Scleral Lenses Improve Quality of Life for Patients With Ocular Graft and Dry Eye

Mini-scleral contact lens
Contact lens designs are classified as scleral lenses when there is full bearing on the sclera, further distinctions of the scleral lens group include mini-scleral and large-scleral lenses. These distinctions emphasize differences in central corneal clearance and other fitting characteristics. A lens that is 6mm larger than the visible iris diameter is classified as a mini-scleral lens.
Downsides to wearing scleral lenses include cost, learning curve, cleaning required during the day, and time spent with lens insertion and removal.

Scleral lenses can significantly improve quality of life (QOL) in patients with ocular graft-vs-host disease (GVHD) who report dry eye symptoms, according to research published in Contact Lens and Anterior Eye.

Researchers retroscopically reviewed the charts of 9 patients (56% men, mean age 56±10 years) with a history of stem cell transplant. They collected demographic information, measured best corrected visual acuity (BCVA), and administered the Ocular Surface Disease Index (OSDI) and Visual Function Questionnaire to all participants. Prior to scleral lenses fitting, participants received preservative-free tears, autologous serum, and punctal cautery or plugs to manage dry eye symptoms. 

Investigators noted that 78% of the patients were still wearing scleral lenses at the time of the interview (median duration of wear= 58 months) for a median 7 days/week (range 0–7), and a median 16 h/day (range 0–16). Mean BCVA was 0.28±0.24 logMAR before scleral lens fitting, which improved to 0.14±0.12 logMAR at follow-up (P =.05). 

All patients who continued wear for more than 1 month (n=7) reported QOL improvements and reduced dry eye symptoms. One patient who discontinued scleral lenses after 1 month reported no change in symptoms or QOL. 

Despite improvements in QOL and dry eye symptomatology, patients reported that cost (22%), learning curve (22%), cleaning required during the day (44%), and time spent with lens insertion and removal (33%) negatively affected their scleral lens wear experience. Researchers observed no complications resulting from scleral lens wear. 

“[S]cleral lenses are safe and effective in improving dry eye symptoms and quality of life in patients with chronic ocular GVHD,” according to the researchers. The team notes the severe and debilitating nature of symptoms prior to scleral lens fitting and states, “most patients in this cohort viewed scleral lenses as indispensable and life-changing for treatment of their otherwise refractory ocular GVHD.”

Study limitations include a lack of standardized slit lamp examination data, small sample size, and the use of a single, cross-sectional survey to compare symptoms before and after scleral lens wear. 


Bae SS, Iovieno A, Yeung SN. Outcomes of scleral lenses for dry eye disease in chronic ocular graft-versus-host disease. Published online May 26, 2022. Cont Lens Anterior Eye. doi:10.1016/j.clae.2022.101721