Scleral lenses are an important option for the management of irregular astigmatism in individuals who have keratoconus (KC) and can provide significant visual and therapeutic benefits. However, complications may occur with long-term scleral lens wear, such as clinical or subclinical corneal edema, corneal vascularization, and corneal hypoxia, which is considered a key contributor to corneal endothelial dysfunction.¹ One of the significant limiting factors of SL wear are endothelial cell abnormalities.² Reduced oxygen transmission during scleral lens wear can promote anaerobic metabolism and lactic acid accumulation, which contribute to subclinical or clinically significant corneal edema.³

A recent study evaluated whether long-term scleral lens (SL) wear leads to significant changes in corneal endothelial parameters in individuals who have KC.¹

The study authors aimed to address the limited data in the literature regarding corneal endothelial cell alterations following long-term scleral lens wear in individuals who have keratoconus. They compared endothelial measurements using specular microscopy before and after scleral lens wear in eyes with KC and eyes in a healthy control group over the same time period.

The study included individuals who had moderate or advanced keratoconus and who had worn scleral lenses for more than 3 years, with an average duration of wear of 5 ± 2 years. Individuals who had a steepest corneal curvature greater than 48.5 D and no corneal scarring were eligible for inclusion.

Individuals in the control group did not wear any type of contact lens. The same measurements were obtained from healthy individuals over a similar time period to determine the natural course of changes in specular microscopy parameters. No differences were observed between the initial and final examinations in the healthy control group, and no significant differences in specular microscopy parameters were noted between the primary and final examinations after long-term SL wear in individuals with KC.

The authors suggest that when recommended fitting and wear practices are followed, scleral lens use appears to be well tolerated by the corneal endothelium. However, further research involving larger cohorts is needed to confirm the long-term safety of scleral lens wear.

References

1. Doğan C, Kılıçarslan O, Özdemir FB, Atakan D, Mergen B. Long-term impact of scleral contact lens use on endothelial cell density in patients with moderate to advanced keratoconus. BMC Ophthalmol. 2026 May 28. doi:10.1186/s12886-026-04964-w

2. Giasson CJ, Rancourt J, Robillard J, Melillo M, Michaud L. Corneal endothelial blebs induced in scleral lens wearers. Optom Vis Sci. 2019;96(11):810-817. doi:10.1097/OPX.0000000000001438

3. Kim YH, Tan B, Lin MC, Radke CJ. Central corneal edema with scleral-lens wear. Curr Eye Res. 2018;43(11):1305-1315. doi:10.1080/02713683.2018.1500610

4. Lu NJ, Elsheikh A, Rozema JJ, et al. Combining spectral-domain OCT and air-puff tonometry analysis to diagnose keratoconus. J Refract Surg. 2022;38(6):374-380. doi: 10.3928/1081597X-20220414-02

Melissa Barnett, OD, FAAO, FSLS, practices at Baker Optometry. She also is an International Coaching Federation (ICF) associate certified coach. She has received remuneration from ABB, AbbVie, Alcon, Azura, Bausch + Lomb, BCLA, Bruder, Cloudbreak Pharma, Dompé, Epion, OCuSOFT, ScienceBased Health, STAPLE Program, Tarsus, Tenpoint Pharmaceuti-cals, and Théa Pharma.

 This content is sponsored by Contamac.