Scleral Lenses for Keratoconus
For people with keratoconus, achieving clear and comfortable vision can become increasingly difficult as the cornea becomes more irregular. Glasses and conventional contact lenses may help in earlier stages, but they often cannot fully correct the distorted vision caused by keratoconus.
Scleral lenses for keratoconus are specially designed contact lenses that vault over the irregular cornea and create a new, smooth optical surface. For many patients, this can provide significantly clearer, more stable, and more comfortable vision than glasses or traditional contact lenses.
At Keratoconus Specialists of Maryland, Dr. Benjamin Azman, OD, specializes in custom and advanced scleral lens solutions for keratoconus, including patients with complex corneas and those who have already tried scleral lenses but are still not satisfied with their vision.
Patients Travel to Us Seeking the Best Vision Possible
Keratoconus patients travel to our Baltimore practice from across the United States and around the world seeking highly customized scleral lens care.
Some are being fitted with scleral lenses for the first time. Others have worn scleral lenses for years but are still experiencing glare, halos, ghosting, poor night vision, discomfort, fluctuating vision, or vision that simply does not seem as clear as it could be.
Our approach is not simply to put a scleral lens on the eye.
Our goal is to determine how much visual quality your eyes are capable of achieving and which lens technology gives us the best opportunity to get there.
For some patients, a well-designed conventional scleral lens can provide excellent vision. More complex eyes may benefit from advanced technologies including wavefront-guided scleral lenses, scan-based scleral lenses, or impression-based scleral lenses.
Why Keratoconus Causes Blurry and Distorted Vision
A normal cornea has a relatively smooth, regular shape that helps focus light clearly onto the retina. With keratoconus, the cornea becomes thinner and develops an increasingly irregular shape.
Instead of focusing light cleanly, the irregular corneal surface can scatter and distort light before it reaches the retina.
This can cause:
- Blurred or distorted vision
- Ghost images or multiple images
- Glare and halos
- Starbursts around lights
- Poor night vision
- Irregular astigmatism
- Fluctuating vision
- Frequent changes in glasses or contact lens prescriptions
As the cornea becomes more irregular, glasses and conventional contact lenses may no longer be capable of adequately correcting the patient’s vision.
That is where specialty contact lenses, particularly scleral lenses, can make an important difference.
What Are Scleral Lenses?
Scleral lenses are large-diameter, oxygen-permeable contact lenses designed differently from conventional soft contacts and traditional corneal gas-permeable (RGP) lenses.
Rather than resting directly on the cornea, a scleral lens is designed to vault over the cornea and rest on the sclera, the white portion of the eye.
Before insertion, the lens is filled with preservative-free sterile saline. Once placed on the eye, this creates a fluid reservoir between the back of the scleral lens and the cornea.
For a patient with keratoconus, the irregular cornea is therefore covered by a smooth optical surface.
How Do Scleral Lenses Help Keratoconus?
The vision problem caused by keratoconus is more complex than simply being nearsighted or having ordinary astigmatism. The irregular shape of the cornea can create complex optical distortions that glasses may not adequately correct.
A scleral lens creates a new, smooth optical surface over the irregular cornea.
Instead of light passing directly through the distorted surface of the keratoconic cornea, it passes through the smooth front surface of the scleral lens and the fluid reservoir beneath it.
For many people with keratoconus, this can provide sharper, more stable, and more functional vision than glasses or conventional contact lenses.
Benefits of Scleral Lenses for Keratoconus
Clearer Vision
Because scleral lenses create a smooth optical surface over an irregular cornea, they can correct forms of distorted vision that glasses often cannot.
Stable Vision
Traditional corneal lenses may move considerably with blinking, particularly on an irregular keratoconic cornea. Properly designed scleral lenses are much larger and can provide a more stable optical system.
Improved Comfort
Traditional RGP lenses sit on or interact more directly with the cornea. Scleral lenses vault over the cornea and are supported by the sclera, which can provide improved comfort for many patients.
