Why the stakes are higher
Wearing any contact lens carries a risk of serious conditions, including eye infections and corneal ulcers. The FDA notes that these can develop very quickly and, in rare cases, cause blindness.[1]
For most people, a serious problem in one eye is frightening, but they still have the other eye. If you have a prosthetic eye, or very limited vision in one eye, that safety net isn’t there. A serious infection or injury in your seeing eye affects all of your vision. That doesn’t make scleral lenses the wrong choice. It makes it a decision to talk through carefully with your eye doctor, and it raises the bar for how strictly you follow your care routine.
How often serious problems happen
We didn’t find studies of scleral lens outcomes in people with one seeing eye specifically. Studies of scleral lens wearers in general give a sense of scale:
- In a survey of scleral lens practitioners covering 72,605 wearers over a year, the estimated share who had to stop wearing lenses because of a corneal infection (microbial keratitis) was 0.45%.[2] These were practitioners’ estimates, and they count only problems serious enough to stop wear.
- In a study of 157 keratoconus eyes that had worn scleral lenses successfully for at least a year, microbial keratitis occurred in 0.6% of eyes.[3]
Uncommon is not never. In your only seeing eye, a small risk deserves serious attention.
How to protect your seeing eye
Follow the routine exactly. The FDA’s advice includes rubbing and rinsing lenses as directed, never topping off solution, keeping all water away from lenses, removing them before swimming, and replacing the case regularly.[1] Scleral lenses add preservative-free saline for filling. See cleaning and disinfecting and saline and solutions.
Never sleep in the lens. Overnight wear of scleral lenses is considered an absolute contraindication.[4]
Wear protective eyewear. Safety glasses are an important way to prevent blindness in people with one seeing eye.[6] An International Olympic Committee consensus says eye protection in sports should be mandatory for functionally one-eyed athletes.[5] People often don’t wear the protection they’ve been advised to. In one study of 83 children with vision loss in one eye, only 35% wore their safety glasses at least 90% of the day.[6] Ask your eye doctor what protection suits your work and activities.
Act fast on symptoms. Know the warning signs below, and don’t wait to see if a red, painful eye settles. Keep your eye doctor’s after-hours number handy.
Keep every follow-up visit. Ask your fitter how often they want to see you given that this is your only seeing eye.
Plan for days without the lens
Lenses break, get lost, or have to come out because of irritation. With one seeing eye, that can leave you with poor vision for days. Before it happens:
- Ask what vision you’ll have without the lens, and whether glasses can help.
- Ask whether a spare lens is sensible for you.
- Put together an emergency kit, and read what to do if you drop a lens.
- If your vision without the lens isn’t safe for driving, plan other transport.
If you have a prosthetic eye
Keep the care of your prosthesis and your scleral lens separate, and wash and dry your hands before handling the lens. An ocular prosthesis can itself be linked to giant papillary conjunctivitis, an allergic-type reaction under the eyelid, on its own side.[7] Mention irritation on either side to your eye care team.
Common questions
Should someone with one seeing eye avoid scleral lenses altogether?
Not necessarily. For some people, a scleral lens is the only way their seeing eye can see well, and the benefit is large. The point is to make the decision deliberately, with your eye doctor, knowing the risks, and then to be very strict about care and follow-up.
What should I do if I can't wear my lens for a few days?
Plan for this before it happens. Ask your fitter what your best vision without the lens will be, whether glasses can give you usable vision, and whether a spare lens makes sense for you. If your vision without the lens isn't safe for driving or getting around, arrange help in advance.
I wear a prosthetic eye on the other side. Does that affect my scleral lens?
The two need separate care. Wash and dry your hands before handling your scleral lens, including after handling your prosthesis, and use the products each one was prescribed with. An ocular prosthesis can also cause an allergic-type reaction under the eyelid on its own side, so mention any irritation in either socket or eye.