What to expect and when
Scleral lens fitting is rarely one visit. In a multinational practitioner survey, fits took a mean of 3.8 visits and 2.4 lenses per eye.[1] Most fitters send a brief note after the first evaluation (findings, plan, expected timeline) and a full report once the final lenses are dispensed. Later notes typically follow refits or problems.
Contents of a complete fitting report
1. Final lens parameters, per eye
- Design or brand, and whether it is an empirical, trial-lens, profilometry-guided, or impression-based design
- Overall diameter
- Sagittal depth or vault value, and base curve where applicable
- Landing zone design: spherical, toric, quadrant-specific, or custom. Spherical landing zones were the most common in the multinational survey, followed by toric, quadrant-specific, and custom designs.[1]
- Optics: spherical, front-toric, or higher-order aberration correcting. Spherical optics were prescribed for 70% of lenses, front-surface toric for 27%, and HOA correction for 3%.[1]
- Power and over-refraction
- Material and oxygen permeability (Dk), and any surface treatment or fenestration
Keep these on file. They let anyone identify the lens if it is lost or the patient presents elsewhere.
2. Visual outcome
- Acuity in the lens, per eye, compared with spectacle BCVA at referral
- Any residual refractive error and whether spectacles over the lens are needed
- Near vision and presbyopic correction, if relevant
3. Fit assessment
Most fitters describe the fit after the lens has settled, since central clearance decreases with time on eye. A review summarizing settling studies reported a loss of roughly 80 to 100 microns over 1 to 8 hours for most designs, usually plateauing around 2 hours.[2]
- Central clearance (fluid reservoir depth), with how and when it was measured (slit lamp optic section, OCT, or Scheimpflug, and after how long on eye). In a three-site study of habitual wearers, experienced examiners’ slit lamp estimates closely matched image-based measurements, and measured depths ranged from 40 to 555 microns among successful wearers.[3]
- Limbal clearance, 360 degrees. Fitters aim for complete corneal and limbal clearance with minimal but sufficient central vault.[2]
- Landing zone: alignment in each quadrant, edge lift, impingement, or blanching of conjunctival vessels.[2]
- Front surface: wetting and deposits.
- Reservoir: debris or haze. In a study of 48 habitual wearers, front-surface nonwetting and diffuse reservoir haze were associated with patient-reported fogging, while fit characteristics were not.[4]
Clearance is also an oxygen question. As summarized in the same review, one study of 18 mm lenses found that 400 microns of clearance reduced oxygen tension at the cornea by about 30% compared with 200 microns.[2] That matters most for grafts and compromised endothelium.
4. Post-wear ocular findings
After a period of wear and lens removal:
- corneal staining and its pattern
- corneal edema or haze, and pachymetry if measured (expected for graft patients)
- conjunctival staining, hyperemia, or impression in the landing zone
- lid findings relevant to wear
5. Care regimen
- Daily cleaner and disinfection system (hydrogen peroxide or GP solution)
- Filling solution: non-preserved saline, ideally in single-use vials
- Rinse instructions and plunger care
Regimens vary, but in the survey 62% of patients used a separate daily surfactant cleaner, 47% used hydrogen peroxide disinfection, and 67% filled the lens with single-use non-preserved saline.[1] A case report of Acanthamoeba keratitis in scleral wearers recommended sterile, preferably single-use saline, rubbing the lens, cleaning the plunger, fresh solution overnight, and never topping off.[6]
6. Wear schedule
- Hours per day, and whether midday removal and refilling is recommended
- No overnight wear, unless a supervised therapeutic protocol is in place, such as continuous wear for a persistent epithelial defect with close medical monitoring[2]
- Mean daily wear in the survey was 12.8 hours, ranging from 4 to 18.[1]
7. Follow-up plan
- When the fitter will see the patient next, and the routine interval after that
- What you should continue to monitor: graft status, IOP and nerve, underlying surface disease
- Fit and the underlying disease should be reassessed at regular intervals, even after a successful fit.[5]
8. Actions for you
The most useful line in any report. Examples:
- “Please switch to a preservative-free formulation of drop X if available.”
- “Please monitor IOP and optic nerve as usual; IOP measured with the lens removed.”
- “Graft pachymetry increased after wear; refit planned; please let the corneal surgeon know.”
- “Patient is struggling with handling; we have scheduled retraining.”
If the report is incomplete
| Missing | Why to ask for it |
|---|---|
| Lens parameters and material | Needed for replacement and for any future provider |
| Post-wear cornea findings | Your baseline for later visits |
| Pachymetry (graft patients) | Edema risk is higher after keratoplasty |
| Care products | To recognize solution reactions and BAK exposure |
| Follow-up interval | To avoid both offices assuming the other is seeing the patient |
For what to look for between the fitter’s visits, see co-managing scleral lens patients.
Common questions
How long after referral should I expect a report?
Practices differ. A reasonable expectation is a short note after the initial evaluation and a full report once the lens is dispensed and the fit is finalized. Since a fit commonly spans several visits, the final report may come weeks after the first appointment.
The report lists central clearance in microns. What range is normal?
There is no single target. In a three-site study of habitual, successful wearers, measured reservoir depth ranged from 40 to 555 microns. The fitter's judgment depends on the cornea, the lens, and whether the value was taken before or after settling.
Should I keep the lens parameters on file?
Yes. If the patient loses or breaks a lens, or presents to you with a problem, the parameters and material let anyone identify what they are wearing.
What if the report doesn't say what the fitter wants me to do?
Ask. A short reply asking whether anything is needed from you (drop changes, IOP follow-up, graft monitoring) is the simplest way to close the loop.