Scleral Lens Applications in Ocular Surface Management

Scleral lenses are large-diameter rigid gas-permeable devices that vault entirely over the cornea and rest on the sclera, creating a tear-filled reservoir that both protects and hydrates the ocular surface. Originally conceived to address severe corneal irregularities such as keratoconus and post-keratoplasty astigmatism, they have evolved into a versatile therapeutic modality for a wide range of ocular surface diseases. The sealed fluid reservoir promotes epithelial healing in conditions such as persistent epithelial defects, chemical injuries and graft-versus-host disease, while the rigid optical surface corrects higher-order aberrations and restores visual acuity. Advances in anterior segment optical coherence tomography and three-dimensional corneoscleral topography have refined haptic designs to match individual scleral contours, reducing lens movement and conjunctival compression. Structured fitting protocols and assessment of practitioner learning curves have accelerated clinical adoption. Globally, scleral lenses offer a non-invasive alternative to surgical intervention, combining refractive correction with sustained ocular surface protection in patients with complex anterior segment pathology.

Research from Nature Portfolio

Recent studies have demonstrated that large-diameter scleral lenses significantly improve both visual acuity and ocular surface health in patients with intractable surface diseases. In a prospective trial involving subjects with persistent epithelial defects, graft-versus-host disease and Stevens–Johnson syndrome, the use of scleral lenses over twelve weeks yielded marked improvements in best-corrected visual acuity, reductions in corneal and conjunctival fluorescein staining and enhanced patient-reported outcomes on both the Ocular Surface Disease Index and National Eye Institute Visual Function Questionnaire. No significant adverse effects were observed, underscoring the safety and efficacy of these lenses for severe ocular surface conditions.

Scleral Lens Applications in Ocular Surface Management publication trend

The graph below shows the total number of articles in scleral lens applications in ocular surface management across all publications each year (not limited to Nature Index journals).

Technical terms

Scleral lens: A large-diameter rigid gas-permeable lens that vaults over the cornea and lands on the sclera, creating a sealed fluid reservoir.

Best-corrected visual acuity (BCVA): The highest level of visual clarity achieved with optimal optical correction.

Fluorescein staining: A diagnostic technique using fluorescent dye to reveal epithelial defects on the cornea or conjunctiva under blue light.

Ocular Surface Disease Index (OSDI): A validated questionnaire measuring symptoms and functional limitations associated with ocular surface disorders.

Corneoscleral topography: Three-dimensional mapping of the combined corneal and scleral contours to guide customised lens fitting.

Fluid reservoir: The layer of saline trapped between the posterior surface of a scleral lens and the cornea, maintaining hydration and promoting healing.

References

1. Large diameter scleral lens benefits for Asians with intractable ocular surface diseases: a prospective, single-arm clinical trial. Scientific Reports (2021).
2. Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas. Arquivos Brasileiros de Oftalmologia (2018).
3. Artefact-free topography based scleral-asymmetry. PLOS ONE (2019).
4. Practitioner Learning Curve in Fitting Scleral Lenses in Irregular and Regular Corneas Using a Fitting Trial. BioMed Research International (2019).