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Until 1979, everyone who wore contact lenses removed and cleaned them nightly. The introduction of "extended wear" enabled wearers to sleep in their contacts. Now, two types of lenses are classified by wearing time:

• Daily wear — must be removed nightly
• Extended wear — can be worn overnight, usually for seven days consecutively without removal

"Continuous wear" is a term that's sometimes used to describe 30 consecutive nights of lens wear — the maximum wearing time approved by the FDA for certain brands of extended wear lenses.

Even with proper care, contact lenses (especially soft contacts) should be replaced frequently to prevent the build-up of lens deposits and contamination that increase the risk of eye infections.

Soft lenses have these general classifications, based on how frequently they should be discarded:

• Daily disposable lenses — Discard after a single day of wear
• Disposable lenses — Discard every two weeks, or sooner
• Frequent replacement lenses — Discard monthly or quarterly
• Traditional (reusable) lenses — Discard every six months or longer

Gas permeable contact lenses are more resistant to lens deposits and don't need to be discarded as frequently as soft lenses. Often, GP lenses can last a year or longer before they need to be replaced.

Soft contact lenses (both standard hydrogel and silicone hydrogel lenses) are available in a variety of designs, depending on their intended purpose:

• Spherical contact lenses have the same lens power throughout the entire optical part of the lens to correct myopia (nearsightedness) or hyperopia (farsightedness).
• Toric soft contact lenses have different powers in different meridians of the lens to correct astigmatism as well as nearsightedness or farsightedness.
• Multifocal contact lenses (including bifocal contacts) contain different power zones for near and far vision to correct presbyopia as well as nearsightedness or farsightedness. Some multifocal lenses also can correct astigmatism.
• Cosmetic contact lenses include color contacts designed to change or intensify your eye color. Halloween, theatrical, and other special-effect contacts also are considered cosmetic lenses. A contact lens prescription is required for cosmetic contacts even if you have no refractive errors that need correction.

All of these lenses can be custom-made for hard-to-fit eyes. Other lens designs also are available — including lenses fabricated for use in special situations, such as correcting for keratoconus.

Bifocal contacts for astigmatism. These are advanced soft contacts that correct both presbyopia and astigmatism, so you can remain glasses-free after age 40 even if you have astigmatism.

Contacts for dry eyes. Are your contacts uncomfortably dry? Certain soft contact lenses are specially made to reduce the risk of contact lens-related dry eye symptoms. 

Colored lenses. Many of the types of lenses described above also come in colors that can enhance the natural color of your eyes — that is, make your green eyes even greener, for example. Other colored lenses can totally change the color of your eyes.

Special-effect lenses. Also called theatrical, novelty, or costume lenses, special-effect contacts take coloration one step further to make you look like a cat, a vampire, or another alter-ego of your choice.

Prosthetic lenses. Colored contact lenses also can be used for more medically oriented purposes. Opaque soft lenses called prosthetic contacts can be custom-designed for an eye that has been disfigured by injury or disease to mask the disfigurement and match the appearance of the other, unaffected eye.

Custom lenses. If conventional contact lenses don't seem to work for you, you might be a candidate for custom contact lenses that are made to order for your individual eye shape and visual needs.

UV-inhibiting lenses. Some soft contact lenses help protect your eyes from the sun's ultraviolet rays that can cause cataracts and other eye problems. But because contacts don't cover your entire eye, you still should wear UV-blocking sunglasses outdoors for the best protection from the sun.

Scleral lenses. Large-diameter gas permeable lenses called scleral contacts are specially designed to treat keratoconus and other corneal irregularities, as well as presbyopia.

Myopia control contacts. Special contact lenses are being developed to slow or stop the progression of nearsightedness in children.

Custom-fit scleral lenses help patients with corneal distortions and irregularities achieve dramatic improvements in visual acuity and comfort. Scleral lenses vault over the cornea and prevent discomfort by resting on the sclera so as not to place any pressure on the cornea. This creates a new optical surface to replace the distorted cornea. Moreover, the reservoir of pure saline solution between the back surface of the lens and the front of the cornea ensures that the eye is always in a liquid environment – making it optimal for healing.

Due to their size, scleral lenses are more stable on the eye than conventional GP lenses and are therefore less likely to accidentally dislodge from the eye. This stability makes them more comfortable, especially for sensitive eyes or irregularly shaped corneas. Moreover, all scleral lenses are made with highly breathable gas permeable material so that plenty of oxygen reaches the front of the eye, keeping it healthy and comfortable.

Types of Scleral Lenses

These three categories are based on the lenses’ size and primary contact with the surface of the eye.

• Corneo-scleral lenses and semi-scleral lenses are significantly larger than traditional GP lenses and rest near the junction between the cornea and the sclera.
• Mini-scleral lenses vault over the whole corneal surface and rest on the anterior sclera.
• Full scleral lenses are the largest in size and provide the most clearance between the back surface of the lens and the cornea.

Scleral Lenses Provide More Comfort and Improved Vision

Our patients report comfort as the most prominent feature of the scleral lens. Throughout the fitting process, we survey our patients on how the lenses feel, and not surprisingly, the usual feedback we get is “fine” or “I can’t feel them at all”.

Traditional contact lenses are much smaller, typically 9 -10 mm in diameter. With each blink, the contact lens moves a bit over the cornea and the lid tends to roll over the edge of the lens as well. Many patients report being unable to wear them for more than a few hours at a time due to the discomfort.

