Keratoconus Relief with Scleral Lenses and IContour Technology by Dr Brandon Cohenmehr
- Dr. Brandon Cohenmehr, OD
- Jul 20
- 8 min read
Keratoconus can turn everyday vision into a constant negotiation. Street signs blur. Night driving becomes harder. Glasses may no longer sharpen the world the way they once did. Standard soft contact lenses may shift, dry out, or fail to mask the uneven shape of the cornea.
For many people with keratoconus, scleral lenses offer a path to clearer, steadier vision. These custom lenses vault over the cornea and rest on the white part of the eye, called the sclera. This design creates a smooth optical surface that can correct the distortion caused by an irregular cornea.
Dr. Brandon Cohenmehr has developed expertise in fitting scleral lenses for patients with keratoconus, including the use of IContour Technology, which captures over 1 million points of the sclera. This level of detail helps create a more personalized fit, especially for eyes that need more than a standard contact lens approach.
This article explains how scleral lenses work, why advanced imaging matters, and how corneal topography plays a critical role in achieving a stable, comfortable fit.
Why keratoconus causes distorted vision
Keratoconus is a progressive eye condition in which the cornea becomes thinner and gradually changes shape. Instead of maintaining a smooth, dome-like curve, the cornea begins to bulge forward into a cone-like form.
The cornea is responsible for much of the eye’s focusing power. When its shape becomes irregular, light no longer focuses cleanly on the retina. That can lead to:
Blurred or distorted vision
Increased glare and halos, especially at night
Frequent changes in glasses prescriptions
Ghosting or double images
Eye strain and headaches
Difficulty wearing standard contact lenses
In early keratoconus, glasses or soft contact lenses may provide useful correction. As the condition becomes more advanced, those options often become less effective. The issue is not only prescription strength. The problem is the uneven front surface of the eye.
Scleral lenses help by creating a new, smooth optical surface in front of the cornea. That is why they can provide meaningful improvement for many patients whose vision cannot be fully corrected with glasses.
How scleral lenses improve vision in keratoconus
A scleral lens is larger than a typical soft contact lens or corneal gas permeable lens. Instead of sitting directly on the cornea, it vaults over the cornea and lands gently on the sclera.
This creates a fluid-filled space between the back of the lens and the front of the eye. That tear reservoir fills in many of the corneal irregularities caused by keratoconus. Light passes through the smooth front surface of the lens rather than the uneven corneal surface alone.
The result can be sharper, more stable vision.
Scleral lenses may help patients with keratoconus in several ways:
Clearer optics
The lens masks corneal distortion and provides a regular refractive surface.
Better stability
Because the lens rests on the sclera, it tends to move less than smaller lenses.
Improved comfort
The lens vaults over the sensitive cornea rather than rubbing against it.
Hydration support
The fluid layer beneath the lens can help keep the front of the eye moist during wear.
Custom design options
Lens shape, diameter, edge profile, vault, and landing zone can be adjusted based on eye measurements.
This is why scleral lenses are often recommended for patients with keratoconus, pellucid marginal degeneration, post-surgical corneal irregularity, and other conditions that affect the shape of the cornea.
They are medical devices and must be fitted with care. A lens that looks acceptable at first can still cause discomfort, redness, poor wetting, fogging, or unstable vision if the design does not match the eye well.
Why scleral lens fitting is different from regular contact lens fitting
A standard contact lens fitting often focuses on prescription, corneal curve, lens diameter, and comfort during a short trial period. A scleral lens fitting goes further.
The doctor must account for the full shape of the eye, including the cornea and the sclera. That matters because the sclera is not perfectly round. It can have subtle hills, valleys, asymmetry, and toric shape changes. Even small differences can affect how a scleral lens lands.
A successful fit should balance several goals:
The lens must vault the cornea with enough clearance.
The lens should not press too heavily on one area of the sclera.
The edge should align well with the eye surface.
The tear reservoir should remain stable.
Vision should stay clear throughout the day.
The patient should be able to apply, remove, and care for the lens safely.
When these elements work together, scleral lenses can feel surprisingly comfortable for many patients. When they do not, patients may experience redness, midday fogging, suction, lens awareness, or reduced wearing time.
That is why fitting skill and technology both matter.
How IContour Technology improves the fitting process
Dr. Brandon Cohenmehr uses IContour Technology to support the design and fitting of scleral lenses for keratoconus. This technology captures over 1 million points of the sclera, giving a highly detailed map of the surface where the lens will rest.
That level of measurement is valuable because scleral shape can vary from person to person and even from one eye to the other. Traditional trial lens fitting relies heavily on diagnostic lenses, observation, and adjustments over time. Those skills still matter. IContour adds more data to guide the process from the start.
With a more complete understanding of the scleral surface, Dr. Cohenmehr can better evaluate how the lens should land on the eye. This can help reduce guesswork and support a more precise design.
The goal is not simply to place a lens on the eye. The goal is to create a lens that matches the eye’s shape, protects the cornea, supports clear vision, and remains comfortable through real daily use.
What makes this fitting process unique in the practice
The advanced fitting process in Dr. Cohenmehr’s practice combines clinical judgment with detailed eye-shape data. IContour Technology provides a broad measurement of the sclera, while the doctor’s fitting expertise guides how that information becomes a wearable lens.
This process is unique because it does not treat scleral lenses as one-size-fits-most devices. Instead, it recognizes that each eye has its own shape. A patient with keratoconus may have corneal steepening, asymmetric scleral curves, dryness, prior lens intolerance, or other details that affect the final design.
