Common worries
Feeling overwhelmed by scleral lenses?
Almost everyone is at first. The lens looks big, the routine sounds complicated, and you're being asked to put something on your eye. Here are straight answers to the worries we hear most, one at a time.
Before you decide
Whether scleral lenses are worth trying, what they cost, and whether they will work for you.
“I can't keep taking time off for appointments that go on for months.” How long does a scleral lens fitting take? Expect several visits spread over weeks, and sometimes longer. In an international survey of scleral lens fitters, patients averaged 3.8 visits and 2.4 lenses ordered per fitting, but the range was wide. Ask your fitter at the start how many visits they expect for you, how long their lab takes, and what's covered if the lens needs to be remade. “What if I go through all of this and they just don't work?” What if scleral lenses don't work for me? Some people do stop wearing scleral lenses, most often because handling or comfort was hard, not because of a medical problem. In a year-long study, 73% were still wearing their lenses at twelve months. Before you give up, tell your fitter exactly what isn't working, since the lens, the tools, and the routine can all be changed. If sclerals still aren't right, there are other lens and treatment options to discuss. “There's no way something that big fits in my eye.” The lens looks huge. Will it fit in my eye? It fits. A scleral lens is bigger than your cornea on purpose: it arches over the cornea and rests on the white of your eye, much of which is hidden under your eyelids. In an international survey of fitters, scleral lenses averaged 16.2 mm across, compared with a cornea of about 11 to 12 mm. Getting it past your lids is a skill you learn, and your fitter can choose a smaller diameter if your eye opening is small. “I don't even know who to go to, or how to tell if they're any good.” How do I find a good scleral lens specialist? Start with a fitter who fits scleral lenses regularly, not occasionally. Your own eye doctor or corneal specialist can often refer you. Before you commit, ask how many visits to expect, what the fee covers, how lens changes and warranties work, and how to reach them if something goes wrong. “I can't even touch my own eye. How am I supposed to do this?” I can't touch my own eye. Can I really wear scleral lenses? Probably yes. You don't poke your eye to put in a scleral lens: the lens sits on a tool, and the first thing that meets your eye is cool saline, not a finger. The flinch is a normal reflex that softens with daily practice, and in a year-long study wearers needed significantly fewer attempts as the months went on. If your hands or nerves really won't cooperate, there are stands, other tools, and the option of a trained helper. “I need these, but I don't know how I'll pay for them.” I need scleral lenses. How will I pay for them? It depends on your eyes, your practice, and your coverage, so start by getting two things in writing: an itemized estimate from the practice and your plan's answer on what it covers. Medical insurance may cover the fitting for a condition like keratoconus while a vision plan's medically necessary contact lens benefit covers the lenses. IRS rules let you count contact lenses needed for medical reasons, and supplies like saline, as medical expenses, which generally makes them HSA and FSA eligible. If a claim is denied, you have the right to appeal. “I've failed with every other lens. Why would these be any different?” I've failed with every other lens. Why would sclerals be different? Scleral lenses work differently from the lenses most people have failed with. They rest on the white of the eye instead of the cornea, arch over the cornea without touching it, and hold a layer of saline against it, so a steep or irregular cornea matters much less for comfort and fit. Many people are fitted with them precisely after other lenses failed, and studies of those groups show clear gains in vision. But they don't work for everyone: handling is harder than with most lenses, and a meaningful share of people stop. “Is all this time, money and hassle actually worth it?” Are scleral lenses worth the time, money and hassle? For many people whose vision or comfort can't be fixed another way, studies say yes: vision improves a lot, and people report large gains in how their eyesight affects daily life. But it isn't worth it for everyone. Roughly a quarter to a third of people stop wearing them in the studies we found, most often because handling is hard, and people who already do well in other lenses may gain little. The answer depends on how much your current vision or comfort is holding you back. “Will my keratoconus keep getting worse no matter what I do?” Will my