Who Is a Candidate for Scleral Lenses?

Often, an eye doctor will let you know during an eye exam about your cornea shape and what type of lenses you can wear. If you visited an eye doctor, and he or she stipulated that you could only wear glasses, they likely lacked the expertise and knowledge to help introduce scleral lenses.

Candidates for scleral lenses are mainly due to corneal issues as stated above. Scleral lenses are often advised to treat astigmatism and dry eye syndrome.

Getting Started With Scleral Lenses

Scheduling an eye exam is the first thing needed to review the health of your eyes and see if scleral lenses are for you. If you fit the criteria for scleral lenses, Dr. Hendrickson will guide you through the methods to install and remove the lenses, proper care and maintenance, and follow ups.

Benefits of Scleral Lenses

Vision from scleral lenses are far better than glasses or contact lenses. The shape of your cornea determines how clearly you see, and glasses or regular lenses don’t fix or reshape the cornea. These lenses, however, mask the cornea, giving you excellent vision.

If you've been told in the past that you cannot wear contact lenses because of an irregular cornea or other problems, you may want to get a second opinion and ask Dr. Matthew Hendickson of Clarity Eye Care about scleral contact lenses.

Scleral contacts are large-diameter gas permeable contact lenses specially designed to vault over the entire corneal surface and rest on the "white" of the eye (sclera). These extra large contacts replace the irregular cornea with a perfectly smooth optical surface in order to correct vision problems caused by corneal irregularities like keratoconus. Also, the space between the cornea and the back surface of a scleral lens acts as a fluid reservoir to provide comfort for people with severe dry eyes who otherwise could not tolerate contact lens wear.

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Types of Scleral Contact Lenses

Scleral contacts are noticeably larger than standard gas permeable (GP) contacts and have a diameter equal to or greater than that of soft contact lenses. The smallest sclerals are approximately 14.5 mm in diameter, and the largest can be up to 24 mm. Typically, lenses that are 18 mm or smaller are subcategorized as mini-sclerals. Another category of gas permeable lenses bridges the size gap between conventional GP lenses and mini-sclerals. These lenses, called corneo-scleral lenses, generally are approximately 13 to 15 mm in diameter.

The size of lens used often is determined by the degree of complexity of the condition. Milder forms of keratoconus and irregular astigmatism from corneal grafts and refractive surgery often are easily managed with scleral lenses at the smaller end of the spectrum. Smaller scleral and mini-scleral contacts can be easier to apply, can be less costly and require fewer care products.

More complex conditions, including advanced keratoconus, pathologically dry eyes or severe ocular surface disease that might require a large tear reservoir, often are fitted with larger scleral lenses, as they have more capacity to hold fluid or bridge large changes in corneal curvature. During your contact lens exam and fitting, your eye care professional will determine the best scleral lens type and size for your specific needs.

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Matthew S. Hendrickson, O.D.

With his own extensive family history of eye conditions, Dr. Hendrickson developed an interest in state-of-the-art eye care in his 20s to help those with their eye health. He studied under doctors who cared about their patients, who provided comprehensive eye exams rather than trying to finish them in record time.

After graduating from optometry school in 2009, Dr. Hendrickson made a decision to go against chain practices that have cheapened the public perception of the value of a comprehensive eye examination. In some cases, these big companies force employed optometrists to perform eye exams so quickly to make their high-volume business model work, that the exam quality inevitably suffers. Worse yet, many eye diseases go undetected until they have already caused damage to sight. Due to his passion for a detailed, quality exam, and genuine care for the eye health of the patients, Dr. Hendrickson decided to open his own practice.

With a background in LASIK co-management, Dr. Hendrickson learned how to be precise with prescription measurements. His training at Illinois College of Optometry provided an excellent skillset to treat an array of injuries and diseases of the eye. In addition, Dr. Hendrickson has a keen interest in specialty contact lens fittings and the latest tech in eye health. Specialty contact lens fittings are for people with diseased or damaged corneas that cannot see well without the use of custom-made contact lenses, and the process to fit these takes extra time and resources, so it is a specialty that the vast majority of offices will not do. So, in September 2013, Dr. Hendrickson opened Clarity Eye Care.

“Patients are consistently surprised at the difference in my eye exam vs. what they’re experienced at “eye exams” elsewhere. Today, in addition to the basic eyeglasses and regular contact lenses, I am able to detect and treat eye disease, prevent nearsightedness in children with contact lenses, repair injured corneas with advanced grafts, and much more. I, unlike many of my colleagues, am using my license to its fullest not just to treat eyes, but to treat the patient as I would my own family.” – Dr. Hendrickson

As with many small businesses, a main struggle as a relatively new practice is how to get the word out and stand out among the noise of advertising from the big corporations who are advertising an inferior service (ever heard of the “free eye exam” advertised?). The main obstacle, though, is public perception of what exactly is an eye exam. Most people think the eye exam is when you get a glasses prescription and the doctor asks you “which is better? 1 or 2?” In fact, that is technically a completely separate service from an eye exam, called a refraction. There are even some online companies touting an “online eye exam” where your eyes aren’t even examined at all!

That is such a misnomer, as they are actually “online refractions,” and even that is questionable. A comprehensive eye exam is accomplished by testing:

  • The function of the visual system in multiple ways
  • Examining the eyes in detail microscopically
  • Scanning the retina, optic nerve, and other structures of the eye for abnormalities.

One patient at a time, Dr. Hendrickson is trying to shift the public perception to expect this level of thoroughness and to realize the importance of the yearly exam.

Scleral Contacts for Keratoconus

Many optometrists and ophthalmologists recommend scleral contact lenses for a variety of hard-to-fit eyes, including eyes with keratoconus.

Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with keratoconus. Also, scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses.

Most insurance programs do not automatically cover the full cost of scleral contact lenses. In some cases, vision insurance may reduce the cost of your lenses and/or fitting fee. In other instances, contacting your medical insurance provider and inquiring what steps are necessary to obtain coverage can be helpful. Ask your eye doctor’s office for details.

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