Learning

Your referring eye doctor is the doctor who normally treats your eye disease or condition. They are usually an ophthalmologist (general, corneal specialist or oculoplastic specialist) but they may be an optometrist. They may refer you to a scleral lens provider if they feel scleral lenses are the most appropriate treatment for you.

Generally speaking, scleral lens providers are optometrists, not ophthalmologists or other eye care providers (though there are rare exceptions). People who get scleral lenses commonly continue with two eye doctors working in tandem over the long term: the one managing their disease, and the one managing their sclerals.

There are also self-referrals. Many people pursue scleral lenses on their own initiative because they have read stories online. If this is you, there may be a significant additional burden of finding a suitably qualified scleral lens provider. And you still have two needs: disease management, and scleral lens management.

Your scleral lens fitter will need to examine you and talk with you, and test out one or more “trial lenses” (or “diagnostic lenses”), in order to verify that you are a suitable candidate and determine the best path forward.

You’ll certainly want to come prepared with your questions at that appointment. See Phase 1b - Preparing for a list of questions.

What if I’m not a candidate? Find out why. Then it’s either back to the drawing board and discuss your other treatment options with the referring doctor, or seek out a second opinion from a scleral lens provider with expertise in your disease or condition.

Once you know your provider is ready to move forward, you have to make a choice about whether you are ready to move forward:

• Should I do this?

• Should I do this now?

• Should I do this with this provider?

This decision is often not a slam dunk. Success is not guaranteed. There may be significant financial commitments involved. Scleral lenses are a medical treatment, not a commodity - you do not get your money back if not satisfied, though in some cases there may be a “warranty period” where you are not liable for the lens part of the cost if you pull out early. The process can also be emotionally taxing (more on that further down the page).

So, don’t rush this part.

Take your time, follow our roadmap, and carefully review the questions in Phase 1b - Preparing.

The fitting process generally involves multiple appointments.

At each appointment you’ll try on a set of lenses, and your provider will assess the fit from the standpoint of technical correctness. You’ll give feedback on comfort and vision.

It is normal for minor design modifications to be needed, sometimes repeatedly, in which case they will order more lenses and you’ll come back to try those.

This process may take days, weeks, or months, depending on lab turnaround time for manufacturing your new lenses, how your provider’s practice arranges the appointment schedule, and how many attempts it takes to get the best fit.

Training happens in parallel with fitting and may be provided by a contact lens technician or optometrist.

You’ll be trained in how to apply (insert), remove, and care for your lenses. Application and removal normally involves use of little rubber “plungers” or other specialty tools.

Training on lens application alone can take days, weeks or months. There is no norm. It takes what it takes. The best antidote for these challenges is a highly skilled trainer who has all the possible tools and techniques at their fingertips. We also have lots of education resources on this site to help with training.

You should be fully trained before you are given any lenses to take home, and you should be given detailed instructions for every step in lens use and care.

Two things come together when your lenses are dispensed:

1) These are “keeper” lenses, meaning your provider is happy with the technical features of the fit and with your vision, and you are happy with your vision and comfort. This does not necessarily mean they are the “final” lenses, however.

2) You are fully instructed, trained and equipped to use and care for your lenses independently at home.

Typically, you are given a kit with “starter” supplies and instructions for what products to buy and where. You should also be told how to get in touch if any issues or questions arise.

Follow-up appointments are essential after your first lenses are dispensed.

During follow-ups, your provider will determine whether any further adjustments are needed, and can review your experience to date, your questions and doublecheck your lens care protocols.

You’ll go through an initial transition period - from weeks to months - where you’re learning new routines, sharpening your application and removal skills, experiencing full time scleral lens wear for the first time, and getting settled with where and how frequently to purchase supplies. You’ll probably have lots of questions at this stage.

When you’ve been solid on the daily routines for awhile, then you may find yourself with lots of questions about how to handle sclerals in a different environment. How do I deal with them at work? Can I take a long drive? Is it possible to travel? Or go camping?

There will be solutions for all of these things, and you’ll probably find it very helpful to tap into the community for inspiration and examples.