What to Expect
What to Expect from a Scleral Lens Fitting
Why a scleral fit takes several visits, what the diagnostic stage involves, and how quickly people adapt to handling them.
This describes the typical course of treatment. It is not an account of any individual patient, and your own timeline and outcome may differ. Nothing here is a promise about your result.
This describes the typical arc rather than any individual patient. Complex corneas need more refinement than straightforward ones, and we would rather set that expectation properly than have you frustrated at visit two.
Anyone promising a same-day scleral fit on an advanced keratoconic cornea is describing an outcome we do not recognise.
Who this is typically for
- Keratoconus patients at any stage, including after cross-linking
- Anyone with an irregular cornea from surgery, injury or disease
- Corneal transplant recipients
- People with severe dry eye who have exhausted other treatments
- Patients who could not tolerate smaller rigid gas permeable lenses
- Anyone told their prescription cannot be corrected with contact lenses
How to prepare
The first appointment is considerably more productive when you bring the right things. This is what actually helps.
- Bring previous corneal topography if you have had it. Comparing scans over time establishes whether the underlying condition is progressing, which is a separate question from the lens fit.
- Bring any lenses you have been fitted with before, even unsuccessful ones. What did not work about them narrows the starting point considerably.
- Stop wearing existing rigid lenses for the period we tell you before the mapping appointment, since they reshape the cornea.
- Allow ninety minutes or more for the diagnostic fitting appointment. It is the longest visit in the sequence and it is not one to schedule against a deadline.
- Bring your glasses. You will be wearing them between the fitting stages.
- Come prepared for the handling training to take time. We teach until you are confident rather than until we have demonstrated.
Stage by stage
- Visit 1
1. Evaluation and corneal mapping
Full eye health assessment plus corneal topography, and where useful scleral profilometry, so we understand the surface we are fitting to.
This is also where we set expectations about the number of visits and the likely outcome, including any ceiling imposed by corneal scarring in the visual axis.
- Visit 2
2. Diagnostic lens application
Trial lenses go on your eye so we can assess three things: the vault clearing your cornea at its steepest point, the fluid layer underneath, and how the lens lands on the sclera.
The sclera is asymmetric rather than spherical, and this is where most of the fitting judgement happens. Expect ninety minutes or more.
Many patients see clearly for the first time in years during this appointment, which is frequently the moment the whole process makes sense.
- Weeks 2 to 4
3. Custom lens manufactured
A lens is designed to your measurements and individually manufactured. Overall diameter, vault height, landing zone shape and the optics are all specified for your eye.
This is a waiting period rather than an appointment. Manufacturing time varies with the complexity of the design.
- Visit 3
4. Dispensing and handling training
You learn to fill the lens with preservative-free saline, insert it, remove it and care for it. Most patients use a small plunger, and it takes a few days to feel natural.
We teach this until you are confident rather than until we have demonstrated it. Hygiene is covered thoroughly, including the point that tap water is never appropriate with these lenses.
- Weeks 4 to 10
5. Refinement
Follow-up visits assessing fit, comfort and vision, with adjustments as needed. Multiple iterations are normal and are part of the service rather than an extra charge.
Comfort typically improves across this period as handling becomes routine. Most patients report forgetting the lens is in.
- Ongoing
6. Long-term monitoring
Regular checks of corneal health and lens fit. Lenses are typically replaced every one to two years depending on your tear chemistry and handling.
For keratoconus, these visits also monitor disease stability, which is a separate question from whether the lens is working.
What we tell every patient up front
These are the things worth knowing before you commit rather than discovering afterward.
- It takes several visits. That is what a good scleral fit requires and it is not a sign anything is going wrong.
- Never sleep in them. The fluid reservoir becomes stagnant over long wear and infection risk rises considerably.
- Handling takes practice. Filling a lens with saline without spilling it is a skill, and it becomes routine within days.
- If your cornea has significant scarring in the visual axis, the vision ceiling is lower. We tell you that at the fitting rather than afterward.
- Tap water is never appropriate with these lenses, for rinsing, storing or anything else.
What it costs
Scleral lenses are frequently covered as medically necessary for keratoconus, irregular corneas and severe ocular surface disease, which is a different benefit from an elective contact lens allowance. We verify coverage and give you the cost in writing before ordering.
The full clinical detail
This page covers the journey. For the clinical explanation, the treatment options and the evidence behind them, read the full guide.
Read the full guideGeneral educational information, not medical advice or a diagnosis, and not a substitute for an examination. Individual outcomes vary and any specific expectation should come from a doctor who has examined your eyes.
Common questions about the process
Why does it take so many visits?
Because every parameter is customised and the sclera is asymmetric. Diameter, vault height, landing zone and optics all have to be right, and getting there takes diagnostic lenses and iteration.
Will they be uncomfortable because they are so large?
Most patients find them more comfortable than smaller rigid lenses. The lens never touches the cornea and lands on the sclera, which has far fewer nerve endings.
How long do they last?
Typically one to two years with proper care, varying with your tear chemistry and handling. We assess this at each review.
I could not tolerate rigid lenses before. Will this be different?
Usually yes, and it is one of the most common reasons patients come to us. Smaller rigid lenses sit on the cornea and move with each blink. A scleral does neither.
Book an appointment with a doctor who has time for you
We schedule 2 patients an hour, so your exam is unhurried and your questions get answered. Most patients are seen within a few days.