Optical considerations for scleral contact lenses: A review

Scleral contact lenses have a range of therapeutic and optical applications. In recent years, scleral lens prescribing has increased due to significant advances in ocular imaging technology, lens manufacturing processes, and the widespread availability of scleral lenses globally. While the optical principles of scleral lenses are identical to those of corneal rigid lenses (i.e. the post-lens tear layer neutralises the majority of anterior corneal astigmatism and higher order aberrations), the nature of scleral lenses and their typical fitting characteristics means that many of the assumptions of 'thin lens' paraxial optics traditionally used for corneal rigid lens calculations may be inappropriate in certain clinical scenarios. This review provides a comprehensive overview of a variety of lens and fitting characteristics that are unique to scleral lenses, or not typically encountered with corneal rigid lenses, and how these factors may potentially influence optical performance based on theoretical modelling, in particular; scleral lens parameters, the post-lens tear layer, and dynamic changes during lens wear. Current front and back surface lens designs and future scleral lens applications are also discussed, along with lens modifications to improve visual outcomes and transient changes in corneal optics induced by appropriately fitted modern scleral lenses.