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`Scleral Contact Lenses
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`By Jason Jedlicka, OD
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`On this page:
`Types of scleral lenses Scleral contacts for keratoconus Scleral lenses for other
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`vision problems Special-effect scleral contacts Cost of scleral contact lenses
`
` or
` because of an irregular
`If you've been told in the past that you cannot wear
`contact lenses
`cornea
`other problems, you may want to get a second opinion and ask your
` about scleral contact
`eye doctor
`lenses.
`
` specially designed to vault over the
`Scleral contacts are large-diameter
`gas permeable contact lenses
`entire corneal surface and rest on the
`. In doing so, scleral lenses functionally
`"white" of the eye (sclera)
`replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused
`
`by keratoconus
` and other corneal irregularities.
`
`Also, the space between the cornea and the back surface of a scleral lens acts as a fluid reservoir to
`
`provide comfort for people with severe dry eyes
` who otherwise could not tolerate contact lens wear.
`
`Types Of Scleral Contact Lenses
`
`Scleral contacts are noticeably larger than standard gas permeable (GP) contacts and have a diameter
`equal to or greater than that of soft contact lenses. The smallest sclerals are approximately 14.5 mm in
`diameter, and the largest can be up to 24 mm.
`
`Typically, lenses that are 18 mm or smaller are subcategorized as mini-sclerals.
`
`The average human cornea is approximately 11.8 millimeters in diameter, so even the smallest scleral
`contacts are designed to cover the entire corneal surface.
`
`In comparison, most conventional GP contact lenses are 9.0 to 9.5 mm in diameter and cover only 75
`to 80 percent of the cornea.
`
`Another category of gas permeable lenses bridges the size gap between conventional GP lenses and
`mini-sclerals. These lenses, called corneo-scleral lenses, generally are approximately 13 to 15 mm in
`diameter.
`
`Corneo-scleral lenses often are a good choice for people who require larger-than-normal GP lenses for
`greater comfort. They also are frequently used when contact lenses are needed after LASIK or other
`corneal refractive surgery to correct irregular astigmatism.
`
`http://www.allaboutvision.com/contacts/scleral-lenses.htm
`
`MYLAN - EXHIBIT 1081
`Mylan Pharmaceuticals Inc. et al. v. Allergan, Inc.
`IPR2016-01127, -01128, -01129, -01130, -01131, & -01132
`
`

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`Page 2 of 4
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`The size of lens used often is determined by the degree of complexity of the condition. Milder forms of
`keratoconus and irregular astigmatism from corneal grafts and refractive surgery often are easily
`managed with scleral lenses at the smaller end of the spectrum.
`
`Smaller scleral and mini-scleral contacts can be easier to apply, can be less costly and require fewer
`care products.
`
`More complex conditions, including advanced keratoconus, pathologically dry eyes or severe ocular
`surface disease that might require a large tear reservoir, often are fitted with larger scleral lenses, as
`they have more capacity to hold fluid or bridge large changes in corneal curvature.
`
` and fitting, your eye care professional will determine the best scleral
`
`During your contact lens exam
`lens type and size for your specific needs.
`
`Scleral Contact Lenses For Keratoconus
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`Many optometrists and ophthalmologists recommend scleral contact lenses for a variety of hard-to-fit
`
`
`
`, including eyes with keratoconus.eyes
`
`In cases of early keratoconus, a standard GP lens may be used. However, if the lens does not center
`properly on the eye or moves excessively with blinks and causes discomfort, switching to a large-
`diameter scleral contact lens may solve the problem.
`
`Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface
`of the sclera, these lenses often are more comfortable for a person with keratoconus.
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`Also, scleral lenses are designed to fit with little or no lens movement during blinks, making them more
`stable on the eye, compared with traditional corneal gas permeable lenses.
`
`SEE ALSO: Ask the Eye Doctor About Keratoconus >
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`Scleral Contact Lenses For Other Eye Problems
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`http://www.allaboutvision.com/contacts/scleral-lenses.htm
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`Page 3 of 4
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`In addition to keratoconus, scleral contact lenses can be used for eyes that have undergone a
`cornea
`, and for people with severe dry eyes caused by conditions such as
`,
`transplant
`Sjogren's syndrome
`graft-versus-host disease (GVHD) and Stevens-Johnson syndrome.
