Introduction to the Scleral Lens

For over 25 years, our specialty lens practice has been dedicated to providing contact lens and scleral lens care to patients who have lost quality vision and ocular comfort due to refractive eye surgery such as LASIK, corneal disease such as keratoconus, corneal transplant surgery, ocular trauma, severe dry eye, and a host of other ocular and corneal conditions.

Rarely in the history of modern medicine has a technology come along that has revolutionized the manner in which we treat a host of diseases and conditions affecting the front surface of the eye. The scleral lens is the technology being referred to.

Scleral lenses have allowed tens of thousands of patients who have suffered vision loss due to keratoconus, post-refractive surgical complications, severe dry eyes and a host of other corneal conditions to see clearly and comfortably once again. Scleral lens technology is the fastest growing area in the contact lens industry.

Every year, more and more specialty lens laboratories are introducing new scleral lens designs. In 2006, there were just two laboratories in North America manufacturing scleral lenses. Today, there are over a dozen laboratories making scleral lenses. The reason for this is that a scleral lens is the only non-surgical technology that will allow patients suffering from a number of ocular and corneal conditions to see clearly and comfortably once again.

What makes our specialty practice unique is that we specialize in taking care of this unique patient population. It is the only thing that we do. We are passionate about creating custom made scleral lenses that will lift and elevate the visual experience. We are on a mission to keep doing this and not to rest on our laurels but to constantly strive to find new and ever improving technologies that will allow our very special patient population see clearly and comfortably once again.

Each scleral lens has its own geometry and architecture much like a unique home. When we design a lens, we are creating a medical device to vault over a damaged ocular surface. This lens in effect replaces the cornea as an optical surface. The compromised vision caused by the damaged cornea is eliminated with the scleral lens. Since the lens does not touch the cornea, saline solution fills the space between the back surface of the lens and the front surface of the cornea. Vision and comfort is almost always excellent. Because the eye is constantly bathed in saline solution, the compromised ocular surface has an opportunity to rejuvenate. In other words, the scleral lens acts as a therapeutic device in addition to a vision correcting device.

To be more specific, gas permeable scleral lenses should be considered for patients suffering loss of vision and ocular comfort due to the following conditions:

• Keratoconus
• Pellucid Marginal Degeneration
• Irregular and Distorted Corneas
• Severe Chronic Dry Eye
• Post Refractive Surgical Complications, such as LASIK, Radial Keratotomy, PRK, ALK
• Secondary ectasias caused by LASIK, Radial Keratotomy, PRK, ALK
• Corneal Dystrophies
• Sjogren’s Syndrome
• Ocular Trauma
• Corneal Transplant Surgery
• Ocular Inflammation due to auto-immune disease
• Stevens-Johnson Syndrome
• Neurotrophic Keratitis

Over the years many patients suffering loss of vision due to keratoconus and post-refractive surgery complications have told me that their gas permeable contact lenses would pop out of their eyes numerous times each day. In addition, most of these patients were only be able to tolerate their lenses for a very short period of time because the lenses hurt their eyes. When these patients would complain to their doctors about this they would typically be told that this was the best fit that could be achieved. In addition, many of these patients were told that if they could not tolerate their lenses, they would need corneal transplant surgery.

It is not unusual for many eye doctors to associate today’s scleral lenses with the poorly tolerated scleral lenses that were used 50 or 60 years ago. The gas permeable scleral lenses used today are made from highly oxygen permeable materials that provide excellent comfort and vision. Sadly, the great majority of eye care providers are not knowledgeable about this amazing technology and have not had the training and education needed to be skilled at providing these unique lenses to their “high need” patients.