Unconventional Uses of Scleral Lenses

This course discusses the diverse applications of scleral lenses beyond vision correction, including piggyback scleral lenses, oblate designs for keratoconus, scleral lenses for ptosis, drug delivery, prism correction, low vision, and optic decentration for fitting.

By
Daddi Fadel, DOptom
Melissa Barnett, OD, FAAO, FSLS
July 1, 2025
20 min

Contact Lens Spectrum

At a Glance

Category	Detail
Condition
Key Mechanisms	Utilization of oblate lens designs for various ocular conditions, including keratoconus and high myopia, with emphasis on their benefits.
Target Population
Care Setting

Key Highlights

Scleral lenses (SLs) extend beyond conventional fitting and vision correction.
Oblate designs reduce high-minus power and improve centration.
SLs can be used for drug delivery and low-vision rehabilitation.
Proper lens design minimizes optical disturbances like glare and halos.
Customizing the front optic zone enhances visual performance.
Monitoring for decentration is crucial to maintain visual quality.

Guideline-Based Recommendations

Diagnosis

Management

Utilize oblate lens designs to optimize fit and reduce negative power.
Implement specific fitting techniques for oblate lenses.

Monitoring & Follow-up

Risks

Patient & Prescribing Data

Oblate designs provide better clearance and comfort, especially in irregular corneas, and may benefit a wider range of ocular conditions.

Clinical Best Practices

Ensure sufficient clearance over the cone apex in keratoconus fittings.
Consider pupil size when assessing lens design to minimize optical effects.
Flattening the back optic zone radius (BOZR) can improve lens performance.
Conduct regular follow-up assessments to monitor lens performance and patient comfort.