Continuous Fluid Reservoir
The fluid reservoir beneath a scleral lens keeps the corneal surface bathed in fluid while the lens is being worn. This can be particularly helpful for patients who also have ocular surface problems or dry eye. Learn more about scleral lenses for dry eye.
Scleral Lenses vs. RGP Lenses for Keratoconus
Rigid gas-permeable lenses have been used successfully for keratoconus for many years and may still be appropriate for some patients.
However, conventional RGP lenses are much smaller than scleral lenses and generally rest on or interact more directly with the cornea.
For some keratoconus patients this can result in:
- Lens awareness or discomfort
- Lens movement
- Fluctuating vision
- Difficulty wearing the lenses for extended periods
- A lens becoming displaced or falling out
Scleral lenses are much larger and are supported by the sclera rather than the central cornea.
For patients who previously wore RGP lenses but became frustrated with comfort, vision, or lens stability, scleral lenses may provide another option.
Learn more about the differences between scleral lenses vs. RGP lenses for keratoconus.
Not All Scleral Lenses for Keratoconus Are the Same
A scleral lens is not simply a scleral lens.
Keratoconus varies tremendously from one person to another and even between the right and left eyes of the same patient.
The location and severity of the cone, corneal shape, scleral shape, pupil size, optical aberrations, ocular surface, previous surgery, and other individual characteristics can all influence the design and performance of a scleral lens.
Some patients achieve excellent vision with a conventional custom scleral lens. Others continue to experience glare, halos, ghosting, reduced contrast, poor night vision, or reduced sharpness even when the lens appears to fit appropriately.
This is why customization matters.
Successful scleral lens treatment involves much more than selecting a lens prescription. The lens must be designed around the individual eye, for both fit and visual performance.
Advanced Custom Scleral Lens Options
At Keratoconus Specialists of Maryland, we have access to multiple levels of scleral lens technology so the lens design can be selected according to the needs and complexity of the individual eye.
Custom Scleral Lenses
Individually designed lenses based on detailed measurements and evaluation of the patient’s eyes.
Scan-Based Scleral Lenses
Advanced imaging can capture the shape of the ocular surface and allow the back surface of a scleral lens to be designed around the individual anatomy of the eye. Learn more about scan-based scleral lenses for keratoconus.
Impression-Based Scleral Lenses
For particularly complex ocular surfaces, an impression of the eye can be used to create an exceptionally customized scleral lens design. Learn more about impression-based scleral lenses for keratoconus.
Wavefront / HOA-Correcting Scleral Lenses
Some patients achieve good conventional visual acuity with scleral lenses but continue to experience glare, halos, ghosting, poor night vision, or other visual distortion. In selected patients, advanced wavefront measurements can identify residual higher-order aberrations and help guide a more sophisticated optical design.
Learn more about wavefront-guided scleral lenses for keratoconus.
The objective is not simply to put a scleral lens on the eye.
The objective is to determine which scleral lens design provides the best combination of vision, stability, corneal health, and comfort for that individual patient.
Already Wearing Scleral Lenses but Still Not Seeing as Well as You Want?
A significant portion of our patients come to us after being fitted with scleral lenses at another practice but are still not satisfied with their vision or comfort.
Some have even been told that their lenses fit properly and that their current vision is as good as it can get.
Yet they may still experience:
- Ghosting or multiple images
- Glare and halos
- Starbursts around lights
- Poor night vision
- Reduced contrast or sharpness
- Fluctuating or inconsistent vision
- Lens discomfort
- Vision that simply feels “off”
There are several reasons why scleral lenses may not provide optimal results, including:
- Residual higher-order aberrations (HOAs)
- Lens design limitations
- Fit issues or lens instability on the eye
- Changes in the cornea over time requiring a redesign
- Dry eye or ocular surface conditions affecting vision through the lens
- Corneal scarring or other ocular conditions limiting vision
An unsuccessful previous scleral lens fitting does not necessarily mean that every scleral lens will produce the same result.
Learn more about our approach to failed or poorly fitting scleral lenses.
Advanced Technology for Scleral Lens Fitting
Successful scleral lens fitting begins with understanding the eye.