keratoconus keep getting worse no matter what I do? Not necessarily. Keratoconus is more likely to progress in younger people and steeper corneas, and less likely as you get older. Scleral lenses give you clear vision but don't slow the disease. Corneal cross-linking is the treatment designed to stop progression, and in a randomized trial in young people it did so in most cases. What you can do: keep your follow-up scans, ask whether you need cross-linking, and stop rubbing your eyes. “I worked so hard for this graft. Could a lens make my body reject it?” Could a scleral lens make my body reject my transplant? No study has shown that scleral lenses cause graft rejection, but none has ruled it out either. Rejection episodes do happen in people who wear them after a transplant, and grafts also reject without any lens, so the studies can't tell the two apart. What is known is that a graft can swell more under a lens, which is why the lens design and regular graft checks matter. Learn the warning signs: rejection caught and treated early can often be reversed. “Can my child, or my elderly parent, really handle these?” Can my child, or my elderly parent, really handle scleral lenses? Often, yes, though usually not alone at first. Studies at specialist centers report that most children fitted with scleral lenses kept wearing them, with a parent trained to put them in and take them out. For older adults, the biggest hurdle is handling, not age itself, and a trained family member or caregiver can do the insertion and removal. Plan for extra training visits, the right tools, and a calm daily routine. “I've tried everything for dry eye. What if these don't help either?” I've tried everything for dry eye. What if scleral lenses don't help either? It's possible, and it's worth knowing that going in. Studies of people with severe dry eye and other surface disease, most of whom had already tried several treatments, report less pain, better vision, and better quality of life with scleral lenses. But the research is mostly small single-clinic studies, not everyone who starts a fitting finishes it, and many wearers still have symptoms and still need other treatment. Sclerals work best as one part of a dry eye plan, not a replacement for it.
Getting started
The fitting, the first tries, and the first few weeks of wear.
“I'll never be able to get that thing in my eye.” Are scleral lenses hard to put in? At first, usually yes. It's a learned skill, and the first tries can take a long time. But in a year-long study, most wearers got noticeably faster and needed fewer attempts as the months went on. Give yourself two to three weeks before deciding you can't do it. “A hard lens that big has to hurt.” Do scleral lenses hurt? A well-fitting scleral lens shouldn't hurt. It's built to vault over the cornea, the most sensitive part of the eye, and rest on the much less sensitive white of the eye, with a cushion of saline in between. You may be aware of it at first, but pain is not something to push through: take the lens out and tell your fitter, because comfort problems can usually be changed. “What if I never get used to them?” How long does it take to get used to scleral lenses? Most of the learning happens in the first few weeks, and handling usually keeps improving after that. In a year-long study, wearers needed fewer attempts to put lenses in and take them out as the months went on, and new wearers wore them longer each day. Give yourself two to three weeks of daily practice before you judge, and follow your fitter's wearing schedule rather than rushing it. “I thought these would fix my vision, and it's still not perfect.” My vision still isn't perfect with sclerals. Why? Scleral lenses correct blur that comes from the front surface of the eye, like an irregular or scarred cornea. They can't fix vision lost to problems further back, such as the retina, the optic nerve, or the brain's visual pathways. Many day-to-day problems, like fogging, halos, and vision that shifts through the day, can often be improved by changing the lens or the routine, so tell your fitter exactly what you're seeing. “We're on remake number four. What if my fitter just isn't getting it right?” We're on remake number four. What if my fitter just isn't getting it right? Several remakes are common, especially for complex eyes. In an international survey of fitters, an average of 2.4 lenses were ordered per patient, with a range of 1 to 16, so a fourth lens is above average but not unusual. What matters more is whether each change has a clear reason and things are getting better. If the same problem keeps coming back without a new plan, talk to your fitter directly, and consider a second opinion.
Living with them
What daily life looks like once the lenses are part of it.
