ROADMAP: THE PROCESS
Getting fitted
I am here: My doctor is working on my customized sclerals. This often involves a series of refinements. I may need information and reassurance.
The fitting cycle
Scleral lens “fitting” refers to the process of designing and refining a scleral lens customized to your eye. While the technical aspects may vary, there is a basic cycle that applies to all of us.
As you progress through the fitting process, you will also undergo training. This is done in parallel so that you are ready to roll when your final sclerals are ready.
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FIRST SET: The process by which your provider determines the specifications for the first lenses will depend on the lens brand and the design technologies involved. This may involve one or more of the following:
Placing a “diagnostic” lens on your eye to assess it
Taking scans of your eye
Taking a mold of your eye surface
ADDITIONAL SETS: Depending on the arrangements and appointment schedule, it may be a day, days, or weeks before your next appointment when this subsequent set can be assessed.
TIP #1: Don’t make judgments based on how high or low tech this process seems. Your provider’s skills and experience are by far the most important factors in your success. The best providers will be using excellent lens technologies and drawing on yours of experience.
TIP #2: Don’t make judgements based on what your vision is like with the first set of lenses, no matter how off it is. Priority #1 is getting a good fit. Vision is next.
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They may immediately determine that further customization is needed, or they may have you wait awhile for the lenses to settle and then re-assess.
You will be asked for feedback on device comfort, and your vision may be tested.
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These modifications may be:
Fit modifications, for technical reasons
Fit modifications, for comfort reasons
Vision correction modifications
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The fitting cycle is repeated until the final scleral lenses are achieved.
There is a certain amount of uncertainty that is inherent to this process. No one can predict exactly how many cycles it may take. The final lenses need to meet both your doctor’s requirements for the technical aspects of the fit (to ensure lens safety), and your needs in terms of comfort and vision.
What if…?
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The number of cycles in a scleral lens fitting process should not be cause for worry, unless there are other concerns too. Scleral lens fitting is an iterative process, every patient is different, and the time it takes can vary even with the best providers and most advanced technologies.
As a practical matter, however, a protracted scleral lens fitting process may present serious challenges or hardships for you if weeks are passing between appointments, and/or distance and transportation are issues. (This is one of the reasons why we emphasize the learning and preparation phases so much. You need to be able to plan for the process.)
Last, there may be circumstances in which too many cycles do indicate cause for concern, for example, if you have been through several cycles with an inexperienced provider with limited training and who lacks an expert mentor. They may have support from lens manufacturer consultants, which can help, but it does not replace provider skills. Further, unfortunately the process may start to become a noticeable financial loss for the provider, which is not good for either of you. Scroll down to “I’m having serious doubts” below for more insights.
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There are three key features of successful lens fitting:
Technical correctness of the fit: This is a safety matter and should not be compromised. Your provider is the judge of whether this goal has been reached.
Vision: Your vision with sclerals should meet an acceptable standard. Visual acuity is something your doctor will measure. Vision quality is something they will need your feedback on if you are having any special issues.
Comfort: There should be no pain or significant discomfort from your sclerals. Your provider will need your feedback about this. The specific reasons for discomfort that you report may, or may not be visible to your provider.
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If your provider says that the fit is “perfect” or “can’t be improved”, they are most likely speaking from a technical standpoint.
You should not hesitate to continue flagging unresolved comfort issues.
Expert providers will be best equipped to troubleshoot non-obvious sources of scleral lens discomfort. If your comfort issues are unresolved, you should not assume that you just “cannot tolerate” sclerals.
Rarely, someone cannot tolerate any scleral, no matter how well adjusted.
MYTH: “Scleral lenses are like RGPs - you have to break them in gradually.”
REALITY: Sclerals are completely different from RGPs. RGPs cause discomfort because they are basically hard plastic sitting on your corneas, which are the most sensitive tissue in the body. Of course, sclerals will be a new sensation and you may have heightened awareness of them for awhile. That may be a bigger issue for some people than others. Some may also have anatomical or disease reasons for discomfort, such as chronic eyelid inflammation, that need to be discussed. But sclerals should not cause discomfort on the surface of the eye and you should not feel the edges. Sclerals do not touch the cornea. Successful sclerals should not be initially uncomfortable and then get more comfortable.
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It is normal to experience anxiety during the scleral lens fitting process. The inherent uncertainties can certainly add to the other challenges.
You should not, however, entertain any serious doubts about your progress without reason. Our first advice to anyone experiencing concerns is to make sure you’re fully informed. This site is here to educate and re-assure you, and to equip you to partner well with your scleral provider.
For some of you, though, there will come a time when there are sound reasons to worry. So the site is also here to equip you to identify true red flags. See Detours and Dead Ends for more information.