Depending upon the individual case, Dr. Azman’s evaluation may incorporate advanced diagnostic technologies including:
- Pentacam corneal tomography
- Corneal topography
- Optical coherence tomography (OCT)
- Wavefront aberrometry
- Higher-order aberration (HOA) analysis
- Advanced ocular surface measurements
These technologies provide detailed information about the cornea, sclera, lens fit, and optical system that cannot be obtained from a standard eye examination alone.
This allows us to evaluate not only how a scleral lens fits, but also how well the entire optical system is performing through that lens.
Scleral Lenses After Corneal Cross-Linking (CXL)
Patients are sometimes confused about the difference between scleral lenses and corneal collagen cross-linking (CXL).
They serve different purposes.
Corneal cross-linking is intended to stabilize progressive keratoconus.
Scleral lenses are designed to improve vision.
Cross-linking does not necessarily eliminate the irregular corneal shape or visual distortions that have already developed. As a result, many patients still require glasses or specialty contact lenses after CXL to achieve their best functional vision.
Likewise, scleral lenses improve vision but do not stop keratoconus from progressing.
For some patients, both treatments therefore play different roles in the long-term management of keratoconus.
Learn more about scleral lenses after corneal cross-linking.
Scleral Lenses for Corneal Ectasia and Post-LASIK Vision Problems
Although this page focuses specifically on keratoconus, scleral lens technology can also be used for other conditions that create an irregular corneal surface.
These include corneal ectasia and certain patients experiencing irregular vision or higher-order aberrations following refractive surgery.
Patients experiencing distorted vision after refractive surgery can learn more about scleral lenses after LASIK.
Because the underlying cause of poor vision can vary, a detailed diagnostic evaluation is important before determining whether a specialty scleral lens is appropriate.
Who Is a Candidate for Scleral Lenses for Keratoconus?
Scleral lenses may be considered for people with mild, moderate, or advanced keratoconus when glasses or conventional contact lenses are not providing satisfactory vision or comfort.
They may be particularly useful for patients who:
- Cannot obtain adequate vision with glasses
- Have irregular astigmatism
- Cannot comfortably tolerate traditional RGP lenses
- Experience unstable vision with other contact lenses
- Have undergone corneal cross-linking
- Have significant glare, halos, ghosting, or poor night vision
- Have previously tried scleral lenses without satisfactory results
- Want to explore whether more advanced customization could improve their visual quality
A detailed examination is necessary to determine which lens technology is most appropriate for a particular eye.
Why Keratoconus Patients Travel to See Dr. Azman
- Keratoconus-focused specialty care -complex keratoconus and specialty scleral lens cases are a major focus of our practice.
- Nearly five decades of experience – our practice has specialized in helping patients with keratoconus since 1977.
- Advanced scleral lens technology – conventional custom, wavefront-guided, scan-based, and impression-based scleral lens options allow the technology to be matched to the individual eye.
- Advanced diagnostic testing – Pentacam tomography, OCT, wavefront aberrometry, HOA analysis, and other technologies help us evaluate both lens fit and visual performance.
- Experience with difficult and previously unsuccessful cases – many patients come to us after having already tried scleral lenses elsewhere but still experiencing poor visual quality or discomfort.
- Medical and specialty lens care under one roof – our practice combines advanced specialty contact lens care with medical corneal expertise when needed.
- Patients travel nationally and internationally – our Baltimore, Maryland office sees keratoconus patients from throughout the United States and around the world seeking highly customized vision care.
Our Approach: Fit the Eye, Then Optimize the Vision
No two keratoconus patients are exactly alike.
Neither should their scleral lenses be.
Our approach begins by understanding your previous treatment, current lenses, visual symptoms, corneal anatomy, ocular surface, and what you are hoping to achieve with your vision.
For some patients, a conventional custom scleral lens may provide excellent results.
For more difficult eyes, additional technologies, including scan-based, impression-based, and wavefront-guided scleral lens designs, may allow us to customize the lens beyond what is possible with a standard fitting approach.
