What Are Scleral Lenses and Why They Work for Keratoconus
Scleral lenses are large-diameter contact lenses that rest on the white part of your eye (the sclera) rather than on the cornea. They vault over the cornea, creating a fluid-filled chamber that can correct vision even when your cornea is severely irregular or cone-shaped. If you've been told your eyes don't fit standard contacts, or that your cornea is too steep or misshapen, scleral lenses may be the answer you've been looking for.
Keratoconus is a progressive eye condition where the cornea thins and gradually shifts into a cone shape. It can develop at any age but often appears during puberty or your 20s. According to the American Academy of Ophthalmology, it affects roughly 1 in 2,000 people, though rates vary by geography and ethnicity. The irregular cornea scatters light, causing blurred or distorted vision that regular glasses and standard contacts can't correct. That's where scleral lenses change everything.
At Vision Palace Optical on Avenue U in Sheepshead Bay, we fit patients with complex corneal shapes every week. Whether you have keratoconus, astigmatism so steep that regular contacts won't stay centered, or scarring from an old injury, scleral lenses offer comfort and clarity that feel like a new world.
How Scleral Lenses Work for Your Vision
The key to scleral lenses is the vault. The lens sits on the sclera, the part of your eye that's white and less sensitive, and bridges over the cornea without touching it. This vault creates a pocket of sterile saline solution between the lens and your cornea. That fluid layer acts like a custom lens, smoothing out all the irregularities in your corneal shape and giving you sharp, stable vision.
For keratoconus specifically, this is revolutionary. Your misshapen cornea no longer dictates your vision. Instead, the smooth front surface of the scleral lens provides a regular optical surface that your eye can see through clearly. Many patients with advanced keratoconus who thought they were headed toward low-vision aids are surprised to see 20/20 or better once they're fitted with scleral lenses.
The American Academy of Ophthalmology notes that scleral lenses also benefit patients with Stevens-Johnson syndrome, graft-versus-host disease, severe dry eye, and other conditions where the cornea or ocular surface is compromised. But for keratoconus, they're often the first choice when glasses and standard contacts have failed.
Why Standard Contacts Don't Work for Hard-to-Fit Eyes
Standard soft contact lenses are thin and flexible. They drape over your cornea and move with it. If your cornea is cone-shaped or very irregular, a soft lens won't stay centered. It'll shift, slide, or fall out. You'll feel discomfort because the lens is constantly moving and tugging on an already sensitive eye.
Rigid gas-permeable (RGP) contacts are firmer and sit on the cornea, which gives better optical control. But for severe keratoconus, even an RGP lens will be uncomfortable because the lens has to press on the cone, and it won't fit the entire surface evenly. You'll experience spotty vision, irritation, and the lens won't last long in your eye before it becomes intolerable.
Scleral lenses sidestep both problems. Because they're much larger and rest on the sclera, which has far fewer nerve endings than the cornea, they're significantly more comfortable. The fluid chamber protects your cornea and eliminates pressure on the cone. You get stable, clear vision without pain.
The Fitting Process and What to Expect
Fitting scleral lenses isn't like getting regular contacts. It takes time, precision, and expertise. Your eye doctor needs to measure the curve of your sclera, the height of your vault, and the exact optical power you need to correct your vision through that fluid layer.
At Vision Palace Optical, we start with a thorough eye exam to evaluate your cornea's shape, measure your keratoconus severity if applicable, and assess your eye's health. We use imaging technology to map your corneal and scleral topography, essentially creating a detailed 3D model of your eye. This data guides the initial lens selection.
Then we fit you with a trial lens. You'll wear it for a few minutes while we check how it sits, whether the vault is right, and whether your vision is clear. We may refine the fit once, twice, or more until we get it exactly right. Once we've dialed in the best parameters, we order your custom lenses, usually in pairs so you have a backup.
When your final lenses arrive, we teach you how to insert, remove, and care for them. Scleral lenses take practice to put in, they're larger than standard contacts, but most patients master it within a week or two. We're here to support you through that learning curve.
Cost and Insurance Coverage for Scleral Lenses
Scleral lenses are more expensive than standard contacts because they're custom-made for your eye and require specialized fitting expertise. Coverage varies by plan. Many insurance plans, including Medicaid and Medicare Advantage, recognize scleral lenses as medically necessary for certain conditions like keratoconus and severe dry eye. Call us or book through Zocdoc to verify your benefits before your visit. Coverage varies by plan.
If your plan doesn't cover the full cost, we'll work with you to discuss options. Don't let cost concerns stop you from exploring scleral lenses, vision that clear and comfortable is worth it, and we can often find a path forward.
Care and Maintenance
Scleral lenses require daily care, but it's straightforward. You'll use a multipurpose solution or a hydrogen peroxide system to clean and store them overnight. Some patients keep their lenses in during the day with rewetting drops to maintain comfort.
Because scleral lenses vault over your cornea and are filled with saline, they don't dry out like standard contacts. This makes them ideal if you spend hours at a computer, live in a dry climate, or have underlying dry eye disease. Many of our patients in Brooklyn who work in offices and deal with winter heating are thrilled to discover how comfortable scleral lenses are compared to what they tried before.
Frequently Asked Questions
How long does a scleral lens fitting take?
A complete fitting typically involves multiple visits over a few weeks: an initial evaluation, a trial fit, and a final adjustment after you receive your custom lenses. Each appointment is focused and purposeful, we're making sure your fit is perfect.
Can I use scleral lenses if I have keratoconus and astigmatism?
Yes, absolutely. In fact, scleral lenses excel at correcting high astigmatism combined with keratoconus. The fluid chamber neutralizes the corneal irregularity, and the lens power corrects the remaining refractive error.
Are scleral lenses safe to wear long-term?
Yes. Scleral lenses have been used for decades, and when fitted and cared for properly, they're very safe. The sclera is a hardy tissue designed to support the eye, and the saline pocket actually protects your cornea. Your doctor will monitor your eye health with regular exams to ensure the lenses are working well and your cornea remains healthy.
What if I can't get used to inserting scleral lenses?
Most people learn to insert them within a few days or weeks with practice. If you're struggling, come back and we'll work with you one-on-one. Some patients benefit from a plunger tool (a small suction device) to make insertion easier. Don't give up, the payoff is worth the effort.
Can children with keratoconus wear scleral lenses?
Yes. Keratoconus often appears in childhood or the teen years, and scleral lenses can be fitted on young eyes. If your child (ages 6 and up) has been diagnosed with keratoconus or has a hard-to-fit eye, bring them in for a contact lens fitting evaluation. Early correction can prevent vision loss and boost confidence.
What's the difference between scleral lenses and corneal RGP lenses?
Corneal RGP lenses sit on the cornea and are much smaller. For mild or moderate corneal irregularity, they can work well. But for severe keratoconus, scarring, or extreme astigmatism, the larger vault and comfort of scleral lenses often make them the better choice. Your doctor will recommend the best option for your specific eye.
References
- American Academy of Ophthalmology, Diagnosis and Management of Keratoconus
- American Academy of Ophthalmology, Update on Scleral Lenses
If you have keratoconus, hard-to-fit eyes, or have been struggling with standard contacts, it's time to explore scleral lenses. Book your contact lens fitting evaluation with Dr. Shlivko or Dr. Sheyko at Vision Palace Optical, book through Zocdoc, get in touch, or call us at (718) 998-8400. We're at 1723 Avenue U in Brooklyn, open Monday through Saturday.