The scleral lens, on the other hand, is larger in diameter and spreads its weight over a much greater, less sensitive area so that when you blink the eyelid doesn’t catch the edge of the lens. Because the lens sits firmly on the eye, it offers more stable vision than traditional lenses. Moreover, having the lens vault over the cornea protects it from any abrasion caused by blinking or external irritants. It is made up of highly oxygen permeable materials and provides a soothing bath of artificial tears that refreshes the ocular surface. Scleral lenses not only improve comfort but make for more stable vision.

Who is a Good Candidate for Scleral Lenses?

Anyone seeking to achieve the best vision with contact lenses is a great candidate for scleral lenses. That said, these lenses are particularly useful in managing the following conditions:

Hard-to-fit eyes: Those with an irregularly shaped cornea, whether due to natural causes, an eye condition (i.e. keratoconus), or complications following surgery, tend to develop vision problems that cannot be fully corrected using soft contact lenses, as the shape of their eye cause the lenses to easily dislodge. For those people, scleral lenses provide a more comfortable, secure fit and improved vision, which may be even better than glasses.

Any of the following conditions can make wearing traditional contact lenses more challenging:

• Keratoconus
• Astigmatism
• Dry Eyes
• Giant papillary conjunctivitis (GPC)
• Post-refractive surgery (i.e. LASIK, PRK)
• Presbyopia

Dry Eyes: Those with dry eyes may find traditional contact lenses difficult to wear. Scleral lenses provide a tear reservoir between the back surface of full scleral lenses and the cornea, keeping the front of your eye moist and comfortable.

Can Children Wear Scleral Lenses?

Young children (over 6 months of age) with an ocular surface disease or severe dry eyes can benefit from wearing full scleral lenses, as they need to protect as much of the eye as possible.

Mini-scleral lenses, typically ranging from 15.0mm to 18.0mm in size, are a great choice for young children with normal corneas and high refractive errors or for those who have irregular corneas such as keratoconus. Mini-scleral are also great for kids who are intolerant to corneal GP lenses and want the comfort of a soft contact lens.

What happens during scleral lens fitting?

We carefully map the patient’s cornea using the latest corneal topography equipment. This generates a detailed diagram of your cornea, which is used to make customized scleral contact lenses.

How difficult is it to insert and care for scleral lenses?

Initially, inserting scleral lenses can be challenging. But after a short period, and thorough training by the optometrist, inserting and removing contact lenses becomes habitual. Scleral lenses are very durable, easy to handle and are easy to care for once the patient is well trained.

What Changes Will I Notice with Scleral Lenses?

Once you have been properly fitted for scleral lenses, you can expect to gradually see improvements in clarity, color, and detailed contrast between multiple images and objects within your visual field. The comfort you’ll experience will enable you to wear your custom-made scleral lenses all day long so that you can keep doing all the things you love – but with better vision.

When Should I See An Eye Doctor Specializing in Scleral Lenses?

If you are interested in seeing whether scleral lenses are right for you, make sure that the eye doctor you visit has the knowledge and experience required to correctly fit you for the lenses. Scleral lenses require precise customization, and every patient’s case varies in degrees of severity and corneal measurements.

Does Insurance Cover Scleral Lenses?

When it comes to scleral lenses, every insurance company is different. Some cover the examination and custom fitting, but not the actual lenses. Others may cover a portion of the cost or 100% of the cost, but only if other treatment methods have been exhausted. To understand the coverage and fees you can contact us or check with your specific insurance provider to understand the particulars.

• First, your contacts must address the problem that is prompting you to wear lenses in the first place. Your contact lenses must provide good vision by correcting your myopia, hyperopia, astigmatism, or some combination of those vision problems.

• Second, the lens must fit your eye. To do that, lenses come in tens of thousands of combinations of diameter and curvature. Of course, not every lens brand comes in every "size."

Your eye care provider is skilled in evaluating your eye's physiology, and your eyesight, to help determine which lens best satisfies the two criteria above.

• Third, you may have another medical need that drives the choice of lens. For example, your eye care provider might pick a particular lens if your eyes tend to be dry.

• Finally, consider your "wish list" of contact lens features — colors, for example, or overnight wear.

When you and your eye care provider decide on the right lens for you, you'll be given a contact lens prescription. You'll be able to buy a supply of lenses from your eye care provider or from the many other outlets that sell contact lenses.

Caring for your contact lenses — cleaning, disinfecting, and storing them — is much easier than it used to be.

A few years ago, you would have needed several bottles of cleaning products, and perhaps enzyme tablets, for proper care. Today, most people can use "multipurpose" solutions — meaning that one product both cleans and disinfects and is used for storage.

People who are sensitive to the preservatives in multipurpose solutions might need preservative-free systems, such as those containing hydrogen peroxide. These do an excellent job of cleaning contacts, but it's very important to follow the directions for using them. The solution should not come into contact with your eyes until soaking is complete and the solution is neutralized.

Of course, you can avoid lens care altogether by wearing daily disposable contact lenses.

Trial and error often is involved in finding the perfect lens for you. People react differently to various lens materials and cleaning solutions.

Also, the correct "parameters" of your lens — that is, power, diameter, and curvature — can be finalized only after you've successfully worn the lens. This is especially true for more complex fits involving extra parameters, such as with bifocals or toric contact lenses for astigmatism.

If you experience discomfort or poor vision when wearing contact lenses, chances are that an adjustment or change of lens can help.

Today, more contact lens choices than ever are available to provide comfort, good vision, and healthy eyes. If your eyes or lenses are uncomfortable or you are not seeing well, remove your lenses and visit your eye care provider to explore available remedies for contact lens discomfort.