About Scleral Lens Providers

Evidence of this will be visible in the provider’s bio. They have probably undergone cornea and contact lens residency training. Alternatively, they may have been mentored by an expert.

Providers who are “dabbling” in scleral lenses will not have the appropriate knowledge and experience.

There are three main motivations for scleral lenses:

• Vision loss, e.g. from keratoconus

• Ocular Surface Disease, e.g. SJS, GvHD, Sjögrens, non-Sjogrens Dry Eye Disease

• Ocular Surface Pain, e.g. burning, grittiness, irritation, light sensitivity or pain

Few providers have equal competence in scleral lens care for each category, let alone all possible indications. For example, they may fit hundreds of keratoconus patients, where the vision outcome is the primary measure of success, but may have much more limited experience with Sjögrens, where vision may or may not be an issue.

Disease-specific skills are a particularly important consideration in circumstances such as these:

• Rare corneal diseases and conditions

• Post refractive vision disorders accompanied by dryness or pain, e.g. RK, LASIK, PRK

• The primary indication is Ocular Surface Disease

• The primary motivation is Ocular Surface Pain symptoms but not associated with severe Ocular Surface Disease, and where corneal neuropathy status is undetermined

Scleral lenses are not simply a specialty contact that can be added to an optometry practice with no other changes.

The optometry practice, as a business, needs to be organized specifically to accommodate the following unique needs of scleral lens patients:

• an uncertain number of progressive lens adjustment appointments (pre-dispense)

• patient training in lens handling and care by an experienced trainer (pre-dispense)

• potential for protracted training support (pre-dispense)

• information and support needs (post-dispense), including guidance on procuring appropriate supplies

If the necessary organizational and staff training investments are not made, the practice cannot consistently offer quality scleral lens patient care.

Scleral lens fitting cost range

We have heard of people paying as low as $600 and as high as $15,000, with $2,000 to $4,000 commonly reported. Costs in excess of $5,000 typically involve unique technologies.

Low cost scleral lens fitting may be a red flag.

A fee structure that does not pay the provider adequately is a red flag. This may include scenarios where a vision care plan (as opposed to a medical plan) is providing inadequate reimbursement to the provider for their services.

Scleral lens fees should be sufficient to ensure the medical practice receives:

• lens costs

• costs associated with providing appointments and training sessions

• (in a private practice) reasonable profit to the practice

When fees are inadequate, providing quality scleral lens patient care is unsustainable.

Less experienced providers who have not fully adapted their business model for sclerals may continue to underestimate the clinical investment required for proper scleral lens patient care.

In an optometry practice like this, patients who are not quick fits and/or quick learners may not get their needs met without financial loss to the business, which can be demotivating to the provider.

Are high costs ever a red flag?

Scleral lenses are a medical process that involves technology.

Generally speaking, the value of the provider’s knowledge and experience plus the support that their practice will offer you both during and after fitting should constitute the core treatment costs.

However, some patients will be offered advanced technologies. These technologies may be designed to offer higher quality vision correction, or to offer lens design customization features that are required because of certain conditions or anatomical features. You may even opt for a high technology solution specifically to speed up the fitting process, i.e. to reach your best possible fit more quickly. This efficiency is a significant value-add, although it’s helpful to keep in mind that this too is not guaranteed.

Depending on the circumstances and your needs, the lens technology employed may or may not play a significant role in your ultimate satisfaction. So, if you are quoted costs on the high end of the range, we recommend that you do not allow advanced technologies to distract you from the need for provider qualifications and the broader services that should be provided.

The standard of care for scleral lens patients is immature and evolving. This makes collaboration amongst scleral lens professionals essential to improving the standard of care and increasing patient access to competent care.

When a scleral lens fitter has a challenging patient, they may need to consult a peer, whether about the fit, or about unique training and adaptation needs.

When a scleral lens fitter experiences lack of success with a given patient, they need to be willing to consider the possibility that this is not exclusively due to patient characteristics but also because the provider has reached the limits of their skillset and/or the technology they are employing. When the patient’s best interests require it, they need to be willing to refer the patient to a colleague with a different skillset or technology.

Different patients have different needs. These needs may be related to medical indication, the nature of vision correction needed, eye or eyelid characteristics, or other factors.

There are many scleral lens technologies available, and they vary greatly in the extent to which their various design parameters and optical properties may be customized to refine the results. The are priced accordingly.

The expert scleral lens fitter has appropriate pathways to meet their various patients’ needs.

EXCEPTION: Specialty centers whose patient base consists entirely of complex corneal disease patients. These practices typically require referrals and offer only advanced technology options.