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Scleral Lenses

Scleral contact lenses are relatively uncommon contacts that are larger than normal ones. Standard lenses only cover the cornea, which is the covering over your iris and pupil. Even then, a contact does not even cover the whole cornea.  Scleral lenses are placed over the sclera, which is the covering over the whites of your eyes. Because of this, scleral lenses are sometimes 3 times as wide as a standard lens. Even those that are deemed mini-sclerals are double the diameter of a standard lens.

The main use of scleral lenses, however, is to treat advanced corneal aberrations such as keratoconus, ocular abrasions, or abnormal astigmatism. Typically, the more severe the condition, the wider the lens.

A scleral lens works by replacing the cornea as the refractive surface through which light enters your eye. The rim of the lens rests on the sclera, while an empty space is left over the center. The gap over the cornea is filled with artificial tears or saline. Effectively, this fluid makes the old cornea just another part of the eye and the scleral lens acts as the “new cornea.” For this reason, scleral lenses are very effective at treating dry eyes. The artificial tears are able to lubricate the eyes and the lenses themselves have high oxygen permeability. Additionally, the lens protects the eye from wind and temperature, two triggers for those with dry eyes. Often times, eyes with a corneal disease are too sensitive to have a standard contact placed directly on the cornea. The liquid space works to put a comfortable barrier between the cornea and the lens. The artificial tears also work to reduce sensitivity to light.

Corneo-scleral lenses are slightly wider than standard lenses. The extra two millimeters are just large enough to cover the entire cornea and rest on the sclera. These lenses are actually more comfortable than standard lenses, at least in the short term. Because of this, they are frequently used after surgeries to correct for the astigmatism that occurs during the healing process.

Other mini-sclerals are used because they are easier to manage. Insertion and removal is a more comfortable process and their durability means they require less care. They do not require a storage solution when not being used, but it is advised that they are cleaned and disinfected as often as normal lenses.

Although they may require less care and are used long-term, the initial investment may be a steep price. The fitting process is longer than that of regular lenses and may require multiple attempts at the correct contact. Additionally, because needing a scleral lens is relatively rare, most basic health insurances will not cover the prescription. Another tradeoff is that the adjustment period for scleral lenses is long, but in the end they are generally considered more comfortable than normal lenses.