PROGENT from Menicon helps clean plaque buildup.

Develop a specialty niche practice by sizing these large diameter lenses.

Scleral lenses have a variety of uses in our practices, including dry eye, post-trauma, keratoconus, keratoplasties, and neurotrophic keratitis. However, many eyecare professionals (ECPs) find the thought of fitting these large diameter lenses to be daunting. With the right education and practice, however, ECPs who fit these lenses can build their confidence and have great patient acceptance.

Scleral lenses are categorized by their lens diameter, which can range from 12.9mm to 24+mm. Corneo-scleral (12.9mm to 13.5mm) and semi-scleral (13.6mm to14.9mm) tend to be the hardest to fit as they land near or on the limbus, and if sized wrong, can cause discomfort and inflammation. Mini-scleral (15.0mm to18.0mm) lenses are most popular in the U.S. and have minimal corneal clearance and moderate scleral landing. Scleral lenses (18.1mm to 24+mm) have broader scleral alignment and complete corneal clearance, and tend to be easier to work on compromised corneas.

•To decrease mucus build up under the lens, decrease the sagittal depth, or change to a less viscous solution. Patients may also need to remove the lens during the day to clean it.

•Mucus may also adhere to the back of the lens and a patient may complain of discomfort upon application. To clean this plaque, the lens must be cleaned once every other week with PROGENT (from Menicon America, Inc.).

•To determine if a lens is warping, perform keratometry over the lens while on the patient’s eye. If you get a reading that is astigmatic over a spherical lens, there is warpage. To combat this, increase the center thickness. Scleral lenses should have central thicknesses between 0.4mm and 0.6mm.

•If a patient complains that a lens hurts after removal and reports discomfort the next day, the sclera is likely being compressed, causing hyperemia and inflammation. To decrease this, change the diameter and/or peripheral curves of the lenses.

•A patient may notice the buildup of debris under their lenses, and this may disrupt the quality of their vision. The larger the lens diameter, the more likely this is to occur, due to increased reservoir capacity and slower tear exchange. Some patients may need to remove their lenses midday, fill them with a high viscosity, non-preserved artificial tear before insertion, or be fit into a smaller diameter lens.

•Fogging can also be a nuisance; changing solutions may prove to be beneficial.

•To eliminate the appearance of bubbles under the lens, reduce the sagittal depth (central bubble) or increase the diameter/flatten the peripheral curve (peripheral bubble).

•Along with periodic protein removal with PROGENT, patients should use Boston One-Step Liquid Enzymatic Cleaner (Bausch + Lomb), or Opti-Free Supra-Clens (Alcon) to decrease buildup and keep lenses clean.

Scleral contact lenses can be very valuable to patients with corneal irregularity and ocular surface disease. ECPs that fit these lenses will experience great practice growth and patient satisfaction. It also allows ECPs to develop a true niche specialty practice.

Jennifer L. Stewart is in private practice at Norwalk Eye Care in Norwalk, CT.


Alcon Laboratories, Inc. •800-451-3937 •

Bausch + Lomb •800-828-9030 •

Menicon America, Inc. •800-636-4266 •


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