“Will these lenses take over my whole life?” Can I live a normal life with scleral lenses? For most people, yes, life goes on largely as normal once the routine is learned. A few rules are firm: keep water away from your lenses, never sleep or nap in them, put makeup on after your lenses go in, and always have backup glasses. Beyond that, plan ahead with a small kit of supplies and ask your fitter about your specific work, sports, and travel. “Will people be able to tell I'm wearing them?” Will people be able to tell I'm wearing scleral lenses? Usually not. The lens is clear, and in everyday conversation most people won't see it. What they might notice is a slight shine on the eye, some redness, or, after you take the lenses out, a faint ring on the white of the eye where the edge sat. If anyone asks, a one-line answer like "they're medical contact lenses for my cornea" is all you need. “Am I going to need these for the rest of my life?” Will I need scleral lenses for the rest of my life? It depends on your eye condition. For keratoconus and other irregular corneas, scleral lenses are usually a long-term way of seeing well, because the lens corrects the shape of the cornea without changing it. For some people, treatment or surgery changes the picture, and a few stop needing them. Either way, it isn't one lens for life: lenses are refit and replaced as your eyes and the lenses change. Your eye doctor is the person who can tell you what's likely for you. “What if my eyes change and these stop working one day?” What if my eyes change and my scleral lenses stop working? Things do change: your cornea, your prescription, the lens surface, and how the lens sits. When a lens that used to work stops working, the usual answer is a refit or a replacement lens, not the end of scleral lenses. Problems are easiest to fix when they're caught early, so keep your follow-up visits and call your fitter when your vision or comfort changes and doesn't come back with a fresh fill. “What happens if I lose or break one? I can't function without them.” What happens if I lose or break a scleral lens? It happens to careful wearers too, so it's worth planning for. On the day: don't wear a lens that's chipped or cracked, keep the pieces, call your fitter to order a replacement, and switch to your glasses or an approved backup lens. Custom lenses can take time to replace, so the best protection is a backup made in advance: current glasses, and ideally a spare lens such as your previous pair. Insurance often won't pay for a spare, but it's worth asking.
Safety and what-ifs
Infections, stuck lenses, and what to do when something goes wrong.
“What if it gets stuck in there, or slides back behind my eye?” What if it gets stuck, or lost behind my eye? A scleral lens cannot get lost behind your eye. The thin membrane that covers the white of your eye folds back on itself to line the inside of your eyelids, so there is no opening for a lens to slip through. A lens can feel stuck, because it holds on with a gentle suction seal, but that seal can be broken safely with artificial tears and your removal plunger. If it won't come out after a few gentle tries and a rest, call your eye doctor. “Is it really safe to have something that big on my eye all day?” Are scleral lenses safe? For most wearers who follow their care routine, serious problems are uncommon, but the risk is not zero. Like any contact lens, a scleral lens can lead to an eye infection, which can threaten your sight. The risks you control most are water, sleeping in your lenses, the products you use, and how well you clean. Talk through your own risk with your eye doctor, especially if you have one working eye or a corneal transplant. “I'm scared I'll get a serious eye infection.” I'm scared I'll get a serious eye infection from my scleral lenses Serious eye infections are uncommon in scleral lens wearers, but they do happen, and they can move fast. Most of the risk you can control comes down to a few habits: no water on your lenses or case, never sleeping in them, fresh sterile saline every time, and cleaning and disinfecting exactly as your fitter showed you. Learn the warning signs, and if you notice them, take the lens out and call your eye doctor that day. “What if something goes wrong at night or on a weekend and my fitter is closed?” What if something goes wrong at night or on a weekend? Most lens problems can wait for office hours if you take the lens out and wear your glasses. A few can't: eye pain, worsening redness, new light sensitivity, discharge, vision that doesn't clear with the lens out, a lens you can't remove, or sudden flashes, floaters, or a shadow in your vision. For those, take the lens out if you can, call your fitter's after-hours line, and if you can't reach anyone, go to urgent care or an emergency room and say you wear scleral lenses. Ask your fitter now what their after-hours plan is.