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Scleral Contact Lenses vs. Soft Contact Lenses

Embarking on the journey to optimal vision involves navigating the diverse landscape of contact lenses, each offering a unique set of advantages and considerations. In the realm of corrective lenses, the choice between scleral and soft contact lenses stands as a pivotal decision, tailored to individual preferences and visual needs. Scleral lenses, with their innovative design covering the entire cornea and part of the sclera, present an intriguing alternative to the more familiar and pliable soft lenses. The comparison of these two contact lens options provided below aims to identify the distinct characteristics, advantages, and potential drawbacks of scleral and soft contact lenses. For more information schedule a consult with one of our Edmonton optometrists.

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Scleral contact lenses are specialized, large-diameter lenses that extend beyond the cornea, covering the entire corneal surface and part of the sclera — the white outer layer of the eye. Unlike traditional contact lenses, which rest on the cornea, scleral lenses create a vault over the cornea, leaving a gap filled with tear fluid. This unique design contributes to enhanced visual clarity, making them particularly beneficial for individuals with irregular corneas, such as those with keratoconus or astigmatism, or that experience dry eye symptoms.

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Scleral Contact Lenses vs. Soft Contact Lenses

What is Keratoconus?

Keratoconus (ker-uh-toe-KOH-nus) is an eye condition in which your cornea — the clear, dome-shaped front of your eye — gets thinner and gradually bulges outward into a cone shape. A cone-shaped cornea causes blurred vision, may cause increased sensitivity to light and glare, and challenges achieving clear vision and comfort with traditional contact lenses.

Normal Eye vs. Eye With Keratoconus

In general, anyone seeking the best vision possible with contact lenses is a candidate for scleral lenses. However, scleral gas permeable contact lenses are particularly advantageous to individuals with the following conditions and/or needs:

Exceptional Visual Clarity. Scleral lenses vault over the cornea, creating a tear-filled chamber that enhances visual acuity. This design is particularly beneficial for those with irregular corneas (resulting from an eye condition such as keratoconus or from eye surgery) or high prescriptions.

Ideal for Irregular Corneas. Conditions like keratoconus or irregular astigmatism can be challenging with traditional lenses. Scleral lenses provide a stable surface, offering clear vision for those with corneal irregularities.

Reduced Dryness and Discomfort. The tear reservoir beneath scleral lenses provides continuous hydration, reducing the risk of dryness and discomfort. This makes them an excellent choice for wearers with dry eye syndrome.

Extended Wear Time. Due to their unique design, scleral lenses can often be worn for longer periods without discomfort, making them suitable for wearers with demanding schedules.

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Advantages of Scleral Contact Lenses

Despite their many advantages, scleral lenses are not without considerations and challenges. These include:

Learning Curve. Inserting and removing scleral lenses requires a bit more skill and practice compared to soft lenses. Patients need to be comfortable with proper lens care routines.

Initial Discomfort. Some wearers may experience initial discomfort as they adapt to the sensation of larger lenses. However, with guidance and patience, this usually improves over time.

Specialized Fitting. Achieving the perfect fit with scleral lenses often requires a more specialized fitting process, and not all eye care practitioners may have extensive experience with them.

Price Point. The initial price of scleral contact lenses is more than soft contact lenese. However, one must be mindful that the initial fee includes the custom fitting, that the lenses are custom-made, and that with proper care and a stable prescription, scleral lenses can have a lifespan of ~2 years.

Replacement Cost & Time. Losing or damaging a lens requires the lens to again be custom-crafted.

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Scleral Contact Lenses - Challenges

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Soft contact lenses are flexible, thin lenses made from a water-containing plastic material that conform to the shape of the eye. Designed to rest comfortably on the cornea, these lenses are a popular choice for vision correction due to their ease of use and immediate comfort. Soft lenses are available in various designs, including daily, bi-weekly, and monthly disposables, catering to different wear preferences and lifestyles. They offer a wide range of prescriptions, making them suitable for individuals with nearsightedness, farsightedness, astigmatism, and even those requiring multifocal corrections. Soft contact lenses are favored by many for their versatility, adaptability, and widespread availability, providing a convenient and effective solution for individuals seeking a seamless integration of corrective lenses into their daily lives.

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Scleral Contact Lenses vs. Rigid Gas Permeable Contact Lenses

Soft contact lenses have many advantages, including:

Comfort at the Forefront. Soft contact lenses are renowned for their comfort. The pliable material conforms to the shape of your eye, ensuring a snug fit that often makes wearers forget they're even wearing lenses.

Wide Range of Prescriptions. Whether you're nearsighted, farsighted, or dealing with astigmatism, soft lenses offer a vast range of prescriptions, making them suitable for a broad spectrum of vision needs.

