Scleral Lenses After LASIK
LASIK provides excellent vision for many patients. But for some people, vision after LASIK does not look or feel the way they expected – even when they are able to read 20/20 on a standard eye chart.
Persistent glare, halos, starbursts, ghosting, blurry or fluctuating vision, poor night vision, irregular astigmatism, dry eye, or other visual disturbances can sometimes be associated with changes in the corneal surface, irregular corneal optics, higher-order aberrations, ocular surface problems, or post-LASIK ectasia.
For appropriately selected patients, scleral lenses after LASIK can provide a very different form of vision correction. Instead of trying to correct an irregular cornea with ordinary glasses or a conventional soft contact lens, a scleral lens vaults over the cornea and creates a new, smooth optical surface.
At Keratoconus Specialists of Maryland, Dr. Benjamin Azman, OD, evaluates complex corneal and specialty contact lens cases and offers multiple levels of customized scleral lens technology for patients whose vision remains difficult after LASIK.
When Vision After LASIK Still Doesn't Look Right
Visual acuity and quality of vision are not necessarily the same thing.
A standard eye chart measures how small a letter a person can identify under specific testing conditions. It does not fully measure contrast, glare, halos, ghost images, starbursts, or the quality of vision experienced while driving at night.
Some patients therefore tell us:
“I can see 20/20, but my vision doesn’t look right.”
Symptoms that may lead someone to seek a specialty evaluation after LASIK include:
- Glare around lights
- Halos, particularly at night
- Starbursts from headlights and streetlights
- Ghosting or multiple images
- Blurred or fluctuating vision
- Reduced quality of night vision
- Difficulty driving after dark
- Irregular astigmatism
- Light sensitivity
- Dry eye or contact lens intolerance
- Vision that measures well on an eye chart but still appears distorted
These symptoms do not all have the same cause.
The first step is determining why the vision remains compromised after LASIK and whether a specialty scleral lens is an appropriate option.
A Patient's Experience With Vision Problems After LASIK
Patients with persistent visual problems after LASIK sometimes spend years trying to understand why their vision still does not look right.
In this patient’s story, she discusses her experience with vision problems following LASIK and the difference specialty scleral lens care made for her.
How Scleral Lenses Can Help After LASIK
LASIK permanently changes the shape of the cornea.
When the resulting corneal surface is regular and the optical system performs well, ordinary glasses may be sufficient for any remaining prescription.
But when the corneal surface is irregular, correcting the eye can become more complicated.
A scleral lens works differently from glasses or a conventional soft contact lens.
Instead of conforming to the irregular corneal surface, the rigid scleral lens vaults completely over the cornea and rests on the sclera – the white portion of the eye.
The space between the lens and cornea is filled with preservative-free sterile saline.
Together, the fluid reservoir and rigid front surface of the scleral lens can create a new, smooth optical system that may reduce the visual effects of corneal irregularity.
For selected post-LASIK patients, this can provide a quality of vision that cannot be achieved with conventional glasses or soft contact lenses.
Why Glasses May Not Correct Some Post-LASIK Vision Problems
Ordinary glasses are excellent at correcting lower-order refractive errors such as nearsightedness, farsightedness, and regular astigmatism.
But not every visual problem after LASIK is simply a glasses prescription.
If the corneal surface has become irregular, light entering the eye may no longer be focused in a simple, uniform way.
This can contribute to symptoms such as:
- Ghost images
- Glare
- Halos
- Starbursts
- Reduced contrast
- Blurred or distorted vision
- Poor night vision
In these situations, simply increasing or changing an eyeglass prescription may not address the underlying optical problem.
A properly designed scleral lens may help by replacing the irregular front optical surface of the eye with a more regular refractive surface.
Higher-Order Aberrations After LASIK
Some patients with persistent visual symptoms after LASIK have higher-order aberrations, or HOAs.
Higher-order aberrations are complex optical distortions that cannot generally be corrected with an ordinary glasses prescription.
They may contribute to symptoms such as glare, halos, starbursts, ghosting, reduced contrast, and poor night vision.
However, these symptoms do not automatically mean that a patient has significant higher-order aberrations.
Similar symptoms can also result from dry eye, tear-film instability, irregular astigmatism, corneal shape changes, lens fit or stability, and other ocular conditions.
