Told You Are Hard to Fit in Contacts? Scleral Lenses Are Usually the Answer
Medically reviewed by Dr. Massimo Gramanzini, OD
If you have been told by more than one office that contacts will not work for you, or you have been handed lens after lens that hurts, blurs, or pops out, you are asking a fair question: is there actually an option left for me, or do I just live with glasses that never quite focus right? For most patients with keratoconus, a corneal transplant, a cornea changed by old RK or LASIK surgery, severe dry eye, or high astigmatism, the answer is yes. You likely just need a lens fit by an office that works with irregular corneas every day, not once in a while.
What a Scleral Lens Actually Is
A scleral lens is a larger, rigid lens that vaults completely over the cornea, the clear dome on the front of your eye, and rests instead on the sclera, the white part of the eye. Because it never touches the cornea itself, it never rubs against the exact surface that is irregular, scarred, or sensitive. Standard soft or small rigid lenses drape over that irregular surface and shift, warp, or fall out during the day. A scleral lens skips that problem by landing on a surface that is far more tolerant of a foreign object sitting on it, and it tends to stay centered and stable instead of shifting with a blink.
The Two Things That Make It Work
A scleral lens does two jobs at once, and both matter for different reasons.
- It creates a smooth optical surface. Underneath the lens sits a layer of fluid that fills in the irregular shape of your cornea. Light passing through that fluid and the smooth lens surface focuses the way it would on a normal, evenly curved eye. Glasses cannot do this because they sit far in front of the eye and cannot correct an irregular surface up close. This is why patients who were told glasses were their best option often see a dramatic improvement once they are properly fit.
- It holds a reservoir of sterile saline against the eye all day. That fluid layer also bathes the cornea in moisture from the moment you put the lens in until you take it out. For patients with severe dry eye, this often makes scleral lenses the most comfortable option they have tried, not the least, because the eye is never exposed to open air the way it is with a smaller lens or with no lens at all. If dry eye has been part of your history, it is worth having that evaluated on its own, and you can read more on our dry eye treatment page.
Why a Bigger Lens Does Not Mean More Discomfort
Most patients assume a larger lens will feel like more foreign material in the eye and expect it to be worse. It usually is not. The cornea is one of the most nerve dense tissues in the body, which is why even a small piece of debris on it feels unbearable. The sclera has far fewer nerve endings. Since a scleral lens rests on the sclera and never touches the cornea, many patients report that it feels more comfortable, once fit correctly, than the small lenses they struggled with before.
The cornea is one of the most nerve dense tissues in the body. The sclera has far fewer nerve endings, which is why the bigger lens is usually the more comfortable one.
Who Scleral Lenses Are For
- Keratoconus
- Corneal transplant
- Post RK corneas, from older radial keratotomy surgery
- Post LASIK corneas with irregular healing
- High astigmatism that standard lenses cannot stabilize
- Severe dry eye that has not responded to drops alone
- Anyone who has been told they are simply hard to fit
A Short Word on Keratoconus
Keratoconus is a condition where the cornea gradually thins and bulges outward into a cone shape instead of staying evenly round. That cone distorts light as it enters the eye, which creates blur and streaking that glasses cannot fully correct because the surface itself is uneven. It typically begins in the teens or twenties and is one of the most common reasons patients end up needing a scleral lens instead of standard correction.
How Family Eye Center Fits Scleral Lenses
Fitting an irregular cornea well takes more than a standard trial lens set off a shelf. At Family Eye Center in Davie, Dr. Gramanzini uses tools built specifically for this kind of fitting, and the process is built around your eye rather than a general starting point.
- Corneal topography maps the exact shape of your cornea, point by point, instead of estimating from an average curve. This map guides the lens design from the very first fitting.
- TSAS, the Tear Stability Analysis System, evaluates the quality of your tear film, since that fluid layer under the lens is only stable if the tears themselves are healthy.
- Lens options include Ampleye scleral lenses for irregular and sensitive corneas. Paragon CRT, an orthokeratology lens worn overnight to temporarily change the curve of the cornea, and standard rigid gas permeable lenses are also fit at our office, but for different needs than a scleral lens addresses.
- Dr. Gramanzini is a member of the Scleral Lens Society, which keeps him current on fitting techniques for exactly these complex cases.
You can read more about the process on our scleral lenses page, and if a full eye exam has not been done recently, that is usually the first step before any specialty fitting begins. You can learn more about that on our eye exam page.
What to Expect From the Fitting Process
A scleral fit is a series of visits, not one appointment where you walk out wearing a finished lens. Every eye is shaped differently, and the lens is refined step by step until the fit, comfort, and vision are right. Patients who arrive expecting a single visit are often the ones who get discouraged early, so we talk about this openly from the start. Patients who understand it as a process tend to stick with it and end up genuinely happy with the result.
Wearing Scleral Lenses Day to Day
- Insertion: the lens is filled with sterile saline and placed on the eye using a small insertion tool or the fingertips, so the fluid reservoir is in place from the moment it goes on.
- The learning curve: most patients need one to two weeks to feel confident inserting and removing the lens on their own. This is normal and expected.
- Daily cleaning: the lens is cleaned each night with the solution recommended for your specific lens, rinsed, and stored properly for the next day of wear.
Why Patients Travel for This
Patients come from Davie, Plantation, Sunrise, Weston, and Cooper City specifically for specialty lens fittings. The most common story we hear is almost always the same: another office told them they were hard to fit, or handed them a lens that never worked, and they gave up looking for a solution. If that sounds familiar, a scleral lens fitting may be worth a conversation before you decide contacts simply are not for you.
If you have been struggling with irregular vision, a previous diagnosis of keratoconus, a corneal transplant, or dry eye that has not responded to drops, call Family Eye Center in Davie at (954) 423-8444 to schedule an evaluation. We will look at your specific eyes and tell you plainly what options exist for your situation.
Been told you are hard to fit?
Medically reviewed by Dr. Massimo Gramanzini, OD. Dr. Gramanzini has practised in Davie for over 25 years and is certified in the treatment and management of ocular disease. Meet Dr. Gramanzini.
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