The fitting process may include:
Careful review of visual symptoms and lens history
Corneal topography to assess the shape of the cornea
Scleral mapping with IContour Technology
Diagnostic lens assessment when needed
Lens design based on both imaging and clinical findings
Refinement visits to improve comfort, clarity, and wearing time
This approach can be especially helpful for patients who have struggled with standard contact lenses or who were told their eyes were difficult to fit.
The critical role of corneal topography
Corneal topography is one of the most important tools in keratoconus care. It creates a detailed map of the cornea’s curvature and shape. For patients with keratoconus, this information helps identify the location and degree of corneal steepening and irregularity.
While IContour Technology maps the sclera, corneal topography focuses on the cornea. Both are important, but they answer different questions.
Measurement tool | What it helps evaluate | Why it matters for scleral lenses |
Corneal topography | The shape and curvature of the cornea | Helps determine how much the lens must vault over the cornea |
Scleral mapping | The surface shape of the sclera | Helps guide how the lens lands around the eye |
Clinical lens evaluation | Lens movement, clearance, comfort, and vision | Confirms how the design performs on the actual eye |
The scleral lens must vault over the cornea without touching it. If the lens sits too low, it may rub or place stress on the cornea. If it vaults too high, it may create excessive fluid thickness, reduced oxygen flow, visual blur, or fogging.
Corneal topography helps guide the needed clearance and lens geometry. It also helps monitor keratoconus over time. If the corneal shape changes, the lens fit may need to be reassessed.
Why topography and scleral mapping work better together
Corneal topography and scleral mapping complement each other. Topography shows the irregular corneal surface that needs to be protected and visually neutralized. IContour mapping shows the scleral surface that will support the lens.
A high-quality scleral lens fit depends on both.
For example, two patients may have similar keratoconus severity on corneal topography but very different scleral shapes. One may need a more toric landing zone. Another may need a quadrant-specific design because different parts of the lens need different adjustments.
Without mapping the sclera in detail, those differences may only become clear after repeated trial lenses. With more complete data, the fitting process can be more directed.
What patients can expect during a scleral lens fitting
A scleral lens fitting is more detailed than a routine contact lens visit. The process often starts with a full review of symptoms, current correction, lens history, medical eye history, and visual goals.
Dr. Cohenmehr may evaluate the eyes using several measurements and tests, including corneal topography and IContour scleral mapping. These tools help build a clear picture of both the cornea and the sclera.
The fitting visit may also include a diagnostic scleral lens trial. This helps assess:
Initial comfort
Vision through the lens
Central and peripheral clearance
Lens landing on the sclera
Edge alignment
Tear exchange or fogging patterns
After the lens design is selected, custom lenses are ordered. Once the lenses arrive, patients return for dispensing and training. Application and removal are important skills. Patients learn how to fill the lens with sterile saline, place it on the eye without trapping air bubbles, remove it safely, and clean it properly.
Follow-up visits allow the doctor to evaluate wearing time, vision stability, eye health, and comfort. Adjustments may be needed. This does not mean anything has gone wrong. Fine-tuning is often part of high-quality scleral lens care, especially for keratoconus.
Signs that a scleral lens fit is working well
A successful scleral lens fit should support both clear vision and healthy wear. Patients often report that vision feels more stable compared with glasses or soft lenses, especially when keratoconus has caused irregular astigmatism.
A well-fit scleral lens should generally provide:
Clearer vision than previous correction options
Comfortable wear for the prescribed schedule
Minimal redness after removal
Stable lens position
No corneal touch
Manageable lens care routine
Less lens awareness through the day
Some patients need time to adapt. Handling the lenses can feel unfamiliar at first because scleral lenses are larger and must be filled with saline before application. With guided training and practice, many patients become comfortable with the routine.
If vision becomes cloudy during the day, the lens feels tight, redness persists, or removal feels difficult, the fit should be rechecked. These issues can often be addressed with design changes, care adjustments, or treatment of dryness and surface inflammation.
Insurance coverage may help with the cost
Custom scleral lenses are more complex than standard contact lenses, and cost is a common concern. Many patients with keratoconus may have coverage through VSP, EyeMed, and other vision insurance plans, especially when the lenses are considered medically necessary.
Coverage varies by plan. Some plans may cover the fitting, lenses, or both. Others may require documentation showing that glasses or standard contact lenses do not provide adequate vision correction.
Patients should bring insurance information to the consultation so benefits can be reviewed. The practice can often help determine what may be covered and what out-of-pocket costs may apply before moving forward.
Because keratoconus is a medical eye condition, some cases may also involve medical insurance, depending on the circumstances and the plan rules. Benefits can differ widely, so verification is the safest way to understand coverage.
Why expertise matters for keratoconus lens care
Keratoconus requires thoughtful, ongoing care. The shape of the cornea, the health of the ocular surface, the patient’s visual needs, and the lens design all influence the final outcome.
Dr. Brandon Cohenmehr’s expertise in fitting scleral lenses with IContour Technology gives patients access to a highly detailed and personalized process. Capturing over 1 million points of the sclera helps guide a lens design that better respects the eye’s natural shape. Combined with corneal topography, this approach supports clearer vision, healthier lens wear, and a more predictable fitting experience.
Keratoconus Relief with Scleral Lenses and IContour Technology by Dr Brandon Cohenmehr is centered on one practical goal: helping patients see more clearly with lenses designed around their actual eyes.
This content is for informational purposes only and does not replace a comprehensive eye examination or personalized medical advice. Anyone with keratoconus symptoms, changing vision, or contact lens discomfort should seek evaluation from a qualified eye care professional.
