Scleral contact lenses are large, rigid gas-permeable lenses that vault over the cornea and rest on the tissue covering the white part of the eye. The space between the lens and cornea is filled with preservative-free saline, creating a smooth optical surface and a protected fluid reservoir.

Research supports scleral lenses as an effective form of visual rehabilitation for many people with keratoconus, corneal irregularity, corneal scarring and irregular astigmatism. They can also protect the eye surface and improve comfort in selected patients with severe dry eye or ocular-surface disease.

However, scleral lenses are not equally suitable for every patient. Results depend on the underlying condition, lens design, handling ability and ongoing clinical monitoring. Research also identifies limitations including midday fogging, redness, air bubbles, deposits, handling difficulty and corneal swelling in susceptible eyes.

Scleral Lens Research at a Glance

Improved Functional Vision

Scleral lenses create a regular optical surface over an irregular cornea. Research shows that they can substantially improve functional vision for many patients with keratoconus and other complex corneal conditions.

Better Comfort and Quality of Life

Many patients experience more stable vision and improved daily visual function. For severe ocular-surface disease, the fluid reservoir may also reduce discomfort and protect damaged corneal tissue.

Benefits Depend on the Fit

Outcomes vary between patients. Accurate lens design, correct handling and regular reviews are important for maintaining vision, comfort and corneal health.

How Do Scleral Lenses Improve Vision?

Conditions such as keratoconus, corneal scarring and complications following eye surgery can cause the cornea to become irregular.

Glasses can correct regular short-sightedness, long-sightedness and astigmatism, but they cannot fully neutralise more complex corneal distortion.

A scleral lens holds its shape over the irregular cornea. The fluid beneath the lens fills the space between the corneal surface and the lens, while the front surface of the lens provides a smoother and more regular optical surface.

This can reduce blur, ghosting, glare and visual distortion that may not be adequately corrected with glasses or soft contact lenses.

Scleral Lenses for Keratoconus

Keratoconus is one of the most common reasons for fitting scleral lenses.

A 2025 systematic review found that scleral lenses can provide substantial and sustained improvements in visual acuity and quality of life for people with keratoconus, particularly those with more advanced disease. However, the review also noted that much of the available evidence comes from observational studies and that additional controlled, long-term research is still required.

A 2026 study examining scleral lenses across different keratoconus stages and cone locations also supported their role in visual rehabilitation. The results reinforce that individual corneal shape and disease severity should be considered when selecting and designing a lens.

For many patients, the main benefits may include:

• Clearer and more stable vision
• Reduced ghosting and visual distortion
• Improved comfort compared with smaller corneal rigid lenses
• Better lens stability
• Improved confidence with work, driving and everyday activities

Do Scleral Lenses Stop Keratoconus Progressing?

Scleral lenses improve vision, but they do not treat the underlying weakening or progression of keratoconus.

Patients with progressive keratoconus may require corneal cross-linking to help stabilise the cornea. Cross-linking and scleral lenses perform different roles: cross-linking is intended to reduce further progression, while a scleral lens is used to improve vision.

Patients with keratoconus should continue to undergo appropriate corneal imaging and monitoring even when their vision is good through their lenses.

Vision and Quality of Life

The effect of keratoconus extends beyond the number of letters that can be read on an eye chart. It may affect driving, work, study, confidence, independence and mental wellbeing.

Research has found that scleral lenses can improve vision-related quality of life in people who have not achieved satisfactory results with glasses or conventional rigid contact lenses.

A 2025 study examining quality of life in people with keratoconus found that scleral-lens wearers reported better outcomes in areas including general vision, mental health and overall vision-related quality of life.

Earlier research also found clinically significant quality-of-life improvements among patients with keratoconus or previous corneal transplantation who had been unable to tolerate or obtain adequate vision from conventional rigid lenses.

Individual results still vary. Some patients achieve excellent visual acuity but continue to notice glare, halos or reduced contrast, particularly in difficult lighting. Advanced lens designs may be considered when standard optical correction does not adequately address these symptoms.

Scleral Lenses After Corneal Surgery or Transplantation

Some patients continue to experience significant irregular astigmatism after corneal transplantation, corneal cross-linking, corneal-ring implantation or refractive surgery.

Because the scleral lens vaults the cornea, it can provide a regular optical surface without relying on the underlying cornea to have a regular shape.

Published research supports scleral lenses as a visual-rehabilitation option following corneal transplantation, including for patients who cannot obtain functional vision with glasses. However, grafted corneas require particular care because endothelial cell numbers and oxygen tolerance may be reduced.

Lens design may need to account for:

• The type and position of the graft
• Clearance over the graft junction
• Corneal thickness and endothelial health
• Lens and fluid-reservoir thickness
• Oxygen transmission
• Previous episodes of swelling or graft rejection
• Changes in corneal shape over time

Not every grafted eye is suitable for unrestricted scleral-lens wear. Wearing time may need to be limited, and additional monitoring may be required.

