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CONTENT SOURCE
This continuing education (CE) activity captures key statistics and insights from contributing faculty.
ACTIVITY DESCRIPTION
In this article, the authors explore the latest advancements in specialty contact lenses, including custom soft, corneal GP, and scleral designs. It highlights innovations in materials, digital fitting, myopia control, and therapeutic applications, shaping the future of vision correction and ocular health.
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This educational activity is intended for optometrists, contact lens specialists, and other eyecare professionals.
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This course is COPE accredited for two hours of CE credit.
COPE Course ID: 97016-CL
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Jason Jedlicka, OD, is a stockholder or owner of Lens Design Solutions LLC and has received remuneration from Bausch + Lomb and Oculus. Maria K. Walker, OD, PhD, reports no conflicts of interest.
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2. That practice recommendations given relevant to the companies with whom they have relationships/affiliations will be supported by the best available evidence or, absent evidence, will be consistent with generally accepted medical practice;
3. That all reasonable clinical alternatives will be discussed when making practice recommendations.
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Release date:May 1, 2025
Expiration Date: April 7, 2028
SPECIALTY CONTACT LENSES are designed to do more than offer a glasses-free experience—they’re used to correct complex refractive errors or serve other unique purposes. As of 2025, patients and practitioners can select from many catergories of lenses, and there are expanding patient indications for specialty lens wear. Soft lenses, corneal and scleral GP lenses, and hybrid designs continue to help manage complex ocular surface issues and enhance patients’ quality of life. With advancements in technology, availability, and expertise, these lenses now offer more precise vision correction and better treatment options for ocular surface conditions. This feature highlights the current landscape of specialty contact lenses, along with updates and future trends in the market.
Custom Soft Lenses
Soft custom contact lenses continue to improve due to the high demand for comfort and convenience. Comfort remains a key focus in the evolution of custom soft lenses. New edge profile designs minimize eyelid interaction, improving lens stability and reducing discomfort during blinking. Advancements in materials, such as moisture-retaining polymers and biomimetic coatings (ie, those designed to mimic the natural corneal surface or tears), help to stabilize the tear film and reduce friction for superior all-day comfort.1,2
Custom soft lenses are increasingly being used in specialized fields, including sports and therapeutic applications. Athletes benefit from lenses with custom tints and contrast-enhancing features that optimize visual performance in various lighting conditions.3 Tinted lenses are also becoming more widely used for managing migraines and visual disturbances,4 with amber- and gray-tinted daily disposable options now commercially available, improving accessibility.
Soft contact lens technology is advancing in myopia control, with innovative designs aimed at slowing myopia progression in children and young adults. Specialized multifocal and dual-focus lenses help regulate eye growth and reduce myopia progression.5,6 Ongoing research continues to refine these designs, incorporating features such as light-filtering technology and drug delivery systems to enhance their effectiveness.
Drug-eluting lenses hold significant promise for therapeutic applications. They deliver medications directly to the ocular surface, potentially improving treatment compliance and efficacy for conditions like dry eye disease and ocular allergies.7 The first commercially available therapeutic soft lens, infused with ketotifen, was introduced outside the United States in 2022.8 However, its commercial success was limited, possibly due to first-mover disadvantages, and the lens was ultimately discontinued. Despite this, that product set the stage for future innovations in this category, allowing for improvements that may overcome initial market challenges.
Corneal GPs
Corneal GP lenses have been the mainstay of specialty lenses for decades, due to their ability to mask anterior corneal irregularity and provide superior vision for most patients. While there have been major developments in GP lens design and application, the basic concept that their rigid nature can provide unique benefits has not changed. Trapping a tear layer to fill in a misshapen cornea, reshaping a cornea for refractive benefits, or translating on an eye to provide different visual correction at different distances are things that soft lenses just cannot do nearly as well.
Although the use of GP lenses for most standard refractive errors has declined over the last 50 years, their place in specialty lens correction is still important. A few areas in which corneal GPs maintain a strong and useful presence are correcting presbyopia, correcting vision in the irregular cornea patient, and orthokeratology.
Corneal GPs for presbyopia: The ability to customize GP lenses makes them a great option for correcting the vision of presbyopic patients. Some design options include simultaneous vision, concentric, and translating lenses. This translation, or movement, of the lens relative to the visual axis, when combined with separate optics for distance vs near vision, allows patients to have a higher quality of vision at each distance than would be achieved with nontranslating, simultaneous vision lenses.
There are 2 subcategories of multifocal corneal GPs: rotational and nonrotational. The rotational category consists of aspheric and concentric designs that are based on simultaneous vision principles. Each type of GP multifocal has pros and cons, and choosing the best type for the patient depends on their unique needs.
