Consider a new presbyopic patient who visits your office for the first time with blurred distance and near vision. Years ago, they had LASIK in both eyes and enjoyed great vision for a time. But over the past few years, their vision has worsened with glare and halos, and night driving has become stressful.
They’ve tried everything. Soft contact lenses, including single vision, monovision, and multifocal, did not deliver the vision or comfort they needed. Rigid gas-permeable (RGP) lenses were once part of their journey, but discomfort ultimately drove them away.
As you dig deeper, the picture becomes clear. Your exam confirms post-LASIK ectasia with dry eye disease. Best-corrected distance visual acuity is 20/30 OD and OS. The patient is discouraged—but you’re not. You know exactly what you are going to do.
After educating the patient about their condition and the available options, you reach for your FitKit®. You perform a standard fitting and an overrefraction, then order a scleral lens that provides multifocal correction and addresses their higher-order aberrations (HOAs).
The patient returns for their follow-up appointment, and the moment of truth arrives.
“Can you read the chart for me?”
They start reading and keep going.
20/20.
The patient pauses, then smiles. Not only is the vision crisp at distance and near, the lens feels comfortable—something they didn’t think was possible anymore.
This is more than a successful fit.
This is the kind of transformation patients experience with BostonSight® SCLERAL Lenses—where advanced design meets real-world results.
Meeting the Modern Ocular Challenge
There has been an increase in scleral lens prescriptions, particularly for patients with dry eye disease and corneal irregularities. Therapeutic benefits include masking irregular astigmatism, reducing HOAs, and managing ocular surface disease (OSD).1
Scleral lenses are large-diameter, gas-permeable contact lenses that sit on the conjunctival tissue over the sclera, vaulting the cornea and limbus while maintaining a tear reservoir.1
The BostonSight SCLERAL system currently offers a diameter range of 16 to 19 mm, accommodating a variety of patient anatomies.2 In April 2026, a smaller-diameter design is being introduced, extending the range to 14.5 to 19 mm and broadening access for new patient groups.3 This data-driven lens design provides an efficient and reliable fit.2
Our inspiration to begin offering scleral lenses in our respective practices stems from our clinical residencies in specialty contact lenses. Scleral lenses address ocular challenges in clinical settings while enabling us to visually rehabilitate patients with OSD and improve their quality of life (QOL).
At our practice locations, a scleral lens desert exists, as few clinicians fit specialty lenses, such as scleral lenses. Patients sometimes have difficulty finding doctors who fit these lenses. Many patients have a history of keratoconus, irregular corneas, high refractive errors, and instability with toric lenses, but truly every patient is a candidate for scleral lenses. Even patients who want crisp vision, such as engineers, athletes, and those with less severe dry eye, can benefit from this lens.
In addition to offering a wide range of scleral lens diameters, BostonSight® SCLERAL addresses this challenge by involving students, residents, and doctors. Dr. Dave had a unique opportunity to train at the BostonSight® non-profit clinic and understands the core mission and foundation, which include innovation, collaboration, and a compassionate, patient-centered experience.4
Drs. Qiu and Moss also participated in FitAcademy®, a two-day educational program that provides optometrists with expert training in fitting and handling scleral lenses through both didactic and hands-on experiences. The program aims to equip optometrists with the skills needed to care for patients with complex needs related to scleral lens design and troubleshooting. It also covers treatment methodologies and emphasizes the importance of co-managing patients with other eye care professionals.5 From this experience, Dr. Qiu introduced BostonSight® SCLERAL to her resident clinic, using the larger-diameter lens tomanage complex cases.
Unmet Clinical Needs
Higher-Order Aberrations (HOAs)
Corneal ectasias, such as keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia, result in severe irregular astigmatism, profound myopia, and HOAs. These conditions degrade visual acuity and visual quality. In fact, HOAs impact high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA).6
Scleral lenses create a tear-filled space between the cornea and the lens, smoothing the surface and compensating for many HOAs, such as coma and trefoil, thereby improving overall visual quality. In turn, these improve the QOL related to visual symptoms such as glare, halos, and starbursts.6
For some patients, HOAs can manifest as ghosting, starburst, and shadowing. Sometimes patients give vague descriptions as they do not know how to describe them.
