According to a survey conducted by Orbis in 2018 in Hong Kong, it was shown that 48% of the respondents suffered from varying degrees of dry eye syndrome, with 30% classified as severe. The widespread use of electronic devices in recent years has also led to a significant increase in the number of patients, with a trend towards younger ages. A study from the United States indicated that half of the contact lens users experience symptoms of dry eye syndrome.

When dealing with the troubles of dry eye syndrome, the usual go-to solution is to use artificial tears. However, for some patients who suffer from moderate to severe dry eye syndrome, treatments such as artificial tears, anti-inflammatory eye drops prescribed by doctors, intense pulsed light therapy, or tear duct occlusion surgery may not be effective in improving their condition. For these dry eye patients, wearing scleral lenses might be a better option. Scleral lenses not only effectively relieve the symptoms of dry eye syndrome and prevent corneal damage, but they also correct vision like regular contact lenses.

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Dry Eye Syndrome / Irregular Cornea (such as Keratoconus, Corneal Ectasia) - Corneal Rehabilitation Solution: Scleral Lenses

Scleral lenses are a type of special hard contact lens. In fact, scleral lenses were invented more than a hundred years ago. Unlike regular contact lenses, scleral lenses have a larger diameter and are made from highly oxygen-permeable materials. They are designed to rest on the less sensitive white part of the eye, the sclera, completely bypassing the sensitive cornea. This design, which covers the entire corneal surface, allows scleral lenses to provide vision correction while also offering protection to the eyes.

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Scleral lenses are suitable for the rehabilitation of patients with various corneal problems, including dry eye syndrome and Sjögren's Syndrome, as well as those with irregular corneas such as keratoconus, patients with corneal scarring, and others. They are also an option for individuals who do not tolerate traditional RGP (Rigid Gas Permeable) contact lenses, those who cannot correct their vision with disposable contact lenses due to high prescriptions or astigmatism, or even those who are dissatisfied with the outcomes of laser vision correction surgery. In addition to providing relief from discomfort, scleral lenses can also help these patients achieve clearer vision.

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Scleral lenses are indeed a unique and advanced type of contact lens with a specific technical principle that sets them apart from standard contact lenses:

Material and Design: Scleral lenses are made from a rigid, gas-permeable material that allows for high levels of oxygen transmission to the corneal surface. Their larger diameter distinguishes them from conventional contact lenses, ensuring that they cover not only the cornea but also a significant portion of the sclera (the white part of the eye).

Protection: Once in place, scleral lenses form a protective barrier over the cornea, similar to a shield. This barrier helps to protect the cornea from the external environment, including wind, dust, and other irritants that can exacerbate conditions like dry eye syndrome.

Corneal Hydration: The design of scleral lenses creates a vault over the cornea. This vault is filled with preservative-free saline solution or artificial tears, which keeps the cornea hydrated for extended periods. The constant hydration promotes corneal healing and provides comfort for those with dry eye conditions.

Optical Correction: The fluid reservoir between the scleral lens and the cornea acts to even out any irregularities on the corneal surface, effectively creating a new, smooth, refractive surface. This can correct irregular astigmatism and other corneal irregularities that are not easily corrected with standard eyeglasses or soft contact lenses, improving the visual acuity for patients with corneal ectasia, scarring, or post-surgical irregularities.

Stability and Comfort: Since scleral lenses are designed to rest on the less sensitive sclera, they are generally more comfortable for the wearer. The size and positioning of scleral lenses make them more stable than traditional contact lenses. They are less prone to displacement with blinking or during physical activities, providing a level of comfort and visual stability that can be superior to other forms of vision correction.

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Scleral lenses provide several therapeutic and vision correction benefits for a range of ocular conditions:

1. Correction of Irregular Astigmatism and Visual Rehabilitation:‍

• Scleral lenses smooth out irregular astigmatism by creating an even optical surface over the cornea.
• They are beneficial for patients with keratoconus, corneal scarring, or those who have undergone corneal transplant surgery.
• Individuals dissatisfied with their vision after laser eye surgery may also see improvement with scleral lenses.

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2. Relief for Dry Eye Symptoms:

• The design of scleral lenses maintains a hydrating fluid layer over the cornea which can provide relief for dry eye symptoms.
• This is particularly beneficial for patients with dry eye disease and Sjögren's Syndrome, as it helps to keep the cornea moist and reduces discomfort.

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3. Protection of the Corneal Surface:

• Scleral lenses protect the cornea from external irritants and assist in healing the corneal surface.
• They are suitable for patients with conditions such as corneal neuropathy, exposure keratitis, and Stevens-Johnson Syndrome.
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4. Stable Vision Correction:

• Scleral lenses can provide a stable correction of vision, overcoming the limitations of standard contact lenses.
• They are useful for individuals with high levels of astigmatism, severe myopia (nearsightedness), hyperopia (farsightedness), and those who do not tolerate traditional RGP lenses well.

