Scleral Fitting Contact Lenses for the “Hard-to-Fit” Patient


It is not uncommon for patients to have difficulty wearing contact lenses for a number of reasons. Due to the individual eye shape, certain conditions or impairments or the aftermath of surgery, some patients are considered to be “hard to fit” as contact lens wearers.

For hard to fit patients that prefer to wear contact lenses however, there are options available that can provide comfortable and effective contact lens wear. This will require a specialized fitting with an eye doctor that is an expert that knows your condition and the various products available to find the right match for your specific condition. You may be considered a hard to fit contact lens candidate if you have one of the following conditions:

  • Dry Eyes
  • Astigmatism
  • Giant Papillary Conjunctivitis (GPC)
  • Keratoconus
  • Pellucid Marginal Degeneration
  • Post-LASIK or other refractive surgery
  • Presbyopia (reduced near vision common in individuals aged 40 and over).
  • Corneal Scarring


Dry Eyes and Contact Lenses

Dry Eye Syndrome causes your eyes to feel dry, gritty, burning, red, and irritated. Dry Eye Syndrome can also cause blurred vision. Often these symptoms can sometimes worsen by the use of contacts. In fact, many people who do not normally suffer from chronic dry eyes, will experience some of these symptoms as a result of contact lens wear.

First of all, if you have chronic dry eyes, you should see your eye doctor for treatment and relief before you think about contact lenses. Once your dry eyes are treated, it is safe to try contacts and there are a number of options that can be considered.

Many brands of soft contacts and products such as disinfectant and cleansing solutions are made with ingredients that are designed to be more comfortable for individuals with dry eyes. Your eye doctor will be able to recommend some of these brands and products to you. Alternatively, gas permeable (GP) or rigid gas permeable (RGP) lenses are made with a hard material that in some cases does not dry out like soft lenses and they are able to hold a certain amount of moisture beneath the lens to keep the eye from drying out. Gas permeable lenses are a very good option and can be quite comfortable for individuals with dry eyes.

Additionally, your doctor might recommend a specific wearing schedule such as limiting the time you wear your contacts throughout the day or replacing your contacts on a more frequent basis.


Scleral Fitting Contact Lenses

Scleral contact lenses are specialty contacts primarily used to improve the vision of people with corneal irregularities. In fact, the most common reasons to wear scleral lenses are if you have keratoconus, had a corneal transplant, or are suffering from severe dry eye disease.


What are scleral lenses?

Scleral contacts are large, bowl-shaped hard contact lenses that range in size, typically from about 15 mm to 18 mm in diameter. Unlike standard hard lenses, sclerals rest on the white part of your eye and vault over your cornea. By resting on the white part of your eye, instead of your highly sensitive cornea, they’re actually quite comfortable.


Being fit with scleral lenses

When fit with a scleral contact lens, your eye doctor will take a few measurements of your cornea before selecting a lens to put on your eye. Because fitting these lenses is more difficult than standard lenses, it may take a few trips to your eye doctor to get things just right! This is also why being fit with scleral contacts lenses is typically more expensive than other contacts.


Putting in and taking out scleral lenses

Before being placed on your eye, these lenses need to be filled with preservative-free saline solution. This is wonderful for patients with dryness because their eye is bathed in saline all day long! Also, by vaulting over the cornea, these lenses create a smooth refracting surface for clearer, sharper vision.

Taking out scleral contacts is different than taking out regular lenses. In fact, most patients prefer to use a scleral plunger to remove these lenses (pictured above).

Been diagnosed with Keratokonus, click on this link to learn more about your options: Contact Lenses for Keratoconus: What Are Your Options?


How long do scleral lenses last?

Like standard hard contacts, scleral lenses can last for up to a couple of years! This all depends on how you take care of them, how you’re seeing, and how they fit your eye. Overall, scleral contact lenses can be life-changing for patients with severe corneal disease and even for patients that have struggled with other types of contacts in the past. To see if you’re a candidate for scleral contacts, talk to Dr. Gunnerson for more information.


Kevin Gunnerson, O.D.
1301 East Highway 24, Suite D
Moberly, MO 65270
Phone: 660-219-9146
Fax: 660-263-2362

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