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Scleral Trends: Mini-Scleral Designs and Toric Landing Zones

A recent retrospective study on prescribing trends in a high-volume Netherlands-based contact lens clinic demonstrates that over the 6-year study, prescribing trends shifted from large-diameter scleral lenses toward mini-scleral designs.

By: Melissa Barnett, OD, FAAO, FSLS
Contact Lens Spectrum June 2, 2025

Clinical Report: Scleral Trends in Mini-Scleral Designs and Toric Zones

Overview

A retrospective study from a high-volume Netherlands clinic reveals a significant shift in scleral lens prescribing trends from large-diameter to mini-scleral designs over six years, with a notable prevalence of toric landing zones. The findings underscore the importance of adapting lens designs to anatomical scleral shapes for optimal fitting.

Background

The evolution of scleral lens designs is crucial for improving patient outcomes, particularly for those with irregular corneas. Understanding these trends helps clinicians make informed decisions about lens selection, which can enhance comfort and visual acuity. The study highlights the growing preference for mini-scleral lenses, which may offer better fitting characteristics.

Data Highlights

YearMini-Scleral Lens Prescriptions (%)Large Scleral Lens Prescriptions (%)
20164456
20227426

Key Findings

  • 60.8% of scleral lenses prescribed were mini-scleral designs.
  • Use of mini-scleral lenses increased from 44% in 2016 to 74% in 2022.
  • 99.8% of scleral lenses fitted utilized toric landing zones.
  • The tangential-to-curved landing zone ratio was 10:1 in mini-scleral lenses.
  • The median age of patients at initial lens order was 43 years.
  • Successful fitting required an average of 1.4 lenses across all designs.

Clinical Implications

Clinicians should consider the increasing trend towards mini-scleral lenses and the necessity of toric landing zones when fitting patients. This approach aligns with the anatomical variations of scleral shapes, potentially improving patient comfort and lens stability.

Conclusion

The shift towards mini-scleral lenses and the widespread use of toric landing zones reflect advancements in fitting practices that cater to individual anatomical needs. These trends are essential for optimizing patient care in scleral lens fitting.

References

  1. van Ooik DJ, Soeters N, Krijgh WAC, Visser ES, Contact Lens Spectrum, 2025 -- Scleral lens prescribing trends in a large specialty contact lens practice in the Netherlands
  2. DeNaeyer G, Sanders DR, van der Worp E, et al., JCLRS, 2017 -- Qualitative assessment of scleral shape patterns using a new wide field ocular surface elevation topographer: the SSSG Study
  3. Otten HM, Van Der Linden BJJJ, Visser ES, Optom Vis Sci, 2018 -- Clinical performance of a new bitangential mini-scleral lens
  4. Macedo-de-Araújo RJ, Van Der Worp E, González-Méijome JM, Biomed Res Int, 2019 -- Practitioner learning curve in fitting scleral lenses in irregular and regular corneas using a fitting trial
  5. Contact Lens Spectrum — THE ADVANTAGES OF TORIC LANDING ZONES
  6. Contact Lens Spectrum — Modern Scleral Contact Lens Fitting
  7. Contact Lens Spectrum — THE SCLERAL LENS VAULT
  8. contact lens spectrum — Scleral Notching for Landing Zone Complications in Nonectatic Corneas
  9. THE ADVANTAGES OF TORIC LANDING ZONES
  10. Modern Scleral Contact Lens Fitting
  11. THE SCLERAL LENS VAULT
  12. Scleral Trends: Mini-Scleral Designs and Toric Landing Zones | Contact Lens Spectrum
  13. Scleral lens landing zone toricity and tear exchange - ScienceDirect
  14. Visual outcomes of scleral lenses in different stages and cone locations of keratoconus: A retrospective observational study - PMC