How often should you see your scleral lens fitter?

Your fitter sets the schedule

We won’t give you a number of months, because there isn’t one that fits everyone. How often you’re seen depends on your condition, your cornea, how long you’ve worn scleral lenses, and how things are going. Ask your fitter directly: “When should I come back, and why?”

The FDA’s general advice for every contact lens wearer is to get regular eye exams to protect the continued health of your eyes.^[1]

During the fitting: several visits

Getting a scleral lens right usually takes more than one appointment. In an international survey of fitters, a fitting averaged 3.8 visits and 2.4 lenses ordered, with a wide range.^[4] In a one-year study of new wearers, the visit schedule included checks at one, three, six, and twelve months after the lenses were dispensed.^[5] That was a research schedule, but it gives a sense of how closely the first year is often watched. More on this in how long a scleral lens fitting takes.

Why visits matter when you feel fine

A scleral lens can feel comfortable even when something needs attention. Your fitter is looking for things you can’t see or feel:

• How the lens sits. A review of how fitters assess scleral lenses says the fluid layer under the lens should be measured at every visit, because too much clearance can cut oxygen to the cornea and cause swelling in vulnerable corneas.^[6] Lenses also settle into the eye over the day, which is why fitters often want to see them after several hours of wear.^[6]
• The white of the eye. After the lens comes out, fitters look for redness, staining, or an impression ring where the edge rested, and adjust the lens if they find them.^[6]
• Corneal swelling and other changes. In a survey of fitters covering 72,605 wearers, corneal swelling was the most common corneal complication that led people to stop wearing scleral lenses (1.2% over a year), ahead of new blood vessels growing into the cornea (0.53%), infection (0.45%), and limbal stem cell damage (0.20%).^[7] Some of these can develop gradually.
• Your underlying condition. In a study of 157 keratoconus eyes, 14.6% lost some of their best vision with scleral lenses during the study period, all because the keratoconus progressed.^[8] After a transplant, the risk of graft problems continues.^[9]
• Your lenses. Your fitter can spot film, scratches, or warping and advise when a lens needs replacing. See when to replace scleral lenses.

Prescriptions expire

Your contact lens prescription has an expiration date, set by your state: some require renewal after one year, some after two.^[2] The FDA notes that if you haven’t had a check-up in one to two years, you may have eye problems you’re not aware of, or lenses that no longer correct your vision well.^[2]

When not to wait

Book an earlier visit if your vision gets worse, fogging increases, your lenses become harder to insert or remove, or they feel different from usual. The FDA’s list of symptoms that need prompt attention includes discomfort, excess tearing or discharge, unusual light sensitivity, itching or burning, unusual redness, blurred vision, swelling, and pain.^[3]

Getting the most from each visit

Write things down before you go: what you notice, which eye, what time of day, and how long it lasts. “After six hours my right eye aches at the outer corner” gives your fitter far more to work with than “it hurts sometimes.” Bring your case and products, too. Our list of questions to ask a scleral lens fitter can help at any stage.