Resurgence of scleral lenses

There's a lot going on out there in scleral-land. Did you know?

For those who don't know what I'm talking about, sclerals are extra-large gas permeable contact lenses. Unlike normal contacts, which, soft or hard, basically drape across the cornea, sclerals vault the cornea entirely and their edges rest on the sclera (white of the eye). They can hold a fluid layer over the cornea.

Sclerals have been around for a long time and while never in common use, historically they've been used mostly to treat keratoconus, a progressive disease where the cornea basically gets lopsided and vision can no longer be corrected with glasses. Sclerals make it possible to improve vision in these challenging situations by providing a sort of artificially regular, smooth, surface comprised of liquid and lens on top of the cornea to help re-focus light entering the eye which would otherwise be hitting the retina in all the wrong places.

In more recent years however, sclerals have started to be used in cases of extreme dry eye. That same fluid layer which fixes optics for people with irregular-shaped corneas can also insulate a cornea which has become extremely vulnerable to the environment around it. So some people suffering severe pain, photophobia and other symptoms have been able to get all-day relief with specially designed scleral lenses.

Boston Foundation for Sight have done the vast majority of pioneering work in this area of dry eye treatment to date, and their success has been beautiful to see. What's just as interesting is that in the past couple of years we've been starting to see a considerably more widespread effort to take commercial scleral lenses and adapt them for severe dry eye treatment.

In conversations with patients on the phone, I've been hearing of people fitted at Mayo (that's sure new - they've never been high on the list of successful dry eye treatment centers), Vanderbilt and other clinics. Today in perusing my Google dry eye newsfeeds I saw several articles on sclerals, some reporting on work done at Loyola University and others on individual optometrists' work.

I say, hurray... keep it up. Kudos to ALL of you doctors and patients pursuing sclerals for dry eye. It is challenging, and frustrating, and I believe largely unprofitable - successes are not nearly so frequent as we'd like, but the individual successes are changing many lives for the better and the aggregate successes are moving the knowledge base forward rapidly.