Dry Eye Syndrome / Irregular Cornea

(e.g., Keratoconus) Rehabilitation  - Scleral Lens

Scleral lenses are a type of specialty rigid contact lens that has been around for over a century. Unlike standard contact lenses, scleral lenses are specialty contact lenses which have a larger diameter and are made from highly breathable materials. They are designed to rest on the less sensitive sclera (the white part of the eye) while completely avoiding contact with the sensitive cornea. This design not only provides vision correction but also protects the eyes.

Scleral lenses are suitable for patients recovering from various corneal issues, including dry eye disease and Sjögren’s syndrome, irregular corneas such as keratoconus and corneal scarring. They are also beneficial for individuals who cannot tolerate traditional rigid gas permeable (RGP) lenses or those with high prescriptions and astigmatism who struggle with disposable contact lenses. Additionally, patients dissatisfied with the visual outcomes of refractive surgery may find relief and clearer vision with scleral lenses.

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Principles of Scleral Lenses

Scleral lenses are crafted from rigid materials with high oxygen transmission and have a larger diameter than standard contact lenses. When worn, they act as a protective shield for the cornea, blocking external environmental irritants. The space between the lens and the cornea is filled with saline solution or artificial tears, creating a rich tear reservoir that keeps the cornea hydrated and promotes healing.

This tear reservoir also smooths out irregularities on the corneal surface, reshaping it into a uniform optical surface that corrects irregular astigmatism not manageable by regular glasses or contact lenses. This significantly enhances visual quality for patients whose corneas have become distorted due to disease, trauma, or surgery. Furthermore, because scleral lenses sit on the less sensitive sclera, they remain stable during blinking or physical activity. The enhanced comfort during scleral lens wear is better than you thought!

‍Benefits of Scleral Lenses

1. Corrects Irregular Astigmatism: Reshapes the optical surface for patients with corneal conditions like keratoconus, corneal scars, corneal transplant and has potential benefits for post-refractive surgeries with undesirable visual outcomes. 

2. Alleviates Dry Eye Symptoms of Moderate to Severe Dry Eye Disease and Sjogren Syndrome: Maintains hydration of the cornea through a stable liquid layer.

3. Protects the Corneal Surface: Shields against external irritants and aids in recovery from conditions such as neuropathic corneal pain, exposure keratitis and Stevens-Johnson Syndrome.

4. Provides Stable Vision Correction: Suitable for individuals with high prescriptions, high astigmatisms or those who cannot wear traditional RGP lenses.

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Fitting Process for Scleral Lenses

Our expert team customizes scleral lenses tailored to the shape and size of your eyes, as well as your specific needs.

✅ Understanding the patient’s visual needs

✅ Comprehensive eye examination, including refraction and biometry measurements

✅ Feasibility assessment for scleral lenses

✅ Trial fitting with scleral lens trial lenses

✅ Evaluation of lens comfort and clarity

✅ Determining parameters and arranging for custom lens production

✅ Lens pickup and inspection

✅ Tutorial on lens application and removal

⏲The initial fitting process typically takes about 1 to 2 hours.

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Suitable Candidates for Scleral Lenses:

1. Individuals with keratoconus or irregular corneas, corneal scars, or those who have undergone corneal transplant surgery, and individuals dissatisfied with visual outcomes after refractive surgery.
2. Patients suffering from moderate to severe dry eye disease and Sjögren's syndrome, seeking relief from dry eye symptoms.
3. Those with high astigmatism, high myopia, high hyperopia, or who do not adapt well to traditional RGP (rigid gas permeable) contact lenses.
4. Patients with corneal neuralgia, exposure keratitis, Stevens-Johnson syndrome (SJS), and similar conditions.

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Technological Advancements in the Next-Generation Scleral Lenses:

‍The next-generation scleral lenses incorporate significant technological innovations compared to traditional scleral lenses, enhancing stability and comfort. These lenses are often referred to as "mini-scleral lenses," measuring between 15-18mm in diameter, while traditional scleral lenses are larger than 18mm. The smaller size allows them to completely bypass the cornea while avoiding irregular areas at the periphery of the eye white, reducing lens weight and minimizing displacement caused by gravity.

The next-generation scleral lenses employ a toric haptic design that closely conforms to the true shape of the sclera, further improving lens stability. They also support quadrant-specific modification for precise adjustments based on the topography of the cornea and sclera. The development of ultra-high oxygen-permeable materials ensures that these lenses can be worn comfortably throughout the day and may include coatings to enhance hydration and overall performance.