The evolution of aspheric multifocal lens designs makes them an excellent entry point for many presbyopic patients because they provide generally good vision at all distances, but particularly at distance and intermediate.9 The first aspheric multifocal designs were constructed with the asphericity on the back of the lens, which allowed for a generous add power but also required a steep base curve to achieve the proper add power and centration.
The unwanted effect of these early designs was corneal molding that could create transient distance blur after many hours of wear.10 Front aspherics initially avoided that problem, but had lower rates of asphericity and limited add power options. Over time, a combination of low back and front asphericity has resulted in higher available add powers and better near vision with less concern about corneal molding. Further evolution of front-surface aspherics now gives us high add options on a fully front-surface aspheric design.
The aspheric multifocal lenses currently available are easy to fit, as they are fitted with base curves and diameters just like a standard GP, typically slightly flatter than K to achieve a center to superior center position in primary gaze, and a superior position in down gaze with the help of some lid control (Figure 1).
Concentric design GP multifocals are another rotational option for presbyopic patients. These designs will typically have the concentric add power on the back surface and, thus, require a steeper base curve (Figure 2). The benefit of a concentric design over an aspheric is the ability to provide higher add powers.10 The drawbacks include corneal molding due to a steeper base curve and less intermediate vision correction. For the patient who prefers the comfort of a thinner lens design that requires less translation for proper function, a concentric design can be quite effective.
Nonrotational GP multifocals or alternating design lenses have the powers placed in the lens top and bottom; thus, they cannot rotate much to maintain proper function. These lenses truly provide the best quality distance and near vision when properly fitted, as the powers are completely segregated (Figure 3).
With alternating GP multifocals, it is more challenging to achieve good intermediate vision, due to the sharp transition of distance to near power and the fit characteristics. The inferior edge is thicker due to prism ballasting, and the lens exhibits more movement due to its riding on the lower lid, causing greater lens awareness when compared to aspheric or concentric design.
Success with any multifocal corneal GP requires that the lens is fit properly and in a way that allows the proper optics to be positioned over the visual axis when the patient is viewing through the lenses at distance, intermediate, and near. For example, an aspheric lens should ride slightly high, but not too high. An aspheric lens that rides too high will place too much of the add zone over the visual axis at distance, creating blurry distance vision and a minus over-refraction, which, if incorporated, will not allow for correction of near vision. Following the fitting guide and understanding what constitutes a proper fit is critical, and successful fitting can lead to satisfying presbyopic vision correction.
Corneal GPs for irregular astigmatism: For most of the last 60 years, corneal GPs were the mainstay of vision correction for the patient who has an irregular cornea. Keratoconus (KC), post-penetrating keratoplasty (PK), post-refractive surgery, corneal dystrophies and degenerations, and trauma are among the reasons for irregular astigmatism to develop. The rigidity of a corneal GP and the resulting tear lens between the lens and the ocular surface provides the clearer vision needed by these irregularly shaped eyes.
In recent years, sclerals have become more commonly prescribed for many of these patients for improved comfort, stability, and, in the case of KC, avoidance of rubbing the pathologic cornea.11,12,13 However, corneal GPs still offer advantages in many cases over sclerals and should still be considered as an excellent option, particularly where oxygen permeability, lens movement, or translation are critical.
Post-PK eyes often have high degrees of regular as well as irregular astigmatism,14 making corneal GP lenses beneficial for vision correction. Because these eyes also need higher degrees of oxygen to avoid edema and vascularization that can lead to rejection, corneal GPs are still often the lens of choice for many patients with corneal grafts.15 Their permeability, thin postlens tear layer, and circulation of oxygenated tears under the lens all provide the healthiest option for the post-PK eye.
In addition, patients who have any type of inflammatory disease that causes vascularization may benefit from a corneal GP as opposed to a scleral lens. Eyes that have undergone glaucoma surgery that resulted in the conjunctiva dramatically elevated focally may be better off with a corneal GP, if tolerated. In cases of post-refractive surgery, the cornea is very flat centrally and much steeper in the midperiphery. A reverse-geometry corneal GP can be very effective in these cases, as the curves can be created to match the cornea precisely.
When fitting a corneal GP for an irregular or postsurgical cornea, it is common to fit a larger lens diameter that approaches full cornea, typically in the 9.8 mm to 12.0 mm range. This is necessary as the cornea will have significant variation in shape, and a larger lens will cover more surface to allow better overall centration and stability.15
Additionally, due to the high level of underlying regular astigmatism in many instances, a back-toric or bitoric lens may be utilized (Figure 4). Because the lens has a larger diameter, using a high- or hyper-Dk material is still a good approach for corneal health. Ultimately, a lid-controlled design, with its enhanced comfort and stability, is ideal.
Piggybacking corneal GPs: In instances when corneal irregularity requires a GP lