Scleral lenses are large contact lenses that rest on the sclera, the white part of the eye, rather than the cornea. The lenses contain saline, so the cornea stays moist, which is helpful for people with dry eyes.
Due to their unique structure and shape, scleral lenses can help treat certain eye diseases, including dry eye disease (DED). In DED, the eyes lack moisture due to inadequate tear production or rapid tear evaporation.
Scleral lenses are large, rigid, gas-permeable lenses that rest on the white part of the eye, called the sclera. Unlike regular lenses, they form a dome over the cornea without physically touching it.
The cornea is the transparent membrane that covers the pupil and iris. It refracts light onto the lens, which then focuses light onto the retina, enabling a person to see.
Ophthalmologists may prescribe scleral lenses to help correct or improve vision or treat certain eye diseases.
People with severe DED may benefit from scleral lenses. Other conditions that may benefit include:
- corneal irregularities
- keratoconus
- refractive errors, such as astigmatism
- ocular surface diseases, such as neurotrophic keratitis
- pellucid marginal degeneration
- post-penetrating keratoplasty
- sensitive eyes
- corneal problems after refractive surgery
Learn about the anatomy of the eye.
Unlike regular contact lenses that sit on the cornea, scleral lenses sit on the sclera and form a dome over the cornea. The space between the scleral lens and cornea acts as a fluid reservoir that helps to keep the eye moist. As a
According to the review, the benefits of scleral lenses for DED include:
- alleviating dry eye symptoms
- protecting the surface of the eye
- healing corneal cell defects
- allowing continual drug delivery to the surface of the eye
- improving visual acuity in moderate to severe DED
The main disadvantage of scleral lenses is the cost, which includes:
- the initial lens assessment
- producing the custom-fit prescription lens
- fitting the new lens, and making any necessary adjustments
Another factor to consider is that scleral lenses typically need replacing every 1 to 3 years, and the replacement lenses are likely to cost more than regular lenses.
When choosing scleral lenses, a person should consider the cost of the lenses and the fitting fee.
According to the American Academy of Ophthalmology, the most expensive option is PROSE treatment, which costs between $5,000 and $7,000 per eye, including fitting. Commercially available scleral lenses are more affordable, typically ranging from $1,000 to $5,000 per eye, including fitting.
Does Medicare cover scleral lenses?
Medicare does not typically cover scleral lenses. However, Medicare will provide cover if a doctor deems the lenses medically necessary. This may only happen in the following situations:
- A scleral lens will help retain fluid in the eye in people with severe DED, reducing the need for artificial tears.
- An eye becomes sightless due to inflammatory disease, and a scleral lens will reduce the likelihood of needing surgery to fit an artificial eye.
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Fitting scleral lenses is a custom process during which a practitioner will apply different lenses to the eye to ensure a proper fit.
In some cases, they may add a yellow dye inside the bowl of the lens to help them assess its fit.
When applying the lens, the practitioner may ask the person to gently hold down their lower eyelid and look downward. They will then hold open the upper eyelid and apply the scleral lens in a smooth, quick motion. They will then assess the fit and may apply a different lens for comparison.
Once satisfied with a particular lens, they may leave it to settle in place for 20 to 30 minutes before performing some additional tests.
If the lens is necessary to correct a person’s vision, the practitioner will contact the laboratory to order the appropriate strength lens. Depending on the complexity of the lens, the turnaround time may be anywhere from 1 to 4 weeks.
A practitioner will ask the person to return once their lenses are ready for collection. At this point, they will apply the custom lenses, check the fit, and test the person’s vision.
If the lenses are not acceptable, the practitioner can reorder new ones. If the lenses are acceptable, they will show the person how to insert, remove, and care for their new lenses.
Tips for using scleral lenses
- Wash and dry the hands thoroughly before handling the lenses to reduce the risk of eye infections from pathogens on the hands and in tap water.
- Clean and disinfect the lenses daily and whenever taking them out.
- Always use fresh lens-cleaning solution to clean the lenses, and never use tap water.
- Check the lenses for signs of damage before use.
- Wet both sides of the lens with wetting solution, then fill the lens with saline before applying it to the center of the eye while looking downward.
- Avoid the following activities while wearing scleral lenses:
- sleeping
- showering
- swimming
- using a hot tub
- Stop wearing the lenses immediately if eye pain or redness develops.
The United Kingdom’s National Health Service provides the following tips on using scleral lenses:
According to the
Some alternatives to scleral lenses include:
- over-the-counter topical treatments, such as artificial tears
- prescription medications, such as cyclosporine (Restasis) or lifitegrast (Xiildra)
- punctal plugs, which are tiny devices that reduce tear drainage
- lifestyle changes, such as using an indoor humidifier, limiting screen time, and getting adequate sleep
- surgery
Learn more about treatments for DED.
Scleral lenses are large, rigid, custom-fit lenses that ophthalmologists may recommend to treat dry eye disease and other conditions. Their dome shape creates a fluid reservoir between the lens and cornea, which helps to retain moisture.
People who have undergone an initial assessment for scleral lenses may need to wait a week or more to receive the finished product. Once they receive their new lenses, their contact lens practitioner will show them how to insert, remove, and care for them.
Most Medicare plans do not cover scleral lenses unless a doctor deems the lenses medically necessary.