`
`Advances in lens design technology are allowing manufacturers to design scleral lenses that can
`correct more conditions than ever before, including bifocal sclerals for the correction of presbyopia.
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`Special-Effect Scleral Contacts
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`Sometimes the term "scleral lenses" (or "sclera lenses") also is used to describe
`
` that dramatically alter the appearance of the wearer's eyes.lenses
`
`special-effect contact
`
`However, these costume contact lenses (also called theatrical contact lenses, Halloween contacts or
`gothic lenses) typically are soft lenses that bear little resemblance to scleral gas permeable contacts —
`other than their large diameter to fully mask the cornea. Also, soft theatrical contacts usually are
`designed for cosmetic purposes only and not for vision correction.
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`Scleral Contact Lens Cost
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`Scleral contact lenses are custom-made for each wearer, so fitting scleral contacts demands greater
`expertise and more time than fitting standard soft or GP contact lenses.
`
`Often, computerized maps of the curvature of
`the entire cornea are generated to facilitate the
`lens fitting, and several trial lenses of different
`sizes and curvatures may be applied to the eye
`during the fitting process.
`
`Also, depending on the complexity of the
`problem and how the individual eye tolerates the
`scleral lens, adjustments of lens parameters may
`be needed, which will require additional lenses to
`be made and exchanged. The entire scleral lens
`fitting process can take several visits to
`determine the optimal lens for each eye.
`
`While many individuals who use scleral lenses
`have worn soft or corneal GP lenses in the past,
`the process for applying and removing scleral
`lenses may take some practice. The additional
`time needed to master this, due to the larger size
`of the lenses and the fluid reservoir under the
`lenses, needs to be taken into consideration
`during the fitting process.
`
`For these and other reasons, scleral contact
`lenses can cost significantly more than standard
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`http://www.allaboutvision.com/contacts/scleral-lenses.htm
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`CONTACT LENS NEWS
`
`Scleral Contact Lenses Help Star
`Perform Crazy Movie Stunt
`
`July 2015 — Actor Tom Cruise is known for doing his
`own adrenalin-pumping, sometimes crazy movie stunts.
`In his new film,
`, Cruise
`Mission: Impossible Rogue Nation
`wears scleral lenses during one of his stunts.
`
`Watch as Tom Cruise prepares for one of his most talked-about
`movie stunts. See if you can catch the clip where they insert his
`scleral contact lenses.
`
`Sidebar continued >>
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`Page 4 of 4
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`The scleral lenses Cruise wears are to protect his eyes and
`allow him to open them while facing high speed winds.
`Why does he need them? Because the actor does a scene
`hanging onto the wing of a real fighter jet that flies 5,000
`feet above the ground.
`
`Scleral lenses have a larger diameter than other gas
`permeable contact lenses and rest on the white part of the
`eye. They are sometimes used to treat severe dry eyes,
`because the space between the cornea and the lens acts
`as a fluid reservoir, keeping eyes moist. Other scleral
`lenses are used for people who have irregular corneas.
`
`However, this instance demonstrates a very unique
`benefit: protecting the surface of the eye from high speed
`winds. — N.B.
`
`More news about contact lenses >
`
`contacts; in fact, it is not uncommon for scleral
`contacts to cost three or four times more. While
`not typical, in cases when a complex, highly
`customized scleral lens is required, cost can be as
`high as $4,000 per eye or more.
`
`Most insurance programs do not automatically
`cover the full cost of scleral contact lenses. In
`some cases,
` may reduce the cost
`vision insurance
`of your lenses and/or fitting fee. In other
`instances, contacting your medical insurance
`provider and inquiring what steps are necessary
`to obtain coverage can be helpful. Ask your eye
`doctor's office for details.
`
`Also, some eye care practitioners offer financing
`options for scleral contacts.
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`Back to top ⤴
`
`[Page updated April 25, 2017]
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