Our goal is not simply better vision on an eye chart. We want to achieve the best overall visual quality we reasonably can for the individual eye.
Schedule a Scleral Lens Consultation
If you have keratoconus and are struggling with glasses, RGP lenses, conventional contact lenses, or even scleral lenses you already own, 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 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 your keratoconus and scleral lens options.
Frequently Asked Questions — Scleral Lenses for Keratoconus
Are scleral lenses good for keratoconus?
Scleral lenses are widely used for visual rehabilitation in keratoconus because they vault over the irregular cornea and create a smooth optical surface. For many patients, this can provide clearer and more stable vision than glasses or conventional contact lenses.
How do scleral lenses improve vision with keratoconus?
Keratoconus creates an irregular corneal surface that can distort and scatter light. A scleral lens vaults over that irregular surface and creates a new, smooth optical surface with a fluid reservoir between the lens and cornea. This can reduce the optical distortion caused by the irregular cornea and provide clearer, more stable vision.
Are scleral lenses comfortable?
Many patients find scleral lenses more comfortable than traditional corneal RGP lenses because scleral lenses vault over the cornea and are supported by the sclera, or white portion of the eye. Comfort depends on the individual eye and proper lens design and fit.
Can scleral lenses give me 20/20 vision with keratoconus?
Some patients can achieve 20/20 visual acuity with scleral lenses, while others cannot. The result depends on factors including the severity of keratoconus, corneal scarring, higher-order aberrations, ocular health, and other characteristics of the eye. Visual quality also involves more than the smallest line a patient can read on an eye chart.
Why am I still seeing glare, halos, or ghosting with my scleral lenses?
There can be several reasons. One important possibility is residual higher-order aberrations (HOAs), which are complex optical distortions common in irregular corneas. Other possibilities include lens fit or stability, ocular surface problems, changes in the cornea, or limitations of the current lens design. Advanced testing such as wavefront aberrometry, corneal tomography, and OCT can help determine what may be limiting visual quality.
Are all scleral lenses the same?
No. Scleral lenses vary considerably in design and level of customization. Depending on the eye, options may include conventional custom scleral lenses, scan-based designs, impression-based designs, and wavefront-guided or HOA-correcting optics. The most appropriate technology depends on the anatomy and optical characteristics of the individual eye.
What if I have already tried scleral lenses and they did not work well?
An unsuccessful previous scleral lens fitting does not necessarily mean that every scleral lens will produce the same result. Different lens designs, fitting approaches, diagnostic technologies, and levels of customization can produce different outcomes. We frequently evaluate patients who have already been fitted with scleral lenses elsewhere but continue to experience poor vision, glare, ghosting, discomfort, or other problems.
Do scleral lenses stop keratoconus from progressing?
No. Scleral lenses are used to improve vision but do not stop the underlying progression of keratoconus. Progressive keratoconus may require separate medical management, such as corneal cross-linking.
Can I wear scleral lenses after corneal cross-linking?
Yes. Many keratoconus patients continue to use specialty contact lenses after cross-linking to improve their vision. Cross-linking and scleral lenses serve different purposes: cross-linking is intended to stabilize the cornea, while scleral lenses are used for visual correction.
What is the difference between RGP and scleral lenses for keratoconus?
Traditional corneal RGP lenses are smaller and generally interact more directly with the cornea. Scleral lenses are larger, vault over the cornea, and are supported by the sclera. Both types of lenses can be used for keratoconus, but differences in comfort, stability, vision, and individual corneal anatomy can influence which option is most appropriate.
Do you see patients from outside Maryland?
Yes. Keratoconus patients travel to our Baltimore, Maryland office from across the United States and internationally. This includes patients seeking their first scleral lens fitting as well as patients who have already tried scleral lenses elsewhere and want to explore whether a more customized approach may improve their vision.
Can you review my records before I travel to Baltimore?
Yes. For patients considering traveling to our office, we can review available previous eye-care records and lens information before scheduling. This can help us better understand your history and determine whether the services available at our practice may be appropriate for your situation. Call (410) 469-7111 for information about submitting your records.