Sometimes our patients are misdiagnosed, which is why careful screening is essential. We recommended using an aberrometer for this purpose. If an aberrometer is not available, clinicians can use a front-surface eccentricity lens on the patient's eye and ask them to describe what they see.
Dry Eye and Ocular Surface Disease (OSD)
There are several categories of patients with OSD who can benefit from scleral lenses:1
- Symptomatic with signs of OSD
- Neurotrophic conditions with signs of OSD but without symptoms
- Keratoneuralgia or neuropathic pain patients who have symptoms of dry eye without signs of OSD
Examples include individuals with keratoconjunctivitis sicca, limbal stem cell deficiency, neurotrophic keratitis, exposure keratitis, PEDs, and cicatrizing conjunctivitis.1
Scleral lenses maintain a fluid reservoir between the back surface of the contact lens and the front surface of the eye. These lenses hydrate the cornea/protects it from the shearing force of eyelids and the environment.1
Advantages of scleral lenses for OSD include:7
- Ocular surface protection
- Corneal healing
- Absence of tear evaporation and contact lens dehydration
- Improved VA with associated increased wear comfort
In our opinion, larger-diameter scleral lenses are particularly beneficial for OSD, as they not only cover the cornea but also the conjunctiva, where some patients may experience dryness.
Key Design Innovations for HOA and Dry Eye Management
The lens has built-in features that ensure a perfect fit easily. Optional Smart features are available for extra customization. Built-in features for BostonSight® SCLERAL lenses include SplineCurve®, SmartChannel®, SmartSight® technologies, oval optic zones, and Quad-specific design™ shown in Table 1.2,8
Table 1. Built-in Features2,8
Figure 1. Patient vision with and without SmartSight FSE
How do these built-in-features benefit patients?
Quad-Specific Design: In a study by Barnett et al. (2020), quadrant-specific scleral lenses were fit in 76 eyes for corneal irregularity, and 9 were fit for the management of OSD. Compared with habitual correction, 22% more eyes achieved 20/20 or better vision, and 21% more eyes achieved 20/40 or better. The study also showed a 60% decrease in the need for midday removal.9
SmartChannel® Technology: In patients with pinguecula, location and depth are calculated with the Eaglet Eye’s ESP. This information helps determine the starting and end points of the SmartChannel® in degrees to ensure the scleral lenses fit the patient appropriately, as shown in Figure 2.8
Figure 2. SmartChannel® Technology With A Pinguecula Patient
Add-on features include SmartSight HOA® and SmartFocus™. SmartSight HOA is used for patients with significant HOA and provides custom HOA correction via a multi-aberrometer platform (Figure 3).8
Figure 3. Vision with and without SmartSight HOA
SmartFocus™ is a proprietary multifocal lens add-on for 16-17 mm lenses that provides near and far vision.8 This addition is simple to add on. In FitConnect, under +SmartFocus™, the patient’s ADD power and mesopic pupil size are entered for each eye.8
Figure 4. SmartFocus™ in FitConnect
For some patients, a custom lens is the best option. Smart360® allows practitioners to design a custom lens for their patient without requiring trial lenses. Smart360® Integrates a profilometer with FitConnect® to transfer scan data to BostonSight manufacturing lab (Fitting Guide).8
Strategy for Personalized Fitting
BostonSight® SCLERAL lenses come in many diameters to accommodate the diverse patient populations that many practitioners encounter. Table 2 shows the diameter range for each FitKit® and its ideal use case.3,11
Table 2. Diameter and Ideal Case Use3,11
The launch of the smaller-diameter scleral lens has been anticipated for some time, especially for pediatric patients. While inserting scleral lenses in the office is generally straightforward, the real challenge arises when patients are unable to insert them at home. A smaller-diameter lens serves as an introduction to scleral lenses without being intimidating.
Other patients who will benefit from this include patients with smaller apertures, smaller HVIDs, or blepharospasm. For some patients, it can feel like the lens is overtaking the entire eye and feels heavy. In our experience, it also increases the likelihood that the lens will decenter and exhibit excess limbal clearance. For patients with blepharospasm, larger-diameter lenses can be difficult to insert at first, making a smaller diameter more beneficial. As patients become accustomed to wearing the lenses, there may be an opportunity to gradually increase the diameter based on their success with insertion and removal.
The entire line follows the same fitting algorithm, maintaining clinical efficiency across diameters:8
For ease of fitting, the lenses are marked with one or two dots to indicate which eye (Figure 6).
