Scleral and Specialty Lenses
Scleral and Specialty Contact Lenses in Phoenix
Most people arrive at scleral lenses after being told they were out of options. A cornea scarred by injury, distorted by keratoconus, or left irregular after surgery cannot be corrected by a spectacle lens, because a spectacle lens has a regular surface and the eye underneath does not.
A scleral lens sidesteps the problem entirely. Rather than sitting on the cornea and following its shape, it arches over the cornea without touching it and lands on the sclera, the white of the eye. The gap underneath fills with sterile saline. Light now passes through a smooth lens surface and a smooth fluid layer before it ever reaches your irregular cornea, so the distortion largely stops mattering.
Patients routinely describe the first properly fitted scleral lens as the clearest vision they have had in years. That reaction is common enough that we expect it.
Conditions scleral lenses solve
- Keratoconus, at any stage, including after corneal cross-linking
- Pellucid marginal degeneration and other corneal ectasias
- Post-LASIK and post-RK corneas with irregular healing or persistent distortion
- Corneal transplant patients, where the graft surface is rarely optically regular
- Corneal scarring from injury, infection or ulceration
- Severe dry eye, including Sjogren's syndrome and graft-versus-host disease
- High astigmatism that soft lenses cannot correct stably
- Anyone who has failed with rigid gas permeable lenses because of comfort
Why sclerals help severe dry eye
This surprises people, because a contact lens is usually the thing that makes dry eye worse. Sclerals work the opposite way, and the reason is the fluid reservoir.
The lens holds a bath of sterile saline against your cornea for the entire time it is worn. Instead of a tear film that evaporates within seconds, the corneal surface sits in continuous liquid all day. For patients with severe dry eye who have exhausted drops, plugs and prescription medication, this is often the intervention that finally works.
It is also the reason sclerals are used in genuinely serious ocular surface disease, where protecting the cornea from exposure matters as much as vision.
Comfort, and why size helps rather than hurts
The most common worry is that a larger lens must be less comfortable. In practice the opposite is true, and the anatomy explains why.
The cornea is one of the most densely innervated tissues in the body, which is why a speck of dust in your eye is agony. The sclera has far fewer nerve endings. A scleral lens never touches the cornea at all, and it lands on tissue that barely registers it. Most patients adapt within days, and many report forgetting the lens is in.
The fitting process, honestly described
Fitting a scleral lens well is difficult, and we would rather set the expectation properly than have you frustrated at visit two. This is not a one-appointment process.
Every parameter is customised: overall diameter, the vault height clearing your cornea at its steepest point, the shape of the landing zone where the lens meets the sclera, and the optics themselves. The sclera is not a sphere, it is asymmetric, and a lens that lands unevenly causes redness and discomfort no matter how good the optics are.
We start with diagnostic lenses on your eye, assess the fluid layer and the landing, then order a custom lens. Refinement across follow-up visits is normal and expected. What you get at the end is a lens that works all day, every day, which is worth several visits.
Daily handling and care
Sclerals are filled with sterile preservative-free saline before insertion, which is the main handling difference from other lenses. Most patients use a small plunger for insertion and removal. It takes a few days to feel natural and then becomes routine.
We teach handling in the office until you are genuinely confident, not until we have demonstrated it. Hygiene matters more with any lens that sits on the eye for long periods, and we go through cleaning, storage and the saline you should and should not use. Tap water is never appropriate with these lenses and we make sure that is understood before you leave.
Who this is for
- Keratoconus patients at any stage
- 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
Our process
Every patient goes through the same sequence, so you always know what happens next.
- 1
Evaluation and corneal mapping
Full eye health assessment plus corneal topography, and where useful scleral profilometry, to understand the surface we are fitting to.
- 2
Diagnostic lens application
Trial lenses on the eye so we can assess the vault over the cornea, the fluid layer and how the lens lands on the sclera.
- 3
Custom lens order
A lens designed to your measurements. These are individually manufactured, not selected from stock.
- 4
Dispensing and training
Handling, filling, insertion, removal and care taught until you are comfortable doing it yourself.
- 5
Refinement visits
Follow-ups to assess fit and comfort with adjustments as needed. Multiple iterations are normal and are part of the service, not an extra.
- 6
Ongoing monitoring
Regular checks of corneal health and lens fit. Lenses are replaced on a schedule and the fit is re-verified as your eye changes.
What is included
- Comprehensive eye examination and corneal mapping
- All diagnostic lens fitting appointments
- Custom lens manufactured to your measurements
- Complete handling, insertion and hygiene training
- All refinement visits within the fitting period
- Care kit and guidance on the correct saline and solutions
Related care
- KeratoconusKeratoconus diagnosis, monitoring and specialty lens fitting in Phoenix. Scleral and custom lenses for irregular corneas, fitted by experienced specialists.
- Dry EyeBurning, gritty, watery or tired eyes in the Phoenix desert climate. We diagnose the actual cause of your dry eye and treat it, rather than handing you drops.
- Contact Lens ExamsA contact lens exam is more than a glasses prescription. Corneal measurement, tear film assessment and a fit that stays comfortable all day.
Scleral and Specialty Lenses questions, answered
How long do scleral lenses last?
Typically one to two years with proper care, though this varies with your tear chemistry and handling. Some patients get longer, some need replacement sooner because of surface deposits. We assess this at each review.
Can I sleep in scleral lenses?
No. Sclerals are worn during waking hours and removed at night. The fluid reservoir becomes stagnant over long wear and sleeping in them raises infection risk considerably.
How long does the fitting take?
Expect several appointments over a few weeks. The initial evaluation and diagnostic fitting is usually ninety minutes or more. Custom lenses take time to manufacture, and refinement follows. Anyone promising a same-day scleral fit on a complex cornea is describing something we do not recognise.
Are scleral lenses covered by insurance?
Frequently, when they are medically necessary, which is how lenses for keratoconus, irregular corneas and severe ocular surface disease are usually classified. That is a different benefit from an elective contact lens allowance. We verify your coverage and give you the cost in writing before ordering.
What if I have tried rigid lenses and could not tolerate them?
That is one of the most common reasons patients come to us for sclerals, and the outcome is usually good. Smaller rigid lenses sit directly on the cornea and move with each blink, which is what causes the discomfort. A scleral does neither.
Will I see perfectly?
Most patients achieve dramatically better vision than with any other correction, and many reach normal or near-normal acuity. If the cornea has significant scarring in the visual axis, or there is other eye disease, the ceiling is lower. We tell you what to expect at the fitting rather than afterward.
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.