What are scleral lenses and how are they different?
A standard contact lens rests directly on the cornea. A scleral lens is much larger, typically 16–22mm in diameter, and instead of resting on the cornea, it vaults completely over it and lands on the conjunctiva over the white of the eye (the sclera). The space between the back of the lens and the cornea is filled with preservative-free saline solution, creating a fluid reservoir. This fluid layer acts as a perfect optical surface over even the most irregular corneas.
Who can benefit from scleral lenses?
Scleral lenses are appropriate for a broad range of conditions that standard lenses cannot adequately address:
Keratoconus and irregular corneas
The fluid vault neutralises the irregular corneal surface entirely. This is why scleral lenses often provide better vision than any previous lens or glasses the patient has tried.
Post-surgical corneas (LASIK, RK, corneal transplant)
After surgery, the cornea has an unusual, often asymmetric profile. Scleral lenses accommodate this geometry in ways that standard lenses and glasses cannot.
Severe dry eye
The fluid reservoir provides continuous hydration to the corneal surface throughout the day, a major benefit for patients with conditions like Sjögren's syndrome, graft-versus-host disease, or severe post-LASIK dry eye.
Failed RGP lens wear
Some patients cannot tolerate traditional rigid lenses because they move too much or cause discomfort. Scleral lenses are much more stable and, once inserted, are not felt at all by most wearers.
Are scleral lenses comfortable?
This surprises most patients: scleral lenses are generally more comfortable than traditional rigid gas-permeable lenses. Because the lens doesn't touch the cornea, which is the most sensitive part of the eye, there is no awareness of the lens edge on the cornea. The fluid reservoir also prevents the lens-on-cornea friction that makes RGPs uncomfortable for some. Most patients describe scleral lenses as comfortable after a brief adaptation period of 1–2 weeks.
What does the fitting process involve?
Scleral lens fitting is significantly more involved than standard contact lens fitting. It begins with detailed corneal topography and sometimes anterior segment OCT (a 3D scan of the front of the eye). Trial lenses are inserted and the fit is assessed with a slit lamp microscope, checking the vault height, alignment, and landing zone. Typically 2–4 fitting sessions are required to achieve the optimal lens design. The complexity is why very few practitioners in India offer scleral fitting, it requires specialist training, equipment, and considerable fitting experience.
How do you insert and remove scleral lenses?
Scleral lenses are inserted differently from standard lenses. You fill the bowl of the lens with preservative-free saline, tilt your head forward, and apply the lens to the eye using a plunger or three-finger technique. Removal is done with a plunger or by pressing gently on the edge to break the seal. It feels daunting the first few times, but most patients become confident and fast within 1–2 weeks of daily practice. We spend time at fitting appointments making sure every patient is comfortable with insertion and removal before they leave.
Scleral lens fitting at Second Sight, Jaipur
Scleral lens fitting is one of our core specialities at Second Sight. Dr. Ashima Bhargava has fitted scleral lenses for keratoconus, post-LASIK ectasia, irregular corneas, and severe dry eye. We use detailed topography and trial fitting sets from leading international manufacturers. Patients travel to us from across Rajasthan for scleral lens fitting that is not available elsewhere in the region.
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