That is why advanced diagnostic testing can be important.
Rather than assuming the cause from the symptom alone, our goal is to determine what is actually limiting the patient’s quality of vision.
Standard vs. Wavefront-Guided Scleral Lenses After LASIK
A well-designed conventional scleral lens can correct a significant amount of visual distortion simply by creating a smooth optical surface over an irregular cornea.
For many patients, that may provide excellent vision.
But some patients continue to experience glare, halos, starbursts, ghosting, or reduced quality of vision even after the corneal irregularity has been corrected with a scleral lens.
When detailed testing identifies significant residual higher-order aberrations, wavefront-guided scleral lens technology may be considered.
Wavefront-guided lenses are designed to incorporate highly individualized optical correction based on measurements of the patient’s visual system.
This technology is not necessary for every post-LASIK patient.
The lens must first fit properly and remain sufficiently stable on the eye. The patient’s residual aberrations then need to be carefully measured to determine whether additional customized optical correction may be beneficial.
Learn more about wavefront-guided scleral lens technology.
Advanced Custom Scleral Lens Options After LASIK
Not every post-LASIK eye requires the same type of scleral lens.
The appropriate design depends upon the patient’s corneal shape, scleral anatomy, ocular surface, visual symptoms, previous contact lens experience, and the source of the visual problem.
Depending on the individual eye, available options include:
Custom Scleral Lenses
Individually selected and customized according to the patient’s corneal anatomy, vision, and response to the lens.
Scan-Based Scleral Lenses
Advanced imaging can map the ocular surface and allow the back surface of the lens to be designed around the individual anatomy of the eye. Learn more about scan-based scleral lenses.
Impression-Based Scleral Lenses
For highly irregular or difficult ocular surfaces, impression-based technology can capture the shape of the eye and use that information to create an exceptionally customized scleral device. Learn more about EyePrintPro impression-based scleral lenses.
Wavefront-Guided / HOA-Correcting Scleral Lenses
For selected patients with measurable residual higher-order aberrations, customized optics may be incorporated into the scleral lens in an effort to further improve visual quality.
The most advanced lens is not automatically the correct lens for every patient.
Our objective is to determine what the individual eye actually requires and then use the appropriate level of technology.
Scleral Lenses for Dry Eye After LASIK
Not every post-LASIK problem is purely optical.
Some patients also experience significant dry eye or ocular surface symptoms following LASIK.
A scleral lens contains a reservoir of preservative-free sterile saline between the lens and the cornea. For appropriately selected patients, this can help protect the ocular surface while the lens is worn.
This means that some post-LASIK patients may receive two different benefits from the same lens:
specialty optical correction and ocular surface protection.
However, scleral lenses do not cure the underlying cause of dry eye.
Patients whose primary concern is dry eye can learn more about scleral lenses for dry eye.
Scleral Lenses for Post-LASIK Corneal Ectasia
In some patients, progressive weakening and distortion of the cornea can occur following LASIK. This condition is known as post-LASIK corneal ectasia.
As the corneal shape becomes increasingly irregular, patients may experience increasing astigmatism, blurred or distorted vision, ghosting, glare, halos, or difficulty obtaining satisfactory vision with glasses.
Scleral lenses can be particularly useful for visual rehabilitation because they vault over the irregular corneal surface and create a new smooth optical surface.
It is important, however, to distinguish between improving vision and treating progression.
A scleral lens can improve vision in appropriately selected patients, but it does not strengthen the cornea or stop ectasia from progressing.
Patients with suspected or diagnosed ectasia may therefore require separate medical evaluation and monitoring in addition to specialty lens care.
Learn more about scleral lenses for corneal ectasia.
What If You Already Tried Scleral Lenses After LASIK?
Some patients come to us after already trying scleral lenses but still being dissatisfied with their vision.
They may continue to experience:
- Glare
- Halos
- Starbursts
- Ghosting
- Blurred or fluctuating vision
- Poor night vision
- Lens discomfort
- Fogging or cloudy vision
- Limited wearing time
An unsuccessful experience with one scleral lens does not necessarily mean that every scleral lens will provide the same result.
Persistent problems can be related to many different factors, including lens fit, lens stability, ocular surface health, corneal irregularity, lens design, or residual higher-order aberrations.
