Visit one: assessment and diagnostic fitting
The visit starts with your history: the condition being addressed, previous lenses and what went wrong with them, your vision goals and how you use your eyes. The eyes are examined at the slit lamp and imaged with corneal topography and tomography, and the tear film is assessed, because dry eye affects lens tolerance. From the maps, a lens type is chosen and a diagnostic lens from the fitting set is placed. Its fit is assessed with fluorescein dye and, where appropriate, imaging, vision is measured over it with a trial prescription, and the adjustments needed are recorded. A custom lens is ordered, which usually takes one to two weeks to arrive.
Visit two: dispensing and training
The custom lens is placed and assessed after settling for twenty to thirty minutes. Fit, movement, clearance over the cornea and vision are checked, and small adjustments are noted. You are taught to insert and remove the lens, using a plunger for scleral lenses, and to clean, disinfect and store it, and you practice until you are confident. You leave with the lens, a wearing schedule that builds up over the first week, and instructions on what to watch for.
Follow-up visits
A check after one to two weeks of wear assesses comfort, vision across the day, the fit after the eye has adapted, and the health of the cornea beneath. Adjustments to the lens's curvature, diameter, edge or power are made by ordering a revised lens, and the process repeats until the lens is right. Most fittings are complete within four visits. A longer term check is scheduled at three to six months and then yearly, or sooner if the underlying condition changes.
What makes a fitting complex
Highly irregular corneas, very steep or very flat corneas, scleral shapes that are asymmetric, previous surgery, and eyes that have failed several lenses all take more iterations. Advanced designs, such as scleral lenses with custom back surfaces made from scleral imaging, or lenses with wavefront-guided optics that correct higher order aberrations, extend what is possible for the most difficult eyes and may be considered when standard designs do not achieve the vision the eye is capable of.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Arbi Melikian, OD. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
