Why this worry makes sense
When you’ve waited months for lenses that finally work, the thought of losing them is frightening. Many wearers describe exactly that: relief, followed by a quiet fear of the day something changes.
Some change is likely over the years. The good news is that change is a normal part of scleral lens care, and fitters deal with it all the time. A lens that stops working is usually a reason for a new lens, not the end of scleral lenses for you.
What can change
Your eye
Corneas can keep changing, especially in keratoconus. In a study of 157 keratoconus eyes that had worn scleral lenses successfully for at least a year, 14.6% lost some of their best vision with the lens during the study period, all because the keratoconus progressed. When problems came up, refits were the most common response, making up 54% of interventions.[1] In other words, the usual answer to a changing eye was a changed lens.
Other things change the eye too: cataract surgery, eyelid surgery, a corneal transplant, a new medicine, or simply age. Any of these can mean a new prescription or a new fit.
Your prescription
Contact lens prescriptions expire, usually after one or two years depending on your state. The FDA notes that if you haven’t had a check-up in one to two years, you may have eye problems you aren’t aware of, or lenses that no longer correct your vision well.[4] Many wearers who need reading help with age, for example, find their distance-only lenses are still fine but need glasses over them, or a different lens design.
The lens itself
Scleral lenses aren’t disposable, but they don’t last forever. In a review of 251 patients at one university hospital eye clinic, the average time between lens orders was 23.9 months, with a very wide range.[2] Over time a lens can pick up film that won’t clean off, scratches, or chips, and vision or comfort slowly slips. See when to replace scleral lenses.
The coating
If your lenses have a Hydra-PEG coating, its maker says it’s bonded to the lens and designed to last the lens’s lifetime, but that tear composition, incompatible cleaners or drops, vigorous rubbing, tap water, and storing lenses dry can all shorten how long its benefits last.[3] A worn coating can feel like a lens that’s suddenly drier, foggier, or more filmy. See how long a Hydra-PEG coating lasts.
How to tell what’s going on
The changes that matter most are often slow, which makes them easy to miss or to blame on a bad week. A few checks help:
- Try a fresh fill first. Remove the lens, rinse, refill with fresh saline, and reinsert. If your vision snaps back, the problem was probably fogging or debris, not a change in your eye.
- Check each eye on its own. Cover one eye, then the other.
- Look at the lens. Hold it up to a light for haze, scratches, or chips.
- Notice timing. Blur that starts hours after insertion is different from blur that’s there from the first minute. See vision that changes during the day.
- Compare old and new. If you have a previous pair, it can be a useful reference for your fitter.
If you’ve just received new lenses and they aren’t as clear as you hoped, that’s a different situation with its own guide: my new scleral lenses are blurry.
What fitters can do
Depending on what’s changed, options can include:
- A new power on the same lens design.
- A refit, changing how the lens sits on or vaults over your eye.
- A replacement lens when the old one is worn, scratched, or filmed.
- A different cleaning routine if deposits are the issue.
- A different design altogether, if your eye has changed a lot.
Wearers who’ve been through refits often say it took more than one lens to get it right, and that speaking up early made the difference. A few found a second opinion helped when a refit wasn’t working. See how many remakes is normal and getting a second opinion.
Keep your follow-ups, even when things feel fine
Regular eye exams are on the FDA’s list of contact lens safety basics.[5] Follow-up visits are where your fitter sees slow changes you can’t: how the lens has settled, early wear on the lens surface, and changes in your cornea. Catching those early usually means a smaller fix. See how often to see your fitter.
When to call
Book a visit soon if your vision is slowly getting worse, a fresh fill no longer helps, your lenses are harder to insert or remove, comfort is slipping, or fogging is happening more than it used to.
Call the same day if you have warning signs. The FDA lists discomfort, excess tearing or discharge, unusual sensitivity to light, itching or burning, unusual redness, blurred vision, swelling, and pain as symptoms of eye irritation or infection. Remove your lenses, don’t put them back in, and keep them in their case for your eye doctor to see.[6]
Have a plan B
Change is easier to live with when you have a fallback. Keep a current pair of glasses, as the FDA recommends.[5] If you can, keep your previous pair of lenses as a backup, with your fitter’s agreement. And ask your fitter now how refits and replacements work at their practice, so you know what to expect when the day comes.
What to ask your fitter
- What changes in my eye are you watching for?
- How will I know when a lens needs replacing?
- If I need a refit, what’s involved and what does it cost?
- Should I keep my old lenses as a backup?
Common questions
My vision has slowly gotten worse. Is it my eye or my lens?
It could be either, and you can't tell from the outside. A lens with film, scratches, or a worn coating can blur things, and so can a change in your cornea or prescription. Your fitter can check both. Bring the lenses and your notes on when you notice the blur.
Will a refit mean starting the whole fitting process again?
Sometimes it's a small change to one part of the lens, and sometimes it's closer to a new fitting. It depends on what changed. Ask your fitter what's involved and what the cost is before you start.
My new lenses feel worse than my old ones, even though they're the same design. Why?
Wearers report this, and it's worth taking back to your fitter rather than putting up with it. Your eye may have changed since the old pair was made, or the new lens may differ slightly. Bring both pairs so your fitter can compare.
What if I need a refit and my fitter has retired or moved?
Your new fitter can start from your records and your current lenses. Ask your old practice for a copy of your lens parameters and records. See switching scleral lens practices.
Is there a point where scleral lenses can't work anymore?
For some people, yes, for example if the cornea becomes too scarred or cloudy for a clear lens to help, or if lens wear isn't tolerated. Then other options, such as surgery, come into the conversation. That's uncommon, and it's a decision you'd make with a cornea specialist.