How often it happens
Scleral lenses don’t work out for everyone. It’s better to know the numbers going in than to feel blindsided.
- A year-long study of 95 wearers found that 73% were still wearing their lenses at twelve months and 27% had stopped. The most common reasons among those who stopped were handling problems (35% of those who stopped) and discomfort (19%). None stopped because of an adverse event.[1]
- Success differed by eye type. In that same study, 77% of people with irregular corneas, such as keratoconus, completed the year, compared with 58% of people whose corneas were regular.[1]
- A study of 120 veterans, with an average age of 56.7, found that 34.2% stopped wearing scleral lenses, a median of 5.2 months after fitting. Difficulty putting lenses in and taking them out was the most common reason, given by 53.7% of those who stopped. People with a neurological condition were more likely to stop.[2]
These are single-center studies of specific groups. They can’t predict what will happen for you. But they show a pattern: when scleral lenses don’t work out, it’s usually because of the daily practicalities, not because the lens failed to help the eye.
What a fitter can change
Before deciding sclerals aren’t for you, it’s worth knowing how much can be adjusted. In a keratoconus study that tracked problems in long-term wearers, the most common responses were refitting the lens (54.0% of interventions) and re-teaching the patient (29.5%).[3] In other words, most problems were handled by changing the lens or the technique.
If handling is the problem:
- Retraining, sometimes more than once
- A different inserter, such as one with a hole in the bottom so you can see through the lens
- An insertion stand, which frees both hands for your eyelids
- A ring-style inserter worn on the finger
- Training a family member or caregiver to help
If comfort is the problem: the part of the lens that rests on the eye can be reshaped to follow your eye more closely. In a study of one practitioner’s first 156 fittings, about 10% of patients in each group needed a new lens because of discomfort even though the fit looked right, and most of those changes to the landing area improved comfort.[4]
If fogging is the problem: your fitter can look at whether the fit, your tear film, or an underlying dry eye condition is the cause. Options include changing how the lens seals, a planned midday removal and refill, a lens surface coating, or treating the dry eye itself.
If vision isn’t sharp enough: the prescription can be refined once the lens has settled, the optics can be changed, and some problems like glare and ghosting can come from a lens that sits slightly off-center. See my vision still isn’t perfect.
The key is being specific. “They don’t work” is hard to act on. “My right lens fogs by early afternoon and the left doesn’t” gives your fitter something to change.
Questions to ask before you start
Because it might not work out, ask these at the beginning, not the end:
- What results can I realistically expect, given my eyes?
- How many visits and lens changes do you expect?
- What does the fitting fee include, and for how long?
- What happens if the lenses don’t work for me after that? Is there any refund or credit?
- What would you suggest instead if sclerals aren’t right?
Policies vary a lot between practices, so ask your fitter rather than assuming.
If scleral lenses really aren’t right for you
Stopping scleral lenses doesn’t mean running out of options. What makes sense depends on why you needed them in the first place, so this is a conversation with your eye doctor. In general terms, the alternatives people discuss include:
- Glasses, which may give enough vision for some tasks even if not as sharp
- Soft contact lenses, including custom-made designs for irregular corneas
- Smaller rigid gas-permeable lenses that sit on the cornea
- Hybrid lenses, with a rigid center and a soft outer skirt
- Piggyback lenses, a rigid lens worn over a soft lens
- Medical and surgical treatments for the underlying condition, which a corneal specialist can discuss
For dry eye and ocular surface disease, treatment of the condition itself is often part of the plan whether or not you wear scleral lenses.
A second opinion is reasonable
Fitters differ in experience, lens designs, and fitting methods. If you’ve struggled for a while and nothing has changed, seeing another fitter is a reasonable step, not a betrayal of the first one. Bring your records, your lens details, and notes on what’s been tried. See finding a scleral lens specialist.
Common questions
How many people stop wearing scleral lenses?
It depends on the group studied. In a year-long study of 95 wearers, 27% stopped during the year. In a study of 120 veterans, 34.2% stopped. Both studies were at single centers, so they give a rough sense of the range rather than a figure that applies to you.
Do I get my money back if they don't work?
That depends entirely on the practice. Ask before you start what the fitting fee covers, how many lens changes are included and for how long, and whether there's any refund or credit if you stop.
Should I get a second opinion?
It can help, especially if you've been struggling for a while and the lens hasn't been changed. Different fitters use different lens designs and fitting methods. Bring your records and lens details so the new fitter can see what's been tried.
Is it my fault if I can't handle them?
No. Handling is the most common reason people stop, and some factors, like hand strength, a tremor, or a neurological condition, make it genuinely harder. Tell your fitter: other tools, techniques, or a trained helper may make the difference.