Scleral Lenses for Dry Eye and Ocular-Surface Disease

The fluid reservoir beneath a scleral lens can protect the cornea from exposure, eyelid friction and tear evaporation.

This can make scleral lenses helpful for selected patients with severe ocular-surface conditions such as:

• Ocular graft-versus-host disease
• Sjögren’s disease
• Stevens–Johnson syndrome
• Neurotrophic keratitis
• Exposure keratopathy
• Limbal stem-cell deficiency
• Severe dry eye associated with corneal damage

Evidence is strongest for severe or complex ocular-surface disease, particularly where conventional treatments have not provided sufficient relief.

A 2024 study of 31 patients with severe ocular graft-versus-host disease found that mini-scleral lenses improved median visual acuity from approximately 20/40 with spectacles to 20/25 with the lenses. Median Ocular Surface Disease Index scores improved from 73 to 27, and corneal staining also decreased. However, approximately 23% of patients eventually discontinued treatment, commonly because of handling difficulty or insufficient subjective benefit.

What About More Common Dry Eye?

The evidence is less established when scleral lenses are used for dry eye in an otherwise regular and relatively healthy cornea.

A 2024 review found growing interest and some supportive evidence for this use, but concluded that the available research remained limited. Scleral lenses should therefore not automatically be considered the first treatment for every person with dry-eye symptoms.

A 2026 pilot randomised trial compared mini-scleral and conventional rigid lenses in patients with irregular corneas and dry eye. Both groups experienced improved corrected vision and reduced dry-eye questionnaire scores. The mini-scleral group reported better subjective comfort and fewer visual fluctuations, although the researchers noted that larger studies are needed.

For patients with uncomplicated dry eye, factors such as meibomian-gland dysfunction, inflammation, incomplete blinking and environmental exposure should usually be assessed and treated before considering scleral lenses.

Are Scleral Lenses Safe?

Scleral lenses are generally well tolerated when they are correctly fitted, made from appropriate high-oxygen materials and reviewed regularly.

However, they are medical contact lenses and are not risk-free.

Possible complications include:

• Corneal staining
• Redness or conjunctival compression
• Lens-edge irritation
• Air bubbles beneath the lens
• Midday fogging
• Surface deposits
• Papillary conjunctivitis
• Corneal swelling or reduced oxygen supply
• Difficulty inserting or removing the lenses
• Inflammation or infection

A comprehensive 2025 review found that many reported complications were associated with an unsuitable fitting relationship or difficulties with lens application and care. The review also highlighted that patients with low endothelial cell density, previous corneal transplantation or other conditions affecting corneal oxygen tolerance may require additional caution.

Serious infection appears uncommon, but it remains possible. Patients should remove their lenses and seek prompt assessment if they develop significant pain, redness, light sensitivity, discharge or a sudden reduction in vision.

Oxygen and Corneal Health

Although modern scleral lenses are made from gas-permeable materials, oxygen must travel through both the lens and the fluid reservoir before reaching the cornea.

The amount of oxygen reaching the cornea may be influenced by:

• Lens material
• Lens thickness
• Fluid-reservoir thickness
• Wearing time
• Corneal endothelial health
• Previous eye surgery
• The presence of a corneal graft
• Lens fenestrations or other design modifications

A 2026 one-year study found that visual acuity remained stable in keratoconus patients wearing scleral lenses, although measurable regional changes in corneal thickness and curvature occurred. The authors concluded that the findings support personalised fitting and continued long-term monitoring rather than assuming the cornea remains unchanged during wear.

Why Does Midday Fogging Occur?

Midday fogging describes a gradual reduction in vision caused by debris or clouding within the fluid reservoir beneath the lens.

It may be influenced by:

• Tear and cellular debris entering beneath the lens
• Inflammation of the ocular surface
• An unsuitable landing-zone alignment
• Excessive lens clearance
• Meibomian-gland dysfunction
• Use of an unsuitable filling solution
• Lens deposits or poor surface wettability

Fogging does not always mean the lens has been cleaned incorrectly. It may indicate that the lens fit, ocular surface or filling system needs to be reassessed.

Some patients need to remove, clean, refill and reinsert their lenses during the day. Changes to lens alignment, clearance, surface treatment or the filling solution may help.

Why Customised Lens Design Matters

The front of the eye is not perfectly symmetrical. The scleral surface often changes shape in different directions and may become particularly irregular after surgery, trauma or advanced corneal disease.

A lens that appears acceptable centrally may still create excessive pressure, lift or instability elsewhere.

