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Dr. Greg DeNaeyer has been practicing optometry for over 20 years and specializes in the fitting and design of scleral contact lenses. Whether it be for keratoconus, post-surgical, post-trauma, or for dry eye disease, he is an absolute expert in this field.
When he first began practicing, scleral lenses were not common and there were very few practitioners using them. He was using gas permeable contact lenses to manage irregular corneal conditions, and he ran into many challenges with this. After investigating scleral lenses as an option, he found immediate success using these lenses on patients, and he’s been successfully fitting patients with sclerals ever since.
If you wear scleral contact lenses or have questions about them, this interview will provide you with everything you need to know!
Scleral lenses are large diameter contact lenses which are made of gas permeable material. This material is firm and not flexible, and it’s the same material used in “harder” contact lenses (vs. soft silicone lenses). The diameter may range from 15-20mm, and this is much larger than a normal contact lens. They actually vault right over the cornea instead of sitting on it, and they instead sit on the sclera. Because of this, they are very comfortable and are also incredibly helpful for those with ocular surface disease. The following are the three main advantages for dry eye patients:
There’s a lot of gray area in this, but great candidates include those who have very severe dry eye disease, have been to many doctors, and have tried “everything” including all medications, eyelid hygiene, and other treatments without success. With that being said, there are less severe patients that may do well with scleral lenses, and there are definitely worst case scenario patients who just don’t do well. If a patient is committed enough to learning about the lenses and how to care for them, they can usually work well.
For some people, they can be very difficult to apply to the ocular surface. The lenses have to be filled with saline solution, and it can be a challenge for some patients to correctly insert the lenses without running into issues. Of course, proper training is always done and there are many patients who will be successful and have no problems, no matter what the age.
Applying a scleral contact lens can be more difficult than applying your average contact lens, but there are tools that make it easier. For example, Dr. DeNaeyer has his patients use a plunger which first works to balance the lens. The lens is then filled with non-preserved saline. The patient will then lean over to have their face parallel to the floor (one great tip is to use a flat mirror and place it onto the countertop, so you’ll be able to see what you’re doing). Then, with the free hand, open the upper and lower eyelids as much as possible and bring the plunger up to the eye to place the lens right onto the cornea. It’s important to get this insertion process correct, because if bubbles are present under the lens it can not only disrupt vision but comfort as well.
The big key to removal is the position of the smaller plunger used. There is some suction with scleral lenses, so you have to make sure that you don’t place the plunger at the center of the lens. This could cause the lens to suction to the eye and be very difficult to remove. Instead, place the small plunger on the corner of the lens, ensuring that it’s suctioned to the lens, and lift outward. This allows you to break the seal of the lens quite easily, and the removal process is usually much easier than insertion. You can find insertion and removal videos here.
This can vary quite dramatically depending on who is fitting the lenses, what part of the country you’re in, and the type of scleral lens (standard vs. custom). Some patients may be able to have them covered by insurance for medical necessity, but there are many variables involved. Either vision insurance or medical insurance may apply here, and the doctor’s office you’re working with should look into your insurance before even fitting the lenses. If they’re not covered for you, hopefully you can use a Health Savings Account or even spread the payments over time. In general, scleral contact lenses are not covered for dry eye disease (they’re more likely covered for keratoconus).
Scleral lenses can last anywhere from 1-3 years depending on the patient. The plastic of the lenses will eventually wear out, get scratches, or even break. In Dr. DeNaeyer’s experience, patients with dry eye disease typically have to replace them more frequently because the dry eye surface can be very drying for the actual lens material.
Make sure to check out The Scleral Lens Center and find more information about scleral lenses at the Scleral Lens Education Society. If you’d like to get in touch with Dr. DeNaeyer or visit their office in Columbus, OH, you’ll find him at Arena Eye Surgeons downtown. Give them a call at (614) 228-4500.
20:05 - Elizabeth Lehmkuhl - I have moderate MGD and I asked my dry eye specialist about scleral lenses and he said they are for patients with more advanced corneal issues. Would you agree or disagree with that?
21:08 - Mary Costello - Are scleral contact lenses available without vision correction--to be used just to help with severe dry eye disease? I have 20/20 vision in the eye that is most affected.
21:45 - Nannette Condie - Can it help people with blepharospasm?
22:01 - Renée Stone - What can you do to minimize hazy/foggy/filmy lenses? They’re clean when they go in then 10 minutes later one or both often get “grimy”.
24:11 - Alison Walters - Based on his experience, do people with severely dry eyes and advanced MGD do better with a smaller or larger diameter lens? Why?
25:00 - Lila Phillips - Are more educational materials being provided &/or standardized as to the proper fitting & care for these lenses? They are so much more complex than regular contact lenses
26:20 - Teresa Locke Cockerill - What questions should I ask when selecting an eye doctor to fit my scleral lenses?
27:45 - Sue Gnacinski - Who is indeed qualified enough to fit these lenses?
28:19 - Colleen Aiken - Should pingueculas be removed before considering Scleral lenses?
28:58 - Connie Furlong - What if you have open angle glaucoma and use Rx drops? What about if you have a Trab or Stent, could you wear them?
30:28 - Julien Len - What is it some people find it very difficult to find a fit and others seem to get it right almost immediately? Are there "more difficult" eyes than others?
31:20 - Cristy Patterson - Is it safe to wear if you have conjunctivochalasis or will it make it worse?
32:10 - Ali Ali - Why would my cornea specialist say no to sclerals if I have a -12 myopia and MGD, Blepharitis, and ocular rosacea?
Dr. Greg DeNaeyer has been practicing at Arena Eye Surgeons for over 19 years with an emphasis on specialty contact lenses. Dr. DeNaeyer was a co-founder and past president of the Scleral Lens Education Society and is a Fellow of the American Academy of Optometry. He is a contributing editor for Contact Lens Spectrum and a contributor to Review of Cornea and Contact Lenses and Optometric Management. Dr. DeNaeyer is an internationally recognized contact lens specialist having delivered invited lectures or workshops at over 70 conferences.
His primary interests include Comprehensive eye care, Contact lens fitting, Specialty contact lens fitting for post-surgical, post trauma, and Keratoconus; Scleral contact lens fitting, Treatment and management of glaucoma, Management of post-surgical cataract, glaucoma, and corneal transplant patients; Evaluation and treatment of dry eye syndrome, and Low vision rehabilitation. Currently his primary research is focused on specialty lens design and corneo-scleral topography. Dr. DeNaeyer has been awarded the GPLI and Scleral Lens Practitioner of the year.
Dr. DeNaeyer received his Pre-Optometry education at the University of Nebraska in Lincoln, Nebraska. Soon after he attended college and received his Doctor of Optometry from The Ohio State College of Optometry.
