Before you go
Come prepared with specifics. Write down what bothers you about your vision now: halos, ghosting, vision that changes through the day, eyes that burn by the afternoon. List every correction and treatment you’ve tried and why each one didn’t work. Bring prescriptions, surgical reports, and notes from other eye doctors. And decide what you most want: driving at night, reading, screens at work, or just getting through a day comfortably.
Then take these questions with you.
1. Are scleral lenses the best option for me right now?
You want to know whether scleral lenses are the right next step, not just whether they’re possible. Your irregularity might be mild enough for glasses, soft lenses, or corneal rigid lenses. A dry or damaged eye surface might benefit from other treatments first.
What a good answer sounds like: an explanation tied to your eyes. “Your cornea is too irregular for glasses, and your corneal lens keeps decentering, so a scleral lens makes sense.” Or, just as good: “I’d try a different option first, and here’s why.” A fitter who mentions the alternatives and why they ruled them in or out is giving you a real answer.
See how scleral lenses compare with corneal rigid lenses, hybrid lenses, and soft lenses.
2. What can I realistically expect?
Ask about vision and comfort, but also about the hard parts.
What a good answer sounds like: a realistic range for your eye, not a promise. A good fitter will tell you whether your other eye health, such as scarring, limits what a lens can do. They’ll be upfront that handling takes practice: in a one-year study of 95 wearers, 27% had stopped by 12 months, and handling problems were the most common reason given.[4] In a study of 120 veterans, more than half had some difficulty with wear, most often irritation or fogging in the middle of the day.[5] A fitter who tells you about those challenges, and how they help people through them, is one to trust.
3. How does the fitting work, and how long will it take?
Different practices use different methods: trial lenses, scans of the eye, or a mold (impression) of the eye. Ask which they use, how many visits to expect, and how long the whole process usually takes.
What a good answer sounds like: a clear outline of the steps and an honest range. For context, in an international survey of scleral lens patients, fits took an average of 3.8 visits and 2.4 lenses.[2] A fitter doesn’t need fancy equipment to do this well. In a survey of fitters, trial lenses, scans, and impressions needed similar numbers of lenses and similar first-visit time.[3]
Our guide to what a scleral lens fitting involves walks through each step.
4. What does it cost, and what’s included?
Ask for the fitting fee and the lens cost separately. Ask what happens if a lens has to be remade, how long that remake period lasts, and how often lenses typically need replacing.
What a good answer sounds like: specific numbers in writing, a clear remake or warranty policy, and an honest word about replacements. Lenses do break: in a study of 157 keratoconic eyes, broken lenses were recorded in 26.1% of eyes during follow-up.[6] Ask what a replacement costs.
Also ask how they handle payment:
- Do you bill my medical or vision insurance, or give me a superbill to submit myself?
- Will you write a letter of medical necessity if my plan asks for one?
- Can I use an HSA or FSA? Do you offer payment plans?
5. What will my daily care routine be?
Ask which cleaner, disinfecting system, and saline you’ll use, and why. In an international survey of scleral lens patients, 62% used a daily surfactant cleaner, 47% used hydrogen peroxide disinfection, and 67% used single-use vials of preservative-free saline.[2]
What a good answer sounds like: specific product types, clear instructions, and a reason for each step. A good fitter will stress sterile saline and hygiene. A small report of a rare, serious infection in scleral wearers listed large saline bottles, overnight storage in saline, and skipping the rubbing step among the risks, and recommended sterile, preferably single-use saline.[7]
6. What happens if something goes wrong?
Ask who to call if you can’t get a lens out, if your eye becomes red or painful, or if your vision suddenly drops, including after hours.
What a good answer sounds like: a phone number, a clear plan, and a simple list of warning signs. You should leave knowing that pain, worsening redness, new light sensitivity, discharge, or vision that doesn’t clear when the lens is out means removing the lens and calling that day.
7. How much experience do you have with eyes like mine?
Ask how many scleral lenses they fit and how many patients with your condition they see.
What a good answer sounds like: a straightforward number and a sense of familiarity with your condition. In a 2020 survey of scleral fitters, the median practitioner had completed 100 scleral fits, with a range from 5 to 10,000.[1] There’s no magic threshold, but you’re entitled to ask.
Reading the room
Beyond the answers themselves, notice how they’re given. You want a fitter who gives specific, realistic expectations, acknowledges the challenges, explains their reasoning, and listens. If you feel rushed or dismissed, that’s information too. Plenty of people see more than one fitter before they find the right fit, and that’s reasonable for a lens you’ll wear every day.
Common questions
How do I know if a fitter is experienced?
Ask how many scleral lenses they fit and how many patients with your condition they see. Experience varies a lot: in a 2020 survey of scleral fitters, the median practitioner had completed 100 fits, but the range ran from 5 to 10,000. An experienced fitter will answer that question easily.
Is it rude to ask about cost up front?
No. Scleral lens fees vary widely between practices, and a good practice expects the question. Ask what the fitting fee covers, what the lenses cost, and the remake policy, ideally in writing.
Should I get a second opinion?
If you're unsure, yes. Seeing more than one fitter is common for complex eyes, and a good fitter won't mind. It's especially reasonable if you've been told you need surgery, or that nothing more can be done.
What if my fitter doesn't take my insurance?
Some specialty practices are out of network. Ask whether they provide a superbill (an itemized receipt you can submit for out-of-network reimbursement), whether they'll write a letter of medical necessity, and whether you can use an HSA or FSA.