Scleral Contact Lenses

Over the last 20 years or so, since the advent of the soft daily disposable contact lens, the number of optometrists fitting any other type of contact lens has fallen dramatically. However, in recent years, thanks in the main, to better technology and supports from the laboratories, optometrists are again beginning to dabble in the dark arts of fitting corneal and scleral lenses.

Corneal lenses are familiar to most as rigid gas permeable contact lenses or RGP’s. These are small hard lenses that were worn on the cornea and the lens most contact lens wearers would have worn before soft lenses became commonplace. In fact, they were the first lenses I wore myself. Corneal lenses were great in that they were long lasting, provided excellent vision and could withstand some abuse. However, it typically took weeks or months for the cornea to become desensitised to the presence of these lenses.

Soft and corneal lenses tend to be suitable for most eyes but unfortunately there is a large cohort of patients for whom these lenses are not suitable. For example, anyone with an irregular cornea caused by scarring, keratoconus (a common condition where the cornea becomes cone rather than dome shaped), corneal transplant surgery, chronic dry eyes, or those unusually high prescriptions. Often these patients can have such poor vision with glasses and traditional contact lenses that it can impact their ability to drive, be independent, work, and do other things most people take for granted. However, there is a potential solution for these people, scleral lenses.

Scleral lenses are large diameter rigid lenses which rest on the sclera (the white part of the eye). The beauty of these lenses is twofold. Firstly, a scleral lens vaults the cornea and rests on the sclera, and as this part of the eye is not densely populated with nerve endings, unlike the cornea, there is very little sensation.  Secondly, on applying a scleral lens, the lens is filled with a reservoir of preservative free saline solution, which serves to create a tear lens between the scleral lens and the irregular corneal surface. This tear lens acts to fill out the corneal irregularities thus creating a smooth ocular surface. In those patients that have an irregular, scarred or dry cornea, it is these irregularities that distort the vision, so when the surface is then smoothed it can dramatically improve the vision.

Scleral lenses can therefore be lifechanging for those patients for whom no other solution exists. 

I developed in interest in fitting scleral lenses after attending a lecture about using them in 2016. However, the opportunity to commence my own scleral lens journey didn’t begin until 2021 when I attended a Euroscole scleral lens workshop. These workshops were being held all over Europe, South Africa, and Asia by renowned optometrist and scleral lens expert Daddi Fadel. Daddi had started Euroscole to try increase the number of optometrists worldwide who were fitting these lenses.  After 2 days intense learning I came away with the confidence to start fitting these lenses in my own practice. 

In 2023 I then had the opportunity to attend the Euroscole advanced scleral lens workshop to further expand my scleral lens knowledge.

Fast forward to today and the journey continues, whilst the numbers of patients we are fitting steadily grows.

So, if you think scleral lenses would be of benefit to you, please do not hesitate to contact the practice and we can arrange a consultation.

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