High Myopia Patient Fit Into Scleral Contact Lens

High myopia, or severe nearsightedness, presents unique challenges for contact lens fitting. When prescriptions reach extreme levels, standard soft contact lenses may not be available in the needed power, and corneal gas permeable lenses can become uncomfortable or unstable. For patients in Las Vegas and beyond dealing with very high prescriptions, scleral contact lenses offer a stable, comfortable alternative that can deliver excellent vision.

This case illustrates how a patient with extreme myopia and a complex lens-wearing history was transitioned into scleral contact lenses for improved comfort and more predictable results.

What Challenges Does Extreme Myopia Create?

A 34-year-old male had been wearing corneal gas permeable lenses since he was approximately 10 years old. His prescription was exceptionally high, with measurements indicating approximately -22.00 diopters in each eye. At this level of myopia, the eye is significantly elongated, and the corneal shape can be altered by decades of rigid lens wear.

To put this in perspective, most soft contact lenses are only manufactured up to about -12.00 diopters. A prescription of -22.00 is well beyond the range of standard lenses, requiring specialty solutions and careful fitting by an experienced practitioner.

Why Were His Previous Lenses Not Working?

Examination of the patient’s current lenses revealed an unusual fitting pattern. The lenses showed central bearing with midperipheral pooling, which is not a standard corneal gas permeable fit. The fitting pattern suggested a reverse-geometry or orthokeratology-style lens design had been attempted as a daytime wear option by a previous provider.

Additionally, the left lens shifted with each blink, causing fluctuating vision throughout the day. This instability is a common problem when corneal gas permeable lenses do not align well with the shape of the underlying cornea, and it can be especially disruptive for patients who depend on their lenses for nearly all functional vision.

Why Was a Scleral Lens the Right Choice?

After a thorough review of all available lens options, a scleral lens was selected as the best path forward. There were several reasons for this decision.

First, years of corneal gas permeable lens wear had likely altered the natural shape of the cornea. Rather than attempting to redesign a corneal lens based on an artificially molded corneal shape, which can lead to a frustrating cycle of repeated adjustments, starting fresh with a scleral lens provided a clean baseline. Scleral lenses rest on the sclera rather than the cornea, so they are unaffected by corneal shape changes.

Second, scleral lenses offer greater stability on the eye compared to corneal gas permeable lenses. Because they are larger and rest on a more uniform part of the eye, they do not shift with blinking the way smaller corneal lenses can.

Third, by using an oblate scleral lens design and adjusting the base curve, the effective lens power was reduced from approximately -22.00 to about -16.00 diopters. This reduction improves optical quality and makes the lens thinner, lighter, and more comfortable.

What Should High Myopia Patients Expect?

For patients with extreme prescriptions, transitioning to scleral lenses is often a multi-visit process. The first lens serves as a custom diagnostic, and the doctor monitors how the cornea responds as it adjusts to the new lens type. If the cornea has been shaped by years of corneal gas permeable wear, its natural shape may gradually return over weeks to months, requiring prescription and fit updates during that period.

Patients should understand that this is a normal and expected part of the process, not a sign that something is wrong. The goal is to arrive at a stable, comfortable fit that provides the best possible vision for the long term.

Key Takeaways for Patients With High Myopia

• Scleral lenses are available in very high prescriptions that exceed the range of standard soft and corneal gas permeable lenses.
• If your current contact lenses shift, fog, or cause fluctuating vision, a scleral lens evaluation may identify a more stable solution.
• Patients with long histories of corneal gas permeable wear may need a transition period as the cornea returns to its natural shape.
• Specialty lens fitting for extreme myopia requires advanced training and technology, so choosing an experienced provider is essential.
• If you experience sudden vision changes, eye pain, or new symptoms like flashes of light, contact your eye doctor right away, as high myopia carries an increased risk of retinal complications.

At Insight Vision Optometry, Las Vegas, Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS have extensive experience fitting scleral lenses for patients with extreme myopia and complex contact lens histories. Call 702-747-4070 or visit www.insightvisionlv.com to schedule your specialty lens consultation.