There are many types of Scleral Contact Lenses. They have been used for years for Keratoconus. More recently in the last 10 years, SCLs have been used for Dry Eye from various causes.
The benefit of Scleral Contact Lenses is that it vaults the Cornea to prevent constant rubbing of the eyelid against the corneal nerves. This can help with many types of dry eye pain.
The negative is that it is still a Contact Lens: constant friction of even this lens on the conjunctiva does cause microtrauma which over time has been associated with inflammation and meibomian gland atrophy.
There are no studies to note a scleral contact lens will definitely destroy meibomian glands as of yet nor have I seen a study to follow the meibography in SCL patients over the years.
Also, I have not seen a study to say which of the below SCLs is the best or least likely to decrease the risk of worsening dry eye and/or Meibomian Gland Atrophy.
Still, SCLs is an option for patients that do not feel an improvement with standard dry eye treatments.
The Indications for Scleral Contact Lenses:
1. Keratoconus
2. Post cornea transplant
3. Severe Dry Eyes: usually if an anesthetic drop helps with pain, SCL may be an option that will help with pain.
4. Severe Dry Eye caused by conditions, such as:
a. Sjogren’s syndrome
b. Graft-versus-host disease (GVHD)
c. Stevens-Johnson syndrome
d. Ocular Cicatricial Pemphigoid
e. Other autoimmune disease
f. Chemical Burn
Types of Scleral Contact Lenses:
1. PROSE (Boston Sight)
2. SynergEyes VS™
3. Jupiter™
Further Information:
1. PROSE (Boston Sight)
The PROSE was the first well-tolerated FDA approved Scleral Contact Lens. I used this when at Harvard and it worked well for patients with severe dry eye from Stevens John’s, GVHD, chemical burns. We had not starting using PROSE for “just dry eye” when I was at Harvard but in the last 5-10 years PROSE has been used more and more for Dry Eye.
Some patients with dry eye from non-systemic causes find that it can help but there are many patients (also on Youtube) noting the PROSE makes their eyes feel worse.
The cost is about $5000-1000 for both eyes. It can take days and many visits to get the fitting correct with all scleral lenses.
2. SynergEyes VS™:
We are now using SynergEyes VS as it allows more customization of the corneal surface and it is much more affordable. The vast majority of patients love this scleral lens.
The cost is about $2800-3200 total for fitting and lenses for both eyes. It usually lasts about 1-4 years depending on the rotational stability. Some insurances will cover this depending on insurance and diagnosis. If a patient cannot tolerate it, some of the funds can be refunded in some cases.
So far so good with this lens for patients with dry eyes, but there will patients who cannot tolerate this one either.
3. Jupiter™
We have used Jupiter for years and found it to work well in many patients depending on the condition. It does not provide as much customizability compared to SynergEyes VS thus we switched.
It costs about $4000 for both eyes with the fitting.
References:
1. https://www.bostonsight.org/PROSE/PROSE-Treatment/About-PROSE
2. https://synergeyes.com/professional/specialty-contact-lenses-scleral-vs/#targetText=The%20SynergEyes%20VS%20lens%20is,wide%20variety%20of%20corneal%20conditions.&targetText=The%20toric%20periphery%20of%20the,ease%20of%20landing%20and%20stability.
3. https://www.visionary-optics.com/scleral-lenses/jupiter/