Figure 6. Right and Left Lens Markings
Clinical Efficiency and Workflow Impact
Integrating new skills and technology into clinical practice can initially take up more time. Macedo-de-Araújo et al. (2019) found that efficiency increases with practitioner experience. Initially, practitioners used an average of 2.35 lenses in the first 20 consultations, which dropped to 1.56 after 140 fittings. Reorders during fittings also fell from 0.95 to 0.25, indicating that approximately 1.95 lenses were needed in the early fits, compared with only 1.25 after more experience.12
But with BostonSight® SCLERAL lenses, you can increase clinical efficiency even further as visits per patient drop from ~3.8 to 2.8 on average,13,14 and practitioners can save 1 hour of chair time per scleral lens fit. Check to see how much time you can save.
BostonSight® SCLERAL has a 75% first-fit success rate with the Standard diagnostic lens, and 90% of fits achieve optimal vision with the built-in SmartSight® Technology. Additionally, 65% of fits don’t require a change to the haptic design.11
Practice Integration and Clinical Value
Patient and Practitioner Benefits
All trial lenses in the BostonSight® SCLERAL FitKits® have +0.25 power with a base curve of 8.00. As previously discussed, these parameters can be modified within FitConnect® when designing your patient’s lens.8
There is clinical value to integrating BostonSight® SCLERAL lenses into clinical practice for patients and practitioners. In the PGHD (Patient-Gathered Health Data) survey, 90% of patients surveyed would recommend BostonSight® SCLERAL to others, and 91% of patients intend to continue using BostonSight® SCLERAL.15
Our clinical practices have expanded with the provision of BostonSight® SCLERAL lenses. Patients are actively seeking providers who can fit these lenses, and ophthalmology offices, particularly those with corneal specialists, are looking for professionals skilled in this area. The most crucial aspect of being a scleral lens fitter is ensuring that other doctors are aware of our services. Collaborating with an ophthalmology practice can create a mutually beneficial relationship in which they handle disease management while we focus on vision correction.
In the BostonSight® SCLERAL Practitioner Survey (2021 - 2026), practitioners reported that BostonSight® SCLERAL had strong lab support, and the ease of fit and the ability to order lenses online were significant benefits. In addition, practitioners appreciated the quadrant-specific design.16
We believe that many ophthalmologists are familiar with the BostonSight PROSE® device and do not realize that a commercial version is available. For many of them, knowing that BostonSight® SCLERAL lenses and PROSE originate from the same company helps them raise awareness for their patients.
BostonSight® SCLERAL also offers Beyond the Fit®, which provides tools to support ongoing fitting success. This assistance can range from ordering a diagnostic FitKit® to providing specialty lens support. This is a great way to provide support for patients and practitioners alike.17
FitAssist® helps financially needy patients access scleral lenses. BostonSight® SCLERAL practitioners can earn free lenses for qualifying patients.18
FitConnect® is an online ordering and management platform that includes the following features:10
- Custom Lens Creation: Design and order lenses based on each patient's specific needs.
- Patient Profiles: Easily store and manage patient information in one central location.
- Order Tracking: Monitor the status and progress of lens orders in real time
- Prescription Management: Organize and track prescriptions for quick reference and easy updates.
- Fast Lens Production: Expedite the lens creation process to reduce wait times.
- Dedicated Customer Support: Access responsive support whenever you need assistance.
FitSmart™ offers online and in-person education opportunities to equip practitioners with critical troubleshooting strategies beyond lens-fitting mechanics and to address the medical management and co-management of ocular conditions that can be treated with scleral lenses. Support includes online seminars, fitting tips, and dine-and-learn sessions in select regions nationwide.19
Patient Starter Kits feature a zippered travel pouch, a scleral lens applicator and remover, six Tangible Fill individual vials, a stand-up pocket mirror, and a Healthy Lens Habits Guide. They also include some Tangible Clean samples suitable for patients using Hydra-PEG-coated lenses.20
Case Studies
Conclusion
Based on our experience, BostonSight® SCLERAL adopts a future-ready, data-driven approach to scleral fitting, tackling modern challenges such as HOAs, dry eye, and irregular corneas. Its integrated optical designs, smart engineering, and upcoming smaller-diameter options broaden options for both complex and new patient groups—grounded in science, efficiency, and patient-focused outcomes.