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Here's a detailed description of the fitting process:

1. Our team will customize scleral lenses based on the specific shape and size of your eyes and your vision correction requirements.
2. You'll undergo a comprehensive optometric examination to determine your prescription and measure your cornea's curvature.
3. We'll assess the suitability of scleral lenses for your particular eye condition and visual needs.
4. You will have a trial fitting with scleral lenses to assess initial fit and comfort.
5. We evaluate the comfort and visual clarity of the trial lenses.
6. Custom lenses are ordered using the determined lens parameters.
7. Upon lens completion, you return for a pickup, where we check the fit and vision.
8. You receive instructions on the proper insertion and removal of scleral lenses.
9. The entire initial fitting process is expected to take between 2 to 3 hours.
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Individuals suitable for scleral lens fittings include:

1. Patients with keratoconus or conical cornea, corneal scarring, or those who have undergone corneal transplant surgery, as well as individuals dissatisfied with the results of laser vision correction surgery.
2. People seeking relief from dry eye symptoms, including those with Sjogren's Syndrome.
3. Individuals with high levels of astigmatism, severe myopia (nearsightedness), severe hyperopia (farsightedness), or those who are intolerant to traditional rigid gas-permeable (RGP) contact lenses.
4. Patients suffering from corneal neuropathy, exposure keratitis, Stevens-Johnson Syndrome (SJS), and similar conditions.

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The FAQ of Scleral Lenses

1. Scleral Lenses vs. Other Contact Lenses

Scleral lenses differ from other types of contact lenses in several ways. Below are some of the key differences:

1. Shape and Size

The new generation of scleral lenses are often referred to as mini-scleral lenses (typically 15-18 mm in diameter), which are slightly larger than soft contact lenses. They vault completely over the cornea and limbal edge, resting on the less sensitive white part of the eye (the sclera), and the space between the sclera lens and the cornea is filled with preservative-free saline or artificial tears. In contrast, traditional contact lenses (both soft and rigid gas permeable) do not extend beyond the cornea, and their stability is highly dependent on the shape and condition of the cornea.‍

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2. Contact Points‍

Scleral lenses are designed to land on the sclera (the white part of the eye), rather than directly touching the cornea. This design avoids pressure and friction on the cornea, which can increase comfort for the wearer.

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3. Visual Acuity

Scleral lenses can create a tear-filled optical surface to correct for irregularities on the corneal surface, thereby improving vision. This is particularly beneficial for individuals with irregular corneas or severe astigmatism.
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4. Corneal Rehabilitation

Scleral lenses act like a protective shield for the cornea, blocking external irritants and allowing the cornea to be continuously bathed in saline or artificial tears, promoting corneal healing. Regular contact lenses do not offer the same therapeutic effect.
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5. Moisture Competition vs. Corneal Hydration

Disposable soft contact lenses have a certain water content, and as they lose moisture through evaporation, they can compete with the eye for hydration, similar to how a face mask worn too long can draw moisture from the skin. Scleral lenses, however, are made of materials that do not absorb moisture from the eye. Instead, they hold a reservoir of liquid, like a breathable bowl, nourishing the cornea throughout the day.
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‍2. Are scleral lenses safe?

‍Scleral lenses have been around for over 100 years and advancements in the past decade have made them one of the fastest-growing segments of rigid contact lenses in the United States. They are FDA-cleared for the treatment of certain eye conditions such as dry eye syndrome as a non-surgical option.Professional optometrists at Berlin Optical conduct comprehensive eye and vision examinations for each potential scleral lens wearer to assess their suitability for the lenses, ensuring that the treatment is appropriate. After beginning to wear scleral lenses, the optometrist provides detailed instructions for application and removal, as well as follow-up appointments to ensure that the lenses are worn safely and comfortably.

‍3. Why can scleral lenses be used as a treatment option for irregular corneas (such as keratoconus, cone-shaped cornea)?

‍Scleral lenses can correct visual impairment caused by irregular corneas, such as those seen in keratoconus, where the cornea is no longer perfectly spherical but has become cone-shaped or irregular. This leads to light not focusing correctly as it enters the eye, affecting vision. Scleral lenses use a tear reservoir to smooth out optical imperfections caused by irregular corneas, and because the lens completely vaults over the cornea, there is no concern about lens stability being affected by corneal shape.

4. "How are scleral lenses charged? 

Scleral lenses are charged annually, depending on the shape of the cornea and the degree of astigmatism, and are expected to be replaced every two years. This includes a pair of scleral lenses and all follow-up consultation fees. After the second year, the cost will be reduced.

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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.

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