Easy Adaptation. For those new to contact lenses, soft lenses often allow for a smoother adaptation period. Most wearers find them easy to insert and remove.

Versatility in Design. Soft lenses come in various designs, including daily, bi-weekly, and monthly disposables. This versatility caters to different lifestyles and preferences.

Availbility. Soft contact lenses can be purchased at any optometry clinic or optical.

Low Maintenance. Daily disposable contact lenses require little to no maintenance.

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Advantages of Soft Contact Lenses

Despite their many advantages, soft contact lenses have their own shortcoming, including:

Limited Oxygen Permeability. Soft lenses may restrict the amount of oxygen that reaches the cornea. This limitation can lead to discomfort for some wearers, particularly if lenses are worn for extended periods.

Sensitivity to Environment. Factors such as smoke, dust, and allergens can affect soft lenses, potentially causing irritation. This makes them less ideal for wearers in challenging environments.

Prone to Dehydration. Soft lenses can absorb moisture from your eyes, leading to dryness. For wearers with dry eyes, this may necessitate frequent use of lubricating eye drops.

Single Use Plastic. Daily disposable contact lenses, along with their indivdiual packaging can amount to a significant amount of plastics that enter landfills.

Not Suited For Irregular Corneas. Soft lenses may not provide optimal vision for individuals with irregular corneas or certain eye conditions.

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Shortcomings of Soft Contact Lenses

Comparing Scleral & Soft Contact Lenses

Feature Scleral Contact Lenses Soft Contact Lenses
Comfort Generally, comfortable due to larger size and tear reservoir. Immediate comfort for most wearers due to flexible material.
Visual Clarity Exceptional clarity, ideal for irregular corneas or high prescriptions. Good clarity for standard prescriptions, may not address all irregularities.
Adaptation Period Longer adaptation period due to larger size and specialized fitting. Shorter adaptation period, usually easier for new wearers.
Oxygen Permeability Generally, provides good oxygen permeability. May limit oxygen to the cornea, especially during extended wear.
Dry Eye Management Reduced risk of dryness due to the tear reservoir. Some wearers may experience dryness, requiring lubricating eye drops.
Fitting Complexity Requires a more specialized fitting process. Generally, simpler fitting process.
Use with Irregular Corneas Ideal for irregular corneas, addressing conditions like keratoconus. May not provide optimal vision for irregular corneas.
Extended Wear Time Can often be worn for longer periods without discomfort. Depending on the type, may have limitations on extended wear.
Daily Maintenance Requires meticulous care, including cleaning and disinfection. Typically simpler daily maintenance routine.
Environment Sensitivity More resilient to environmental factors like smoke or dust. More susceptible to environmental factors, potentially causing irritation.
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Dry Eye Syndrome

Dry Eye Syndrome (DES) is an eye disease caused by either decreased tear production or increased tear film evaporation.

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Yes! Cleaning the lenses with an approved solution removes deposits from the lens surface and kills microbes that potentially cause eye infections.

Non-preservative, non-buffered, inhalent saline is required for scleral contact lenses. There is minimal tear exchange when the lens is on the eye. Long-term exposure to preservatives can cause a sensitivity or toxicity to the cornea resulting in redness and irritation. Non-buffered saline contains only 2 ingredient - purified water and sodium chloride (i.e., salt, or NaCL). By comparison, buffered saline has four ingredients - purified water, sodium chloride,, sodium borate and borc acid. The latter two ingredients can often cause irritation.

If you apply the lens and notice that your vision is blurry or the lens feels uncomfortable, you may have an air bubble trapped underneath. Sometimes you can see the bubble if you look in the mirror, but other times you cannot. If you think there is a bubble, remove the lens and reapply it.

Foggy or cloudy vision is often attributed to two causes. First, there may be mucous or debris trapped between the lens and the cornea. This can occur when the lens does not align properly to the eye. Second, the front surface of the lens may not be wetting well. There are multiple reasons for this including poor tear film chemistry, improper cleaning, or lens surface breakdown. On rare occasions, foggy vision can also occur when the cornea becomes edematous (swollen). If your vision is still foggy after removing the lens, please inform your eye care practitioner. It is strongly recommended that any foggy or cloudy vision be addressed with your eye care practitioner.

No. Sleeping in lenses reduces oxygen transmission to the eye. This can cause swelling of the cornea and the abnormal growth of blood vessels into the cornea.

Yes, it is normal. We call it an impression ring. Similar to when you remove a watch or a pair of socks, there is often an impression in the tissue due to the placement of a device. This is not a problem and should disappear within about 5 minutes. If, however, you experience a significant amount of redness in this area after removing the lenses, especially if it persists after a few minutes, talk to your eye doctor, as this may indicate that the lens is fitting too tightly.

If cared for properly, most lenses are expected to last at approximately one year.
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