Why does my scleral lens rotate, and does the dot have to stay at 6 o'clock?

What the dots are for

Small dots or marks on a scleral lens are added by the lab, and there’s no single system. Depending on the lab and the practice, they can mean:

• Right or left. For example, one dot on the right lens and none or two on the left. Some labs use a tint instead.
• Orientation. Where the lens should sit on your eye, often with the mark at the bottom (6 o’clock) or top (12 o’clock).
• Both.

Wearers are often surprised to learn that their dots were only ever for telling right from left. Others learn the hard way that their lens must sit one way. The only way to know is to ask your fitter, and to write the answer down.

Which lenses need to stay in position

Some lenses work the same whichever way they sit. Others are designed for one position:

• Toric, quadrant-specific or custom landing zones. The edge of the lens is shaped to match a white of the eye that isn’t evenly curved. If the lens turns, the shaped parts no longer line up with the eye, which can cause pressure in one spot, edge lift, or bubbles. See what is a toric landing zone?
• Notched or channeled edges, made to clear a bump such as a pinguecula or a glaucoma surgery site.
• Front-surface astigmatism correction. If the optics correct astigmatism at a set angle, rotation shifts that angle and blurs vision. See do scleral lenses correct astigmatism?
• Customized optics, such as wavefront-guided lenses, which need to sit in a precise position.

A shaped landing zone can help a lens hold its position, which is one reason fitters use them.

Why a lens rotates

• Settling. A lens can turn a little after insertion before it settles into its natural position. Wearers say fitters have told them the settled position is what counts, and that the dot isn’t always placed exactly by the lab.
• A loose fit. A lens that keeps rotating, especially if it also bounces, fogs quickly, or lets in bubbles, may be too loose. Several wearers say a new lens fixed it.
• The eyelids. Lid pressure, allergies, or irritated lids can drag a lens around. Rubbing the eye can too.
• Film on the lens. Deposits can make the lid grip the lens more.

What to do if your lens has rotated

1. Check how you see and feel. If vision and comfort are fine, note it and tell your fitter at your next contact. If not, take the lens out.
2. Don’t push it into place with a finger. That can let in air or irritate your eye. Some fitters prefer that you never reposition a lens yourself; ask yours.
3. If your fitter has said it’s fine, remove the lens, rinse, refill and reinsert in the right position. See lens off-center.
4. Keep notes: which eye, where the dot ends up, how long after insertion, and whether vision or comfort changes.
5. Wear your lenses to the appointment so your fitter can see where the lens sits after a few hours.

What wearers say

Answers in the community vary because lenses vary. Some were told a turn of the dot doesn’t matter for their design as long as they see and feel well. Others were told their lens must not move, and had it remade when it did. Wearers whose lenses kept spinning often found the fit was loose, sometimes only after a second opinion. The common advice: ask what your dot is for, before it becomes a worry.

What to ask your fitter

• What do the marks on my lenses mean?
• Does my lens need to sit in a particular position? How far can it turn?
• Where should the mark be when I insert it?
• If it rotates, should I leave it, reinsert it, or call you?
• Could a shaped landing zone help it stay put?