Advanced diagnostic testing can help us determine what may still be limiting the patient’s vision and whether a different fitting approach, more customized lens design, or advanced optics should be considered.
Learn more about our approach to failed or poorly fitting scleral lenses.
Advanced Diagnostic Technology for Post-LASIK Scleral Lens Fitting
Complex post-LASIK vision problems may require more information than a standard eye examination provides.
Depending upon the individual case, Dr. Azman’s evaluation may incorporate advanced diagnostic technologies such as:
- Corneal topography and tomography to evaluate corneal shape and irregularity
- Pentacam imaging for detailed three-dimensional evaluation of the cornea
- Optical coherence tomography (OCT) to evaluate the relationship between the scleral lens and the eye
- Wavefront aberrometry to measure complex optical distortions
- Higher-order aberration analysis when glare, halos, ghosting, starbursts, or poor visual quality remain unexplained
- Corneo-scleral mapping for selected scan-based lens designs
- Detailed evaluation of lens stability, clearance, landing, and edge alignment
The purpose of this technology is not simply to collect more measurements.
It is to determine why the patient is having difficulty and use those findings to guide the design of the lens.
Scleral Lenses Are One Option for Post-LASIK Problems
It is important to recognize that not every problem after LASIK should be treated with a scleral lens.
Post-LASIK symptoms can have many different causes, and the appropriate approach depends upon what is actually responsible for the patient’s difficulty.
This page is specifically focused on scleral lenses after LASIK.
Patients looking for broader information about persistent LASIK complications, including glare, halos, starbursts, dry eye, corneal irregularity, higher-order aberrations, ectasia, and other post-surgical vision problems, can visit our affiliated LASIKFailures.com – Global Complex Eye Care website.
The goal is not to prescribe a scleral lens simply because someone has symptoms after LASIK.
The goal is to determine the cause of the problem and whether a specialty scleral lens is an appropriate solution for that individual eye.
Who May Be a Candidate for Scleral Lenses After LASIK?
A specialty scleral lens evaluation may be appropriate for selected patients who:
- Have persistent distorted or blurry vision after LASIK
- Experience glare, halos, starbursts, or ghosting
- Have difficulty seeing or driving at night
- Have irregular astigmatism or an irregular corneal surface
- Cannot obtain satisfactory vision with glasses or conventional contact lenses
- Have post-LASIK corneal ectasia
- Have significant dry eye or ocular surface problems in addition to visual symptoms
- Have measurable higher-order aberrations
- Already wear scleral lenses but remain dissatisfied with their visual quality
- Have been told their vision is 20/20 but still feel that something is not right
The presence of one or more of these symptoms does not automatically mean a scleral lens is appropriate. A detailed evaluation is necessary to determine the cause of the problem and which options should be considered.
Why Patients Travel to Us for Post-LASIK Scleral Lens Care
Patients with difficult post-LASIK vision problems travel to our Baltimore practice seeking a more individualized approach to specialty scleral lens care.
Some have already seen multiple eye doctors. Others have tried glasses, soft lenses, rigid lenses, or scleral lenses and still feel that their vision is not as clear or comfortable as they would like.
Our approach includes:
- Experience with complex corneal cases – including irregular corneas and difficult post-surgical vision problems.
- Multiple scleral lens technologies – including conventional custom, scan-based, impression-based, and wavefront-guided designs.
- Advanced diagnostic testing – allowing us to evaluate corneal shape, ocular surface health, lens fit, and optical quality in greater detail.
- Experience with previously unsuccessful lens wearers – including patients who already wear scleral lenses but continue to experience visual problems.
- Individualized care – the lens design is based on the individual eye rather than assuming one technology is appropriate for every patient.
For patients traveling from outside Maryland or the United States, available previous records and diagnostic testing can be reviewed before scheduling to help us better understand the case.
Our Approach: Determine What Is Limiting the Vision
Two patients can experience similar symptoms after LASIK for completely different reasons.
One patient may have an irregular corneal surface.
Another may have significant dry eye.
Another may have post-LASIK ectasia.
Another may have residual higher-order aberrations.
And some patients may have several contributing factors at the same time.
That is why our approach is not simply:
“You had LASIK and your vision is poor, so you need a scleral lens.”