Customisation may involve adjusting:

• Overall lens diameter
• Central and limbal clearance
• Scleral landing-zone shape
• Toric or quadrant-specific haptics
• Lens thickness
• Optical-zone position
• Front-surface prescription
• Fenestrations or channels
• Surface coatings
• Higher-order optical correction in selected cases

At Westmead Eyes, scleral-lens fitting may involve corneal topography, anterior-segment OCT and three-dimensional corneo-scleral profiling. These measurements help guide lens design, but clinical assessment and follow-up remain essential because a lens can settle and interact differently with the eye after several hours of wear. Your existing scleral-lens service describes the fitting technology and lens options available at the practice.

Why Regular Reviews Are Important

Seeing clearly does not necessarily confirm that the lens is fitting safely.

Follow-up examinations allow the optometrist to assess:

• Vision and prescription
• Corneal and limbal clearance
• Lens settling
• Landing-zone alignment
• Redness or tissue compression
• Corneal staining or swelling
• Lens deposits and surface condition
• Handling and cleaning technique
• Wearing time and comfort
• Changes in the underlying eye condition

The review schedule depends on the complexity of the eye, the lens design and the patient’s clinical history.

Patients with corneal grafts, severe ocular-surface disease, low endothelial cell counts or a history of corneal swelling may require closer monitoring.

Key Recent Research

Select a study below to read a patient-friendly summary of its findings.

One-Year Impact of Scleral Lens Wear on the Keratoconic Cornea 2026

Long-Term Corneal Monitoring

This study followed people with keratoconus wearing scleral lenses over 12 months.

Visual acuity remained stable, although measurable regional changes in corneal thickness and curvature were observed. These changes did not result in reduced visual performance during the study period.

The findings support scleral lenses as an effective option for visual rehabilitation while also reinforcing the importance of personalised lens design and regular corneal monitoring.

View the published research

Long-Term Effectiveness of Scleral Lenses for Keratoconus 2025

Systematic Review

This systematic review examined the long-term use of scleral lenses for people with keratoconus.

The review found that scleral lenses can provide substantial and sustained improvements in vision and quality of life, particularly for people with more advanced keratoconus.

The authors also noted limitations in the available evidence, including differences in how outcomes were measured and a shortage of long-term controlled studies.

View the published research

Scleral Lenses and PROSE: Indications and Complications 2025

Comprehensive Clinical Review

This broad review examined the use of scleral lenses and PROSE devices for irregular corneas and ocular-surface disease.

The authors found that scleral lenses can improve vision, protect the ocular surface and assist patients with complex corneal conditions.

The review also discussed possible complications relating to lens fit, oxygen delivery, handling, deposits, fogging and the patient’s underlying eye condition. Many of these problems may be reduced by modifying the lens design or care system.

View the published research

Keratoconus, Scleral Lenses and Quality of Life 2025

Vision-Related Quality-of-Life Study

This study examined how keratoconus and different forms of vision correction affect patients’ everyday quality of life.

Scleral-lens wear was associated with better results in several vision-related quality-of-life areas when compared with corneal rigid lens wear.

This highlights that successful scleral-lens treatment is not only about reading smaller letters on an eye chart. Stable vision, comfort and the ability to perform everyday activities are also important treatment outcomes.

View the published research

Mini-Scleral Lenses for Ocular Graft-Versus-Host Disease 2024

Vision and Ocular-Surface Outcomes

This study evaluated mini-scleral lenses in patients with chronic ocular graft-versus-host disease and severe ocular-surface symptoms.

Patients experienced improvements in vision, corneal staining, symptoms and eye-related quality of life.

Some patients still discontinued treatment, commonly because of handling difficulty or insufficient subjective benefit. This demonstrates that clinical improvement does not always overcome the practical challenges of wearing scleral lenses.

View the published research

Scleral Lenses for Dry Eye Without Corneal Irregularity 2024

Review of the Available Evidence

This review examined scleral-lens treatment for dry-eye disease in patients without significant corneal irregularity.

The authors identified potential benefits including reduced tear evaporation, improved corneal protection, clearer vision and better comfort for selected patients.

However, the available evidence was described as limited. Scleral lenses should therefore not automatically be considered the first treatment for every person with dry eye. The cause and severity of the condition should be assessed first.

View the published research

Book a Scleral Lens Assessment

A scleral-lens assessment allows us to examine your eyes, assess your vision and determine whether a scleral lens is appropriate for your condition.

Depending on your needs, the assessment may include:

• Refraction and vision testing
• Corneal topography
• Anterior-segment OCT
• Three-dimensional corneo-scleral imaging
• Diagnostic scleral-lens fitting
• Assessment of comfort and visual improvement
• Discussion of suitable lens designs and expected outcomes

Scleral lenses are highly customised medical devices. An initial assessment cannot guarantee that a particular lens will provide a specific level of vision, comfort or wearing time.

No referral is required.

This page provides general information about published scleral-lens research. It does not replace an individual examination, diagnosis or personalised clinical advice.