A recent retrospective study on prescribing trends in a high-volume Netherlands-based contact lens clinic demonstrates that over the 6-year study, prescribing trends shifted from large-diameter scleral lenses toward mini-scleral designs, except in patients who underwent keratoplasty. What’s more, a vast majority of scleral lenses had toric landing zones, reflecting anatomical scleral shape.1
Specifically, data from all scleral lens orders placed between 2016 and 2022 were analyzed. A total of 27,430 scleral lenses were evaluated across 6,635 unique patients, including 2,594 patients fit unilaterally. Of these lenses, 60.8% (16,685) were mini-scleral lens designs, and 39.2% (10,745) were large scleral lens designs.
Patient demographics, scleral lens parameters, scleral lens design, and a single lens order per eye per fitting period were analyzed. All scleral lenses were fit with diagnostic fitting sets using the Visser fitting philosophy.
The median patient age at the time of the initial lens order was 43 years (range: 3 to 95 years), with 53.4% of patients male. Patients who had keratoconus represented the youngest subgroup, with a median age of 35 years (range, 9 to 83 years).
The study’s results revealed that, for all indications except keratoplasty, the use of mini-scleral lenses increased significantly over time—from 44% in 2016 to 74% in 2022. The tangential-to-curved landing zone ratio was 10:1 in mini-scleral lenses and 1:1 in large scleral lens designs. Additionally, use of toric landing zones was noted in 99.8% of all scleral lens fittings. This aligns with existing evidence that the scleral shape is rarely spherical; one study showed that 5.7% of scleral profiles are symmetric, with the shape becoming increasingly toric toward the periphery.2 As a result, toric landing-zone designs are often necessary to achieve optimal lens fitting.2
The proportion of mini-scleral lens prescriptions has increased over time compared to large scleral lens designs. This trend may be attributed to the introduction of the bi-tangential mini-scleral lens in 2018, which offers enhanced performance and improved fitting characteristics.3
The mean number of lenses (± standard deviation) required for a successful new fit across all designs was 1.4 ± 0.7.1Previous literature reports a range of 1.5 to 3.2 lenses needed for successful scleral lens fitting.1Macedo-de-Araújo and colleagues found that contact lens specialists with increased experience required fewer additional lenses. Specifically, after the 60th fitting, fewer diagnostic lenses were necessary.4
That publication demonstrates that the vast majority of scleral lenses were fitted with toric landing zones, reflecting anatomical scleral shape. Over that 6-year study period, prescribing trends shifted from large-diameter scleral lenses toward mini-scleral designs, except in patients who underwent keratoplasty.Diagnostic fitting sets were used for fitting and yielded high success rates with few re-orders.
References
1. van Ooik DJ, Soeters N, Krijgh WAC, Visser ES. Scleral lens prescribing trends in a large specialty contact lens practice in the Netherlands. Cont Lens Anterior Eye. 2025 May 10:102426. doi: 10.1016/j.clae.2025.102426.
2. DeNaeyer, G, Sanders, DR, van der Worp, E, et al. Qualitative assessment of scleral shape patterns using a new wide field ocular surface ocular surface elevation topographer: the SSSG Study. JCLRS. 2017;1(1):12-22. doi:10.22374/jclrs.v1i1.11
3. Otten HM, Van Der Linden BJJJ, Visser ES. Clinical performance of a new bitangential mini-scleral lens. Optom Vis Sci. 2018;95(6):515-522. doi: 10.1097/OPX.0000000000001228
4. Macedo-de-Araújo RJ, Van Der Worp E, González-Méijome JM. Practitioner learning curve in fitting scleral lenses in irregular and regular corneas using a fitting trial. Biomed Res Int. 2019;2019:5737124. doi: 10.1155/2019/5737124
This editorial content was supported via unrestricted sponsorship.