Money and paperwork
Unwilling to explain fees or the remake policy. The total may depend on your eye, but a practice should be able to explain how its fees work, what the fitting fee covers, how long lens changes are included, and what happens if the fit isn’t finished. See what is included in a scleral lens fitting fee.
Pressure to prepay without a written estimate. Paying when custom lenses are ordered is common. Paying a large amount up front with nothing in writing isn’t something you should feel pushed into. If you’re paying yourself, you can ask for a Good Faith Estimate before you schedule, and the provider should give it to you in writing within 3 business days.[3]
Vague answers about insurance. “We’ll see” isn’t a plan. You should know before you start whether they bill your medical plan, your vision plan, or neither, and whether they’ll give you a superbill. See out-of-network claims and superbills.
Withholding your prescription or records. Once a contact lens fitting is complete, the prescriber must give you a copy of your prescription, and can’t require you to buy lenses from them, pay an extra fee, or sign a waiver to get it.[4] You also have a right to copies of your health records.[5]
Care and follow-up
No follow-up plan. Scleral lenses settle on the eye over hours, and the fit is checked after wear. A practice that hands over lenses with no follow-up visit, or reviews a new fit only by phone, isn’t giving you the checks a scleral fit needs. See how often should you see your fitter?
No after-hours plan. You should know who to call if you can’t get a lens out or your eye becomes painful at night or on a weekend.
Not listening. If you report pain, redness, or blur and are told repeatedly that everything is fine without an explanation or a plan, that’s worth questioning. See my fitter says it fits, why does it still hurt?
Refusing to adjust or refer when the fit isn’t working. Many remakes without progress, with no change in approach and no offer of a referral, is a reason to seek another view.
Promises and pressure
Promises of perfect results. No fitter can promise perfect vision or comfort; underlying disease, scarring, and dry eye set limits. Specific, realistic expectations are a better sign.
Pressure to commit before your questions are answered, or discouragement from getting a second opinion.
Unsafe care advice
Some advice goes against basic contact lens safety. Be cautious if you’re told it’s fine to:
- Rinse or store lenses with tap water, or shower or swim in them. The FDA advises never exposing contact lenses to any water, including tap water, and notes that tap and distilled water have been associated with a serious, hard-to-treat eye infection.[1]
- Sleep or nap in daily wear lenses. The FDA advises against it because it may increase your chance of infection or irritation.[2] Overnight scleral wear is only ever a supervised medical treatment. See can you sleep in scleral lenses?
- Reuse or top off solutions, or use homemade saline. The FDA advises discarding leftover solution after each use and never using non-sterile water or homemade saline.[1]
- Keep wearing a lens through pain or redness to “get used to it.”
If you hear advice like this, ask your fitter to explain it. See scleral lens habits to avoid for safer alternatives.
What isn’t necessarily a red flag
- Not taking insurance. Many specialty practices are out of network and provide paperwork for reimbursement.
- Needing several lenses. Remakes are a normal part of fitting. See how many remakes is normal?
- A long wait for a first appointment at a busy specialty practice.
- Being referred elsewhere. A fitter who refers you to someone better suited is doing right by you.
- Trainees at a teaching clinic, when they’re supervised.
What wearers say
The warning signs wearers mention most often are a fitter who stopped listening, follow-up done only by phone when the lens clearly wasn’t right, being told the fit was perfect while the eye stayed red, and unclear money arrangements. Many say they stayed too long hoping things would improve. Wearers also strongly push back on advice to shower or rub the eyes with lenses in, even when it came from a professional.
Finding a practice
For where to look and what good looks like, see how do I find a good scleral lens specialist? and the checklist for choosing a specialist.
Common questions
Is it a red flag if a practice doesn't take insurance?
No. Many specialty practices are out of network by choice and give you paperwork to seek reimbursement yourself. The red flag is not explaining how payment and insurance will work before you start.
Is it normal to pay a deposit before lenses are ordered?
Many practices ask for payment when lenses are ordered, since each lens is custom-made. What's worth questioning is being asked to prepay a large amount without a written estimate of what it covers.
My fitter told me I can shower in my lenses. Is that right?
The FDA advises not exposing contact lenses to any water, including tap water. Ask your fitter to explain the advice, and see our habits-to-avoid page. If the answer doesn't reassure you, a second opinion is reasonable.
Should I worry if I see a resident or student at a university clinic?
Not necessarily. Teaching clinics are supervised by experienced faculty, and many see complex eyes. Ask who supervises your care and who designs the lens.
The practice uses only one lens brand. Is that a red flag?
Not by itself. Many fitters know one or two designs very well. It becomes a concern if your fit isn't progressing and they won't consider another approach or a referral.