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Scleral Contact Lenses: Customized Vision

Have you been informed in the past that you are not a candidate for contact lenses, or that you cannot wear contact lenses because of an irregular cornea, dry eye, or another issue? If so, you may want to inquire about pursuing scleral contact lenses. They are a customizable lens that can worn by a greater number of individuals.

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Scleral contact lenses are large-diameter gas permeable contact lenses specially designed to span the entire corneal surface and rest on the "white" portion of the eye (sclera). The result is that the scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by keratoconus or other corneal irregularities. The gap formed between the cornea and back surface of a scleral lens becomes a reservoir for a saline solution that provides comfort for people with severe dry eyes, who otherwise could not tolerate contact lens wear.

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Scleral contacts are comparatively larger than standard gas permeable (GP) contact lenses and have a diameter equal to or greater than soft contact lenses. With the average cornea being approximately 11.8 millimetres in diameter, even small scleral contact lenses cover the entire corneal surface. Corneo-scleral lenses often are a good choice for people who require larger-than-normal GP lenses for greater comfort. They also are frequently used when contact lenses are needed following corneal refractive surgery to correct irregular astigmatism. Larger scleral lenses are great for conditions such as keratoconus, chronic dry eyes, and severe ocular surface disease that may benefit from a large tear reservoir. That is because the gap created between lens and cornea would have a greater capacity to hold fluid (i.e., saline) and span large corneal variances.

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Scleral contact lenses are tailor-made for each patient. Accordingly, fitting scleral contacts requires greater expertise, technology (i.e., corneal topographer) and more time than fitting standard soft or gas permeable contact lenses. Also, because scleral contact lenses are a precision product, adjustments to lens parameters may be needed and addtional be made and exchanged. The complete fitting process can require several visits to determine the optimal lens for both eyes. Mastering inserting and removing scleral lenses may also take some practice, even for experienced contact lens wearers. This is due to the larger lens size and the need to maintain a fluid reservoir under the lenses. Because of the expertise needed to fit and manufacture scleral lenses, costs are noteably greater than compared to fitting soft or GP contact lenses.

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Yes! Cleaning the lenses with an approved solution removes deposits from the lens surface and kills microbes that potentially cause eye infections.

Non-preservative, non-buffered, inhalent saline is required for scleral contact lenses. There is minimal tear exchange when the lens is on the eye. Long-term exposure to preservatives can cause a sensitivity or toxicity to the cornea resulting in redness and irritation. Non-buffered saline contains only 2 ingredient - purified water and sodium chloride (i.e., salt, or NaCL). By comparison, buffered saline has four ingredients - purified water, sodium chloride,, sodium borate and borc acid. The latter two ingredients can often cause irritation.

If you apply the lens and notice that your vision is blurry or the lens feels uncomfortable, you may have an air bubble trapped underneath. Sometimes you can see the bubble if you look in the mirror, but other times you cannot. If you think there is a bubble, remove the lens and reapply it.

Foggy or cloudy vision is often attributed to two causes. First, there may be mucous or debris trapped between the lens and the cornea. This can occur when the lens does not align properly to the eye. Second, the front surface of the lens may not be wetting well. There are multiple reasons for this including poor tear film chemistry, improper cleaning, or lens surface breakdown. On rare occasions, foggy vision can also occur when the cornea becomes edematous (swollen). If your vision is still foggy after removing the lens, please inform your eye care practitioner. It is strongly recommended that any foggy or cloudy vision be addressed with your eye care practitioner.

No. Sleeping in lenses reduces oxygen transmission to the eye. This can cause swelling of the cornea and the abnormal growth of blood vessels into the cornea.

Yes, it is normal. We call it an impression ring. Similar to when you remove a watch or a pair of socks, there is often an impression in the tissue due to the placement of a device. This is not a problem and should disappear within about 5 minutes. If, however, you experience a significant amount of redness in this area after removing the lenses, especially if it persists after a few minutes, talk to your eye doctor, as this may indicate that the lens is fitting too tightly.

If cared for properly, most lenses are expected to last at approximately one year.
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Doctor Jennifer Ash, Eye Doctor (Edmonton)

Dr. Jennifer Ash is the Resident Optometrist at Eye-deology Vision Care. Dr. Ash provides patient care 5 days a week. Read more about Dr. Ash.

Doctor Sarah Virji, Eye Doctor (Edmonton)

Dr. Sarah Virji is an Associate Optometrist at Eye-deology Vision Care. Dr. Virji regularly provides patient care Thursdays and Saturdays. Read more about Dr. Virji.

Doctor Ruhee Kurji, Eye Doctor (Edmonton)

Dr. Ruhee Kurji is an Associate Optometrist at Eye-deology Vision Care. Dr. Kurji provides patient care Tuesdays & Fridays. Read more about Dr. Kurji.

Doctor Jade McLachlin, Eye Doctor (Edmonton)

Dr. Jade McLachlin is an Associate Optometrist at Eye-deology Vision Care. Dr. McLachlin provides patient care 5 days a week. Read more about Dr. McLachlin.

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