Instead, we evaluate the cornea, ocular surface, optical quality, previous treatments, previous contact lenses, and the patient’s specific visual complaints.
If a scleral lens is appropriate, we then determine what level of customization is necessary.
Our goal is to understand the eye first, fit the lens appropriately, and then optimize the vision as much as the individual eye allows.
Schedule a Post-LASIK Scleral Lens Consultation
If your vision has not been the same since LASIK, or if you have already tried specialty or scleral lenses without achieving the visual quality you expected, we would be happy to learn more about your case.
For patients considering traveling to our office, our team can review available previous eye-care records, corneal imaging, and contact lens information before scheduling your visit and discuss whether our advanced scleral lens services may be appropriate for your situation.
Keratoconus Specialists of Maryland
1427 Clarkview Road, Suite 200
Baltimore, Maryland 21209
(410) 469-7111
Call today to speak with our team about advanced scleral lens options after LASIK.
Frequently Asked Questions - Scleral Lenses After LASIK
Can scleral lenses help vision problems after LASIK?
For selected patients, yes. Scleral lenses vault over the cornea and create a new smooth optical surface that can help compensate for corneal irregularity after LASIK. Whether they are appropriate depends on the cause of the patient’s symptoms and the condition of the eye.
What LASIK symptoms may lead to a scleral lens evaluation?
Patients may be evaluated for scleral lenses when they have persistent blurry or fluctuating vision, glare, halos, starbursts, ghosting, poor night vision, irregular astigmatism, contact lens intolerance, dry eye, or other visual problems after LASIK. These symptoms can have different causes, so diagnostic evaluation is important.
Why can vision still look distorted even if I see 20/20 after LASIK?
A standard eye chart measures visual acuity but does not fully measure quality of vision. Corneal irregularity, tear-film problems, or higher-order aberrations may contribute to glare, halos, starbursts, ghosting, reduced contrast, or poor night vision even when standard visual acuity is good.
How do scleral lenses work after LASIK?
A scleral lens vaults over the cornea and rests on the sclera. The fluid-filled space beneath the lens and the smooth front optical surface can help create a more regular optical system while also protecting the corneal surface.
Can scleral lenses help higher-order aberrations after LASIK?
Standard scleral lenses can reduce some optical distortion by masking corneal irregularity. For selected patients with residual higher-order aberrations, wavefront-guided or HOA-correcting scleral lens technology may be considered after detailed diagnostic testing.
Are wavefront-guided scleral lenses necessary for every post-LASIK patient?
No. Many patients do not require wavefront-guided correction. The appropriate lens design depends on the corneal shape, ocular surface, lens stability, visual symptoms, measured optical aberrations, and how the patient responds to conventional scleral correction.
Can scleral lenses help dry eye after LASIK?
They may help selected patients by maintaining a preservative-free saline reservoir over the cornea while the lens is worn. Scleral lenses do not cure the underlying cause of dry eye, and some patients require separate evaluation and treatment of the ocular surface.
Can scleral lenses help post-LASIK ectasia?
Scleral lenses may be used to improve vision in selected patients with corneal irregularity from post-LASIK ectasia. They do not stop ectasia from progressing, so patients with suspected or diagnosed ectasia may also require medical evaluation and monitoring.
What if glasses or soft contact lenses do not correct my vision after LASIK?
If the problem is related to corneal irregularity or complex optical distortion, conventional glasses or soft contact lenses may not provide adequate correction. A specialty scleral lens evaluation can help determine whether a rigid optical surface provides better visual quality.
What if I already tried scleral lenses after LASIK and still have glare or ghosting?
Persistent symptoms can have several causes, including lens fit or stability, ocular surface problems, residual corneal irregularity, lens design, or higher-order aberrations. Additional diagnostic testing and a more customized lens design may be appropriate in selected cases.
Do you offer advanced custom scleral lenses for post-LASIK problems?
Yes. Depending on the individual eye, options can include custom scleral lenses, scan-based designs, impression-based designs, and wavefront-guided or higher-order-aberration-correcting scleral lenses.
Do patients travel to your office for post-LASIK scleral lens care?
Yes. Patients travel to our Baltimore, Maryland office from outside the local area for evaluation of complex post-LASIK vision problems and advanced scleral lens fitting. Available previous records can be reviewed before scheduling to help us understand the case.