What type of scleral lens is best for me?
Scleral lenses are my main specialty. I strive to provide the best fits possible, with minimal fogging and crisp vision, using a combination of technology and experience. Although I always say that the fitter of the lens matters more than its brand, I get a lot of questions regarding what type of scleral lens is best and the differences between the various brands.
Let’s break it down.
Standard Scleral Lenses
The most common mode of fitting, sometimes referred to as a “diagnostic” fitting.
Generally the least expensive type of scleral lens.
Traditional scleral lenses are fitted using a pre-manufactured fitting set. Based on certain measurements, the fitter will select a lens from their fitting set and evaluate it on a patient’s eye. They will then order an initial lens based on their observations. Once that initial lens arrives, the fitter will again observe it on the eye and potentially order a further adjusted lens. Subsequent adjustments are performed the same way, through trial and error, until the fitter reaches a lens design they are satisfied with.
Good for: regular corneas, dry eye, mild-to-moderately irregular corneas and relatively symmetrical corneas & scleras
Common brands include (but are not limited to): ZenLens, Custom Stable, BostonSight scleral, Atlantis, Jupiter, Europa, OneFit, SynergEyes VS
Scan-Based (Custom) Scleral Lenses
Lenses are designed using technology, sometimes referred to as “empirical” fitting.
Scan-based scleral lenses are manufactured based on the results of a profilometry scan that maps out the contours of both the cornea and sclera. You and your doctor will likely reach an optimal fit faster with this method. Due to the more intricate, contoured fit, patients tend to experience less fogging and more comfort.
There are two types of scan-based lenses. One is what I call a freeform lens - this is a true 3D printed scleral lens. The other is a super-customized “standard” lens that more closely matches the contour of the eye with additional customization that only a scan provide. My office can use any of the standard designs that are integrated with the Eaglet ESP profilometer to create a scan-driven lens.
Good for: large degrees of corneal & scleral irregularity, asymmetric & advanced keratoconus, conjunctival irregularity, and anyone who has “failed” with traditional lenses
Freeform brands include (but are not limited to): Gaudi, Wave, Boston 360, Maxim3D, ScanFit, Latitude
Impression-Based (Ultra-Custom) Scleral Lenses
Lenses are created from taking a physical mold of the eye.
The most precise fit option.
Provides the most customization options.
An impression-mold is taken of the cornea and sclera for a super-customized and specific scleral lens. The impression takes a few minutes and the resulting lens is much more likely to fit optimally on the first attempt. 40 to 80,000 data points are collected to create a truly precise fit for the most significantly irregular eyes. Certain customizations are available with this method of design that are not available with the other methods of fitting.
Good for: highly irregular scleras, highly irregular corneas such as advanced keratoconus, large pingueculas, post-surgical eyes (especially post-glaucoma surgery), severe dry eye (can cover up to 24mm in diameter), anyone who is difficult to scan, those who have “failed” with other types of scleral lenses due to discomfort, those who need rotationally stable lenses for HOA correction, and those who need prism correction in their lenses
Brands include: EyeFitPro, EyePrintPro
Ovitz Wavefront Guided Scleral Lenses
Although patients get excellent vision through their scleral lenses, there are still many users who continue to experience poor quality of vision or residual higher order aberrations (HOA). These include visual degradation such as glare, starbursts, halos, visual fog, residual astigmatism and “soft” vision after an otherwise successful scleral fit. This technology allows us to reduce or eliminate residual aberrations by taking a wavefront map of the eye to quantify and correct for an individual's aberrations. This information can then be applied onto their current scleral lens device. A precise fit is necessary for the best visual results, though this technology can be added to any of the fitting modalities (standard, custom, or ultra-custom) mentioned above.
Good for: those looking for the sharpest vision possible
Brands that allow for this technology to be added onto their designs include: Zenlens Chroma, Ares, Gaudi, BostonSight scleral, EyeFitPro, EyePrint Pro.