular complications by significantly improving quality of life.
Scleral Lenses for Stevens-Johnson Syndrome (SJS):
SJS leads to severe ocular surface damage, dryness and scarring. Scleral lens provides essential relief by providing hydration, reducing discomfort and helps in prevention from further damage. Their fluid filled reservoir improves vision, corneal health and overall ocular surface health. Thus, scleral lenses serve as a crucial management option in terms of visual rehabilitation and comfort in SJS condition.
Scleral Lens Fitting:
Fitting Process for Scleral Lenses:
1. Comprehensive Eye Examination: Vision testing, refraction, evaluation using slit-lamp biomicroscope, corneal topography, ocular surface health of the individual.
2. Trial Lens Fitting: Initially trial lenses are used to assess fit, comfort, and vision performance.
3. Customization: Lenses are than customized based on corneal shape and ocular needs.
4. Lens Dispensing and Training: Once practitioner receive lenses, patient is called to train for insertion, removal, and care.
5. Follow-Up Appointments: Regular check-ups are must for optimal fit and eye health.
Scleral Lens Problems and Solutions:
1. Common Scleral Lens Issues
Scleral lens users may experience discomfort, blurry vision, fogging, redness, or fitting issues. Regular cleaning, proper lens handling, and professional adjustments help prevent complications.
2. Scleral Lens Discomfort
Discomfort can result from improper fit, trapped air bubbles, dry eye, or lens deposits. If the lenses are not aligned properly it may cause pressure points or irritation.
3. Scleral Lens Blurry Vision
Blurry vision can be caused by improper lens fit, residual astigmatism, lens deposits, or air bubbles trapped beneath the lens. Regular lens cleaning and correct insertion techniques help reduce blurriness.
4. Scleral Lens Fogging
Fogging occurs due to tear film instability, debris accumulation beneath the lenses, or excessive mucus production. This requires frequent lens removal and reapplication. Using high-quality saline, lubricating drops, and maintaining a clean lens surface help reduce
fogging. Adjusting lens fit can also improve tear exchange and minimize debris entrapment.
5. Scleral Lens Redness
Redness may indicate hypoxia, mechanical irritation, dryness, or an allergic reaction. Poor oxygen permeability, excessive lens suction, or prolonged wear can exaggerate the symptoms. To prevent redness, get lens fit assessed, and maintain adequate hydration.
6. Scleral Lens Complications and Troubleshooting
Complications with scleral lenses include corneal hypoxia, lens intolerance, microbial keratitis, and conjunctival prolapse. Proper lens care regime, hygiene, and regular follow up help in preventing severe complications.
Scleral Lens Brands available in India:
1. BostonSight Scleral Lens
2. PROSE Lens
3. Maxim 3D
4. Keracare
5. Jupiter Scleral
6. MC Aspheric Mini-Scleral Lens.
Conclusion:
Scleral contact lenses are a revolutionary solution for individuals with corneal irregularities, dry eyes, and complex visual needs. The ability of the lenses to provide clear vision, hydration, and stability makes them good option for patients who struggle with conventional lenses. If you are considering scleral lenses, consult with your eye care specialist to determine the best solution for your visual needs.
