Scleral Lenses for Keratoconus in North Fulton & Forsyth: What to Expect From Your Fitting

At a glance: Scleral lenses are one of the most effective ways to see clearly with keratoconus. They are large rigid gas permeable lenses that cover the irregular cornea, while tears fill the space underneath to form a smooth new surface to see through. At Reimbold Eye Group in Alpharetta we fit scleral lenses for keratoconus, corneal scars and high astigmatism for patients across North Fulton and Forsyth County. Here is what your fitting looks like, step by step.

Why keratoconus needs a specialty lens

Keratoconus makes the cornea, the clear front window of the eye, thin and bulge into a cone. That irregular surface distorts light as it enters the eye, which is why vision can look streaky, ghosted or full of halos at night. Glasses only help to a mild degree, because light still has to travel through the irregular cornea after it passes through the glasses. Soft contact lenses drape over the cone and take on its shape, so they often don't improve vision much either.

Specialty hard lenses hold their own shape. They sit over the irregular cornea, and the tears underneath fill in the gap. In effect, the lens and the tear layer create a new, smooth front surface for the eye, and that is what brings vision back into focus.

Scleral, hybrid or RGP: which lens is right for you?

• Scleral lenses are rigid gas permeable lenses that are a bit larger than most soft lenses. Thanks to their size and stability, they give excellent vision, they rarely pop out unexpectedly, and they are our lens of choice for most complicated fits. Large-diameter sclerals are often the only lens that can correct the most advanced cone shapes.
• Hybrid lenses combine a rigid gas permeable center with a soft outer skirt. The skirt adds comfort, and the rigid center gives good vision in most cases.
• Rigid gas permeable (RGP) lenses are smaller hard lenses. They still have a place in milder cases and usually cost less, but debris under the lens is common and some people find them hard to get used to.

Which lens fits best depends on where your cone sits and how steep and thin the cornea is, which is exactly what your corneal maps show.

What to expect at your scleral lens fitting

1. A detailed look at your cornea

Every exam at Reimbold Eye Group includes corneal topography, retinal (fundus) photos and an OCT scan. Topography is a color map of the front of the cornea: cooler blues are flatter, and warmer oranges and reds show steepening. For keratoconus, these maps show the location and size of the cone, and repeating them over time shows whether it is stable or changing.

2. Choosing and fitting the lens

Using your maps and your eye's measurements, we select the lens design and check how it sits on your eye. A scleral lens should rest on the white of the eye and clear the cornea, with an even tear layer underneath. Comfort and vision are both part of the fit, and many first-time wearers are surprised by how comfortable sclerals feel from the first day.

3. Learning insertion, removal and care

Sclerals are filled with saline before they go in, and most people remove them with a small suction tool called a plunger. We teach you both, along with daily cleaning. For tips on technique and comfort, see our posts on removal soreness, itching and rotation and our answers on how many hours a day you can wear scleral lenses.

4. Follow-up visits and fine-tuning

Your first lenses are a starting point. At follow-up visits we check the fit after you have worn the lenses for a while and adjust the design if needed. If lenses fog, collect deposits or trap air bubbles, those are common, fixable fit and handling issues; our answer on fogging and bubbles explains why.

Sclerals and corneal crosslinking

Scleral lenses and crosslinking do different jobs. Corneal crosslinking uses riboflavin (vitamin B2) and ultraviolet light to strengthen the cornea and is aimed at stopping keratoconus from getting worse. Sclerals are about seeing clearly. When serial maps confirm progression, crosslinking may come first, and sclerals can still deliver strong vision afterward once the cornea settles. Read more in Keratoconus After Diagnosis.

Insurance and scleral lenses

Because keratoconus is a medical diagnosis, scleral lenses for keratoconus are usually billed as medically necessary contact lenses, not routine or cosmetic contacts. Many plans cover them when that is documented. If a claim is denied, the problem is often how it was submitted rather than the condition itself, and an appeal with a letter of medical necessity can help. Our Scleral Lens Insurance & Appeals FAQ walks through denials, appeals and prior authorization for replacement pairs.

Coming from North Fulton and Forsyth County

Our office is at 4180 Old Milton Pkwy, Suite 1-D, in Alpharetta, and scleral lens patients come to us from all over the area:

• Alpharetta eye exams
• Eye doctor for Roswell
• Eye doctor for Milton
• Optometrist for Johns Creek
• Eye doctor for Cumming and Forsyth County

Cumming is about 23 minutes down GA-400, Johns Creek is about 5 miles away, Milton is about 7 to 8 miles from Crabapple, and downtown Roswell is about 9 miles from our office.

Frequently asked questions

Do scleral lenses cure keratoconus?

No. Scleral lenses don't change the shape of the cornea or stop keratoconus from progressing. They give you clear, stable vision by creating a smooth new surface over the cone. Corneal crosslinking is the treatment aimed at stopping progression, and sclerals can still give strong vision after crosslinking once the cornea settles.

Are scleral lenses comfortable?

Usually, yes. Although they are larger than traditional gas permeable lenses, they rarely cause discomfort, and many patients who have never worn contacts find them comfortable the first time they put them in.

Will insurance cover scleral lenses for keratoconus?

Often, when it is documented. Keratoconus is a medical diagnosis, so scleral lenses for keratoconus are usually billed as medically necessary contact lenses rather than routine contacts. Coverage depends on your own plan, and our Scleral Lens Insurance & Appeals FAQ explains denials and appeals.

Do I have to live in Alpharetta to be fitted?

No. Patients come to our Alpharetta office from Roswell, Milton, Johns Creek, Cumming and across North Fulton and Forsyth County for scleral lens fittings and follow-up care.

Book a scleral lens consultation

If your vision is streaky or ghosted even with new glasses, or soft contacts no longer give you sharp vision, let's map your cornea and talk about scleral lenses. Book online, or start with our scleral and specialty contact lens page and keratoconus treatment page.