Why it takes more than one visit
A scleral lens is custom-made. It has to arch over your cornea without touching it, land evenly on the white of your eye, and give you clear vision through its front surface. Every eye is shaped a little differently, and many people who need sclerals have corneas that are irregular in the first place.
Some of that can be measured on day one. Some of it can only be judged once a lens has been on your eye for a while and has settled. That’s why a fitting is a process, not a single appointment.
The steps, in order
1. The first visit. Mostly measurement and history. Your eye doctor checks the health of your eyes, measures your vision, and maps the shape of your cornea. Depending on the practice, that may include corneal topography, which maps the surface, Scheimpflug imaging, which builds a 3D picture, or a scan of the white of the eye as well. Bring your current prescriptions, any surgical reports, and diagnoses from other doctors.
2. Choosing the first lens. Fitters use different methods:
- Trial lenses. Your fitter puts lenses from a diagnostic set on your eye and evaluates how they sit.
- Scan-based design. Detailed measurements of your eye are used to design the lens without trial lenses.
- Impression-based design. A mold of the front of your eye is used to make a lens that matches its shape.
3. Ordering and manufacturing. The lens is made to order by a lab. How long that takes depends on the lab, so ask your fitter what to expect.
4. The dispensing visit. You get your lenses, your fitter checks them on your eyes, and you learn to put them in and take them out. Practice here until you can do it yourself, more than once, before you go home.
5. Follow-ups and changes. Your fitter checks how the lenses are doing after you’ve worn them. If something needs to change, such as clearance over the cornea, how the edge lands, or the prescription, a new lens is ordered.
What the research says about visits and lenses
There’s no single “normal” number, but several studies give a sense of the range.
- An international survey of fitters collected details on 259 patients (419 eyes). On average, fittings took 3.8 visits and 2.4 lenses ordered. The range was wide: from 1 to 18 visits, and from 1 to 16 lenses.[1]
- A study of one practitioner’s first 156 scleral fittings, in 85 people, found that the first lens ordered was the final one for 40% of eyes. 48% needed one lens change, 9% needed two, and 4% needed three or four. More than 70% of lens changes were made at the dispensing visit. The number of trial lenses and changes fell significantly as the practitioner gained experience.[2]
- A small study of scan-guided fittings in 15 eyes of nine people with ocular surface disease averaged 2.9 follow-up visits and 2.1 lenses ordered. The authors note this was similar to earlier reports of fittings that used trial lenses, and that imaging didn’t replace careful clinical judgment.[3]
Two things stand out. Needing more than one lens is common. And the range is wide: a straightforward fitting may take a few visits, while a complex eye can take many more.
Remakes, warranties, and fees
Because lens changes are a normal part of fitting, most practices build some of them into the fitting fee. The details vary a lot from practice to practice. Before you start, ask:
- Does the fitting fee include lens changes? How many, and for how long?
- What happens if the lenses still don’t work at the end of that period?
- Is there a refund or credit if you decide to stop?
- What’s the cost of a replacement lens later, if one breaks or is lost?
- What’s included in follow-up visits after the fitting is finished?
Get the answers in writing if you can.
Making the time work
A few things make the process easier to fit into your life:
- Ask for a timeline up front. How many visits your fitter expects for you, and how far apart.
- Bring everything to the first visit. Records from other doctors can save a repeat measurement.
- Plan for the dispensing visit to take a while. You need time to practice handling before you leave.
- Consider distance. If you’ll need several visits, a fitter you can reach easily may matter more than you’d think. See finding a scleral lens specialist.
- Keep notes between visits. Specific details help your fitter make the right change the first time.
Even after the fitting is finished, keep your follow-up visits. Eyes and lenses change over time, and your fitter can only adjust what they see.
Common questions
Can I get scleral lenses the same day?
Usually not. Scleral lenses are custom-made from measurements of your eyes, so there's normally a gap between the fitting and the day you receive your lenses while the lab makes them.
Why does it take more than one lens to get it right?
The lens has to clear the cornea, land evenly on the white of the eye, and correct your vision, all at once. Some of that can only be judged once the lens has been on your eye for a while. Changing a lens after the first one is a normal part of the process, not a sign anything went wrong.
Is a scan-based fitting faster than one with trial lenses?
It can change how the first lens is designed, but it doesn't remove the need for follow-up. A small study of scan-guided fittings needed a similar number of lenses and visits to earlier reports of trial-lens fittings. Ask your fitter which method they use and why.
What should I ask about remakes and warranties?
Ask whether the fitting fee includes remakes, how many, for how long, and what happens if the lenses don't work for you in the end. Policies vary from practice to practice, so get the answer before you start.