Since introducing the first ESP scleral topographer in East Asia, we have upgraded our scleral lenses to a fully-individualized level. By scanning the topography and creating a three-dimensional map of the sclera, we can tailor-made scleral lenses based on the individualized data. This advancement eliminates the previously complex fitting procedures, ensuring that the curvature of each lens perfectly matches the unique shape of each client’s sclera, further enhancing both comfort and accuracy.

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Frequently Asked Questions about Scleral Lenses

1. What is the difference between scleral lenses and other contact lenses?

Scleral lenses differ from other contact lenses in several key aspects:

a. Shape and Size: The next-generation scleral lenses typically fall into the category of mini-scleral lenses, which measure between 15-18mm in diameter, slightly larger than soft contact lenses. These lenses are designed to completely cover and bypass the cornea, resting on the less sensitive sclera (the white part of the eye), with the space between the lens and cornea filled with preservative-free saline or artificial tears. In contrast, traditional contact lenses (both soft and rigid) do not bypass the cornea, making their stability highly dependent on the shape and condition of the cornea.

b. Contact Points: The design of scleral lenses allows them to land on the sclera rather than directly contacting the cornea. This design avoids pressure and friction on the cornea, potentially enhancing comfort for wearers.

c. Visual Effects: Scleral lenses create a tear reservoir that fills in irregularities on the corneal surface, improving vision. This is particularly beneficial for individuals with irregular corneas or high astigmatisms.

d. Corneal Rehabilitation: Scleral lenses act as a protective shield for the cornea, blocking external environmental disturbances while keeping the cornea hydrated with saline or artificial tears, thus promoting corneal healing. Traditional contact lenses do not provide the same rehabilitative effects.

2. Are Scleral Lenses Safe?

Scleral lenses have a history of over 100 years, and recent technological advancements have made them the fastest-growing type of rigid contact lens in the United States. The FDA has cleared scleral lenses for use as a non-surgical option to treat certain eye conditions, such as dry eye disease.

At Berlin Optical, our professional optometrists conduct comprehensive eye examinations for each scleral lens patient to assess the feasibility of wearing these lenses, ensuring that each individual is suitable for the treatment. After fitting, our optometrists provide detailed instructions on how to wear and remove the lenses, along with follow-up appointments to ensure safe use.

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3. Why are Scleral Lenses an Effective Treatment Option for Irregular Corneas (e.g., Keratoconus)?

Scleral lenses can correct irregular corneas and restore vision. An irregular cornea, such as in keratoconus, is one in which the shape of the cornea is no longer optically perfect but becomes conical or distorted. This condition causes light to disperse when entering the eye, affecting vision.

Scleral lenses utilize a tear reservoir to smooth out optical imperfections caused by the irregular cornea and the lenses also completely bypass the cornea. This design alleviates concerns about lens instability due to corneal deformation, ensuring effective wear without compromising comfort or vision quality.

4. How are Scleral Lenses Priced?

Scleral lenses need to be replaced approximately every two years. The pricing includes a pair of scleral lenses as well as all follow-up consultation fees. The cost will be decreased at the lens replacement and onwards.

‍Our Optometrists at Berlin Optical

Jeff graduated with First Class Honors from the University of Melbourne with a Master of Clinical Optometry and a Bachelor of Science in Optometry (Honors) from the Hong Kong Polytechnic University. He is currently in private practice at Berlin Optical Vision Center and also serves as a visiting clinical instructor at the School of Optometry at Polytechnic University. Additionally, he is an expert blogger for the Oh! Parent-Child Platform. Jeff is also often invited to participate in academic conferences around the world, committed to addressing the eye care needs of different types of clients.

Jeff also continuously advances his expertise in various areas of optometry, including obtaining a certificate in orthokeratology from the Polytechnic University, which involves vision correction through orthokeratology lenses (OK lenses) particularly suitable for those who love sports and prefer not to wear glasses; and completing a certificate from the Optometric Extension Program Foundation Clinical Curriculum in the United States. This program involves a series of examinations and visual training to improve problems with binocular coordination in children and visual-related learning issues in children with Special Educational Needs (SEN).

Moreover, Jeff has successfully attained the qualification of Fellow of The American Academy of Optometry. The American Academy of Optometry, established in 1922, is an organization dedicated to advancing the optometric profession. To achieve fellowship status, optometrists must have certain educational qualifications and professional experience, demonstrate their professional knowledge and competence by writing various case reports and passing an interview to meet internationally recognized standards.

According to the website of the American Academy of Optometry, there are currently only around 30 optometrists in Hong Kong who hold this qualification.