Specialty Contact Lenses
Scleral Lenses
Custom lenses that restore clear, comfortable vision when glasses and standard contacts no longer can — fitted by specialists inside an eye-surgery network.
Overview
A different kind of contact lens — for eyes that need a different approach.
A scleral lens is a large, custom-made contact lens that rests on the white of the eye (the sclera) rather than on the cornea — the clear front window of the eye. Instead of sitting directly on a damaged or irregularly shaped surface, the lens arches completely over it, holding a thin layer of fluid between the lens and the eye. The result is a smooth, stable new optical surface that can restore sharp, comfortable vision even when the cornea itself can no longer support glasses or standard contact lenses.
Scleral lenses are not an off-the-shelf product. Every lens is designed from detailed measurements of one specific eye, and getting the fit right is a genuine specialty — the kind of work most optical shops and many optometry practices don’t take on. At U Optical, our optometrists fit scleral lenses as part of our specialty contact lens services, working inside the U Vision Group network alongside the cornea surgeons at Uptown Eye Specialists and the ocular-surface team at the U Dry Eye Institute. That means the people fitting your lens can see the same imaging, the same records, and the same clinical picture as the specialists managing the underlying condition.
If you’ve been told your cornea is “too irregular,” that you’re “hard to fit,” or that you’ve simply run out of options with glasses and regular contacts — this page explains what scleral lenses are, who they help, what the fitting honestly involves, and how care is coordinated across the Greater Toronto Area within our network. If you arrived here through a referral from your own optometrist or surgeon, welcome: scleral fitting is exactly the kind of work we do in partnership with the clinicians who already know your eyes.
How They Work
A vault over the cornea, and a reservoir of fluid beneath it.
Two ideas explain almost everything about why scleral lenses work. The first is the vault. A standard contact lens drapes over the cornea and takes on its shape — which is exactly the problem when the cornea is cone-shaped, scarred, or uneven, because the lens reproduces every distortion. A scleral lens does the opposite: it lands gently on the sclera, the tougher and far less sensitive white part of the eye, and arches completely over the cornea without ever touching it. The front surface of the lens becomes the eye’s new optical surface — perfectly smooth and shaped precisely for your prescription, no matter what the cornea underneath looks like.
The second idea is the fluid reservoir. Before insertion, the bowl of the lens is filled with sterile, preservative-free saline. Once the lens is in place, that fluid is held against the cornea all day — continuously bathing it. For an irregular cornea, the fluid layer optically fills in the irregularity, much like water smoothing over a rippled surface. For an eye with severe surface disease, the same reservoir keeps the cornea protected and hydrated for the full wearing day. One design, two distinct benefits — which is why scleral lenses serve both visual and therapeutic roles.
The lens rests on the sclera and vaults the cornea entirely — the trapped fluid layer smooths the optics and bathes the surface beneath.
Because the lens never bears weight on the cornea, and because the sclera has far fewer nerve endings, most patients find scleral lenses surprisingly comfortable — often more comfortable than the smaller rigid lenses they may have struggled with before. The trade-off is precision: a lens this customized only works when the vault height, the landing zone, and the optics are all tuned to your individual eye. That’s what the fitting process is for.
Who They Help
The conditions we fit — and co-manage.
Most scleral lens patients arrive with a diagnosis already in hand — often referred by their own optometrist, a cornea surgeon, or a dry eye specialist. These are the conditions where scleral lenses most often change what’s possible:
Keratoconus
The most common reason for a scleral fitting. As the cornea progressively thins and steepens into a cone, glasses and soft lenses stop delivering usable vision. A scleral lens vaults the cone entirely, restoring a stable optical surface — and published studies consistently show meaningful gains in both vision and quality of life, even in advanced disease.
Irregular Cornea & Corneal Scarring
Scarring from old injury, infection, or inflammation leaves the corneal surface uneven in ways no spectacle lens can correct. Because the scleral lens replaces the cornea as the eye’s optical surface, vision is corrected in front of the scar rather than through it.
After Corneal Transplant (PKP / DALK)
A transplanted cornea is rarely perfectly regular, and the resulting astigmatism is often complex. Scleral lenses are one of the most effective ways to rehabilitate vision after a full-thickness (PKP) or partial-thickness (DALK) transplant — fitted carefully and co-managed with the surgeon who performed the graft.
Post-Refractive Ectasia & Post-LASIK Irregularity
A small number of eyes develop irregular steepening (ectasia) or uneven optics years after refractive surgery. When that happens, scleral lenses can restore the crisp vision the original procedure was meant to provide — without further surgery in many cases.
Severe Dry Eye & Ocular Surface Disease
For eyes where the surface itself is the problem, the fluid reservoir behind a scleral lens shields and bathes the cornea throughout the day. We fit the lens; the underlying ocular surface disease is assessed and treated by our partners at the U Dry Eye Institute — a genuinely co-managed pathway.
High & Complex Astigmatism
Some prescriptions are simply beyond what standard soft toric lenses can hold steadily on the eye. When every off-the-shelf option blurs, rotates, or fluctuates, a custom scleral lens provides the stability and optical precision the prescription demands.
Not sure whether your situation fits one of these categories? That’s normal — candidacy is determined by examination and imaging, not by a label. And if a scleral lens turns out not to be the right tool for your eyes, our role is to say so plainly and help map the next step, whether that’s a different lens design within our contact lens services or an opinion from the appropriate specialist within our network.
The Fitting Process
A custom fit is a process, not an appointment.
We want to be honest about this up front: a scleral lens fitting takes several visits over a number of weeks. That isn’t inefficiency — it’s how a fully custom medical device gets dialled in. Patients who arrive expecting a single appointment and a box of lenses are usually the ones who end up frustrated; patients who understand the process almost always find the investment worth it.
Imaging & Measurement
Detailed corneal topography and ocular-surface assessment map the exact shape of your eye — the same class of diagnostic imaging our network’s cornea surgeons rely on. This data drives every design decision that follows.
Custom Lens Design
Our optometrists work with specialty lens laboratories to design a lens for your eye specifically: vault height over the cornea, landing alignment on the sclera, and the optics for your prescription.
Dispense & Teaching
When your lens arrives, we verify the fit on your eye and teach you insertion, removal, and care — hands-on, at your pace, until you’re confident. Most people are comfortable with the routine within days.
Follow-Up & Fine-Tuning
Over the following weeks we assess how the lens settles, check the health of the eye beneath it, and refine the design where needed. One or two revisions are normal, not a sign of trouble.
From first measurement to a finalized lens, plan for roughly three to five visits across four to eight weeks, depending on the complexity of your eye. Once the fit is settled, care shifts to a normal rhythm: periodic reviews of the lens and the eye’s health, replacement on the schedule appropriate to your lens material, and an open line back to us if anything changes. If your own optometrist referred you, they remain part of that rhythm — we report back at each milestone.
The Connected Difference
Fitted by specialists inside an eye-surgery network.
Most of the conditions scleral lenses treat are medical conditions first and optical problems second. Keratoconus can progress. A corneal graft needs surgical oversight. An ocular surface in crisis needs treatment, not just a lens over top. This is where a standalone optical shop reaches its limit — and where U Optical’s position inside the U Vision Group network becomes the difference that matters.
Shared Records with the Cornea Surgeons
Our specialty lens fitters share records and diagnostic imaging with the cornea surgeons at Uptown Eye Specialists — the same topography and tomography the surgeons use to track corneal disease. Your fitting plan is built on the complete clinical picture, not a snapshot taken in isolation.
Direct Escalation if Disease Progresses
Because we image the cornea at every fitting stage, we are positioned to notice change. If your keratoconus shows signs of progressing, the escalation isn’t a fax into the void — it’s a direct referral to the cornea specialists at Uptown Eye for evaluation, with your imaging already in hand. The lens work and the medical work stay synchronized.
Ocular Surface Care with UDEI
When severe dry eye or ocular surface disease is part of the picture, the surface itself is assessed and treated by the U Dry Eye Institute team. We handle the lens side; UDEI handles the disease side. A scleral lens works best on a surface that’s being properly cared for — and within our network, it is.
One Network, No Dead Ends
If at any point a scleral lens isn’t the right answer — or stops being the right answer — you don’t start over somewhere new. Our optometrists coordinate the next step within the network, and your referring clinician stays informed throughout. Nobody leaves without a clear path forward.
This connectedness is also why community optometrists across the Greater Toronto Area refer their hardest-to-fit patients to us with confidence: the patient gets specialist-level fitting backed by surgical oversight, and the referring optometrist gets their patient back — better corrected, fully documented, and still theirs.
Cost & Coverage
An honest word about cost and coverage.
Scleral lenses are a custom-manufactured medical device paired with a specialty fitting service, and the honest framing is that they are typically a private or extended-benefits expense rather than a publicly funded one. The cost reflects the diagnostic imaging, the lens design work, the laboratory manufacturing, and the follow-up visits required to get the fit right — it is a different category of care than a standard contact lens fitting, and it is priced as such.
The encouraging part: many extended health plans include a medically necessary contact lens allowance — a separate, often substantially larger benefit than the routine contact lens allowance — that applies precisely to conditions like keratoconus, corneal transplant, and corneal irregularity. Some plans also allow fitting fees and lens costs to be claimed under different categories, and patients with health spending accounts frequently apply those funds here as well.
We help you understand your coverage before you commit.
Before any lenses are ordered, we walk through your plan’s specialty and medically-necessary lens provisions with you, provide the documentation insurers require, and make sure you know what to expect. No surprises — that’s part of the service.
For Referrers
For Referring Optometrists & Physicians
Have a keratoconus, post-transplant, post-refractive, or hard-to-fit patient who needs a scleral or specialty lens? Refer them to us for the fitting. We handle the specialty fit — imaging, design, dispense, and follow-up tuning — and we keep you in the loop at every stage with reporting back to your office. Your patient remains your patient: routine care, annual examinations, and ongoing primary eye care stay with you. We do the one thing you sent them for, and we send them home.
Common Questions
Frequently Asked Questions
Evidence
Grounded in Published Evidence
The recommendations on this page reflect the peer-reviewed literature on scleral lenses for keratoconus and irregular corneas — the same evidence-led standard applied across the U Vision Group network.
Quality-of-Life Improvement After Scleral Lens Fitting in Patients With Keratoconus
In keratoconus patients fitted with scleral lenses, vision improved significantly and quality-of-life scores on the NEI-VFQ instrument rose by approximately 19.5 points after fitting — and the benefit held even in advanced keratoconus. Read the study →
- Kreps EO, et al. “Mini-Scleral Lenses Improve Vision-Related Quality of Life in Keratoconus.” Cornea, 2021;40(7):859–864. DOI · PMID 32947413
- Ozek D, et al. “Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas” — including keratoconus, pellucid marginal degeneration, and post-keratoplasty eyes. Arquivos Brasileiros de Oftalmologia, 2018;81(6):475–480. DOI · PMID 30231157
Next Step
Request a Specialty Lens Consultation
Whether you were referred by your optometrist or surgeon, or you’re researching options for a diagnosed condition — book a specialty lens consultation online or call (416) 292-0336. We’ll assess whether scleral lenses are right for your eyes, honestly.
Request a Consultation