Why you may still need a specialty lens after surgery
A cataract is a clouding of the lens inside your eye. Surgery removes it and usually puts in a clear artificial lens, called an intraocular lens or implant. What surgery doesn’t change is the cornea, the clear front window of the eye. If your cornea is irregular from keratoconus, a transplant, scarring, or earlier refractive surgery, that irregularity is still there after cataract surgery.
Cataract surgery in keratoconus is harder to plan. Measuring the cornea accurately is difficult, and in severe keratoconus the results are less predictable, with a higher risk of the eye ending up farsighted.[1] Even with newer formulas, prediction errors are larger than in typical eyes. Toric implants, which correct regular astigmatism, are an option only in carefully selected mild to moderate cases.[2]
So if you wore scleral lenses before cataract surgery because of an irregular cornea, expect to need them, or something similar, afterward. Your lens prescription is likely to change, because the focusing power inside your eye has changed.
When the cornea becomes irregular after surgery
Rarely, the surgery itself can leave the cornea irregular. In one published case, an unusually long, centrally placed incision caused irregular astigmatism, and a rigid gas permeable contact lens restored the patient’s vision.[3] That is a single case, not a common outcome. If your vision is distorted after cataract surgery and glasses don’t fix it, ask whether your cornea has been mapped. If irregularity is found, a rigid lens such as a scleral lens is one option to discuss.
If you don’t have a lens implant (aphakia)
Some people are left without an implant after cataract surgery, a condition called aphakia. They need strong correction. Scleral lenses have been used for this, although other contact lenses are often preferred, and scleral lenses are an alternative for selected patients.[4]
They’re also used in children after congenital cataract surgery. In a study of 50 eyes in 35 children, 34% of eyes reached 20/40 or better and 76% reached better than 20/200. Outcomes were held back by lazy eye (amblyopia) and eye misalignment, which were common in this group. No corneal infections were recorded during follow-up.[5]
Before you restart: questions about your cornea’s health
The inner lining of the cornea, the endothelium, keeps it clear by pumping fluid out. Surgery inside the eye, including cataract surgery, is one of several things that can reduce the number of these cells. A 2025 review lists a low cell count as a relative or absolute reason not to wear a scleral lens, depending on how severe it is.[4] Ask your surgeon or fitter whether your endothelium has been checked, especially if you’ve had more than one eye surgery.
What Medicare covers
Medicare Part B doesn’t usually cover glasses or contact lenses. The exception: it covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants a lens. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount, and Medicare pays only if the supplier participates in Medicare.[6]
The underlying federal rule also makes exceptions for lenses used while recovering from cataract surgery, and for people who have no natural lens and were not given an implant.[7] The same rule excludes eye exams done only to prescribe or fit lenses for refractive error.[7]
Rules change, and how a custom scleral lens fits within this benefit can vary. Before you order, ask your fitter’s office whether they participate in Medicare, how they will bill the lenses, and what you’ll owe. Medicare Advantage plans may offer extra vision benefits, so check with your plan too.[6]
Common questions
Will cataract surgery fix my keratoconus vision so I won't need scleral lenses?
Usually not on its own. The new lens implant sits inside the eye, behind the cornea, so it can't smooth an irregular corneal surface. Toric implants can help with astigmatism in carefully selected mild to moderate keratoconus, but many people with irregular corneas still need a specialty contact lens after surgery. Ask your surgeon what to expect for your eye specifically.
How soon after cataract surgery can I wear my scleral lenses again?
There's no single answer, and no published rule we can point you to. It depends on how your eye heals and on your surgeon's instructions. Don't restart until both your surgeon and your fitter have said it's OK. Your prescription may also change after surgery, so your old lenses may need to be updated.
Should I stop wearing scleral lenses before cataract surgery?
Ask your surgeon. Measurements of your eye, including the cornea, are used to choose the power of the implant. Your surgeon will tell you whether and for how long to leave your lenses out before those measurements and before surgery.
Does Medicare pay for scleral lenses after cataract surgery?
Medicare Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants a lens. After the Part B deductible you pay 20% of the Medicare-approved amount, and the supplier has to participate in Medicare. How a custom scleral lens is billed under that benefit can vary, so ask your fitter's office before you order.