Scleral lenses were initially made out of glass until poly-methyl methacrylate was available in the 1940s.

To simplify this, scleral contact lenses are defined as large-diameter rigid gas permeable lenses that rest entirely on the sclera ranging from 14 mm to >20 mm in diameter. The Scleral Lens Education Society classifies scleral contact lenses based on diameter: semi-scleral (12.5–15 mm), mini-scleral (15–18 mm), and large scleral (18–25 mm). 8 These lenses are unique when compared to corneal gas permeable contact lenses in that they maintain a fluid reservoir between the back surface of the contact lens and the front surface of the eye. Scleral lenses are large-diameter gas permeable contact lenses that are supported by a tear reservoir, rest on the conjunctival tissue overlying the sclera, and vault the cornea and limbus. Corneal gas permeable contact lenses are supported exclusively by the cornea and do not extend past the limbus. Scleral lenses differ from corneal gas permeable lenses based on lens diameter and fitting characteristics. 3, 4 This review focuses on one of the least used indications for scleral lenses, ocular surface disease. 7 The precorneal fluid reservoir hydrates the cornea while mechanically protecting the ocular surface from the shearing forces of the lids and environment.

6 There are many therapeutic uses of scleral lenses in addition to providing similar benefits as a corneal gas permeable lens by masking irregular astigmatism and reducing higher order aberrations in patients with corneal irregularity. 6 This increase may be due to innovations in technology, advancements in educational platforms, and increased availability of commercial lenses from laboratories. 6 More than 80% of scleral lens prescribers reported fitting their first lens after 2005 and >54% after 2010. The Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) study group in 2015 reported that 16% of scleral lenses are currently being prescribed for ocular surface disease, 74% for corneal irregularity, and 10% for uncomplicated refractive error.

1 – 5 The large diameter of the medical device completely covers the cornea protecting it with a fluid reservoir creating an ideal ocular surface environment and making these lenses particularly useful for ocular surface disease. The prescription of scleral lenses for the management of corneal irregularity, uncomplicated refractive error, and ocular surface disease is increasing.

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