Scleral Lens Tutorial 1 - Introduction & contents

Tutorial Contents

This is a living, growing handbook, modified constantly as products in the market change, standards of care evolve, and our conversations on our Facebook group continue. We value input and feedback from doctors and patients alike! Reach out with suggestions and corrections any time.

Scleral lenses are like prosthetics... but more so.

They are not just fancy contact lenses. They require special medical skills on the part of your doctor, and special handling by yourself, and special types of supplies. They require ongoing care and monitoring. And nothing about them is cheap. Scleral lenses are not something you want to adopt casually as a minor upgrade from other contact lenses. They are an investment and commitment.

Scleral lenses come in many sizes!

What makes them "scleral" lenses is that they are rigid lenses that completely vault the cornea and hold fluid over it. But they may be anywhere from about 15mm (often called "mini sclerals") to about 25mm and covering most of the eye.

We scleral lens users are a diverse community!

We end up in scleral lenses for all different reasons and at all different times of life!

AGE: From young children to age 90+!

MOTIVATION: You may be motivated by VISION loss, ocular surface DRYNESS or exposure, or PAIN, or a combination of factors.

CONTACT LENS HISTORY: You may never have worn any type of contact lens before. Or you may have worn every contact lens before. For example, if you have keratoconus, you may have graduated from soft lenses to soft torics to rigid gas permeable lenses to "piggybacks" (rigid lens over soft lens) to hybrid lenses (lenses with a soft skirt and rigid middle) and, finally, sclerals.

MEDICAL FACTORS: You may have a corneal disease or dystrophy. You may be suffering from Sjogrens Syndrome or ocular GvHD or Stevens Johnson Syndrome or herpes zoster or keratoconus or pellucid marginal degeneration. You may have exposed corneas because of an eyelid surgery or an acoustic neuroma surgery. You may have Graft-v-Host Disease from a bone marrow transplant. You may have "garden variety" dry eye or meibomian gland dysfunction. You may have vision complications from an eye surgery such as RK, PRK or LASIK. You may have had a corneal transplant or two (or three)! These are just examples.

REFERRAL: Your doctor may have recommended scleral lenses. Or you may have found them by doing your own research. Your cornea specialist may have referred you to an optometrist, or you may have sought out an expert on your own. Some of you have needed to track down a scleral lens provider who has specific expertise in your disease, and some of you pursued a scleral lens technology for your particular needs.

You see, we all have a story.

What's yours? Come share it at

A personal note from Rebecca...

...To my fellow scleral lens user peeps:

I don't want to weigh you down with legalese. But it really is critically important to understand that you need ongoing medical advice, not just practical advice, for safe and successful scleral lens use. This tutorial is practical, NOT medical. I have no medical qualifications. Involve your eye doctor in every decision. Talk to them about every concern and question.

My hope for this tutorial is to provide a framework for understanding the scleral lens experience, conversation prompts for your eye doctor appointments, and a plethora of practical tips for the non-medical aspects of life with scleral lenses.

What you are seeing now is the first draft of a series that I expect to evolve and improve over time. I spent just one week, mostly evenings, writing this start to finish... so I know there's probably still a lot missing!

You, my scleral lens community have been instrumental in this project. Most of what I share here, I have learned from interacting with you. I am looking forward to your feedback and suggestions for future 'updates'!

May you all enjoy safe, comfortable vision with scleral lenses for a long time to come.

To the optometrists browsing these pages:

I am so indebted to the many ODs I've had the opportunity to learn from over the years, whether through conversations or studies published by leaders in the field, or simply information posted in our Facebook scleral lens group. Thank you for all your hard work advancing the science of scleral lenses!

Scleral lenses are a huge growth area in optometry right now. The advances are exciting, bringing huge potential for better vision and comfort for people with a variety of corneal diseases. But post-fitting patient care standards need to catch up and keep pace. I know some of you share my concerns about that. My vision for this peer-to-peer tutorial is to provide patient education that helps improve safety, success and satisfaction with scleral lenses; to support and improve patients' relationships with their providers; and to help raise the bar in scleral lens patient care. I am eager for your feedback and constructive criticism at any time!

It's my honor to share everything I write freely. To the extent that you find any of what I have written worthy of sharing with your patients, I ask that you do me the courtesy of crediting your source.