Scleral Lenses, Keratoconus, & Corneal Change

Explore the implications of scleral lens wear on corneal changes and visual acuity in keratoconus patients, highlighting critical findings from a year-long study.

By
Melissa Barnett, OD, FAAO, FSLS
January 1, 2026
5 min

Contact Lens Spectrum

At a Glance

Category	Detail
Condition
Key Mechanisms	Scleral lenses induce corneal changes including mild edema (~2%) and curvature alterations, with potential risks in patients with reduced endothelial cell density.
Target Population
Care Setting

Key Highlights

Scleral lenses cause mild corneal edema (~2%) in healthy eyes.
Significant corneal thickness changes observed in keratoconus patients with ICRS.
Visual acuity remained stable despite corneal morphological changes, but measurable reductions occur with corneal thickness increases of ~4-6%.
Individualized fitting and monitoring are crucial for patient satisfaction.
Corneal topography should be performed before and after lens wear.

Guideline-Based Recommendations

Diagnosis

Perform corneal topography to assess keratoconus severity.

Management

Use scleral lenses for vision correction in keratoconus patients, ensuring individualized fitting based on corneal topography.

Monitoring & Follow-up

Regularly monitor corneal thickness and curvature changes, with follow-ups every 6-12 months.

Risks

Potential for epithelial and stromal edema in patients with reduced endothelial cell density.

Patient & Prescribing Data

Scleral lenses are a safe long-term option for vision correction in keratoconus, but patients should be informed of potential risks.

Clinical Best Practices

Encourage patients to report any transient visual changes after lens removal.
Ensure lenses are fitted based on individual corneal topography.
Educate patients about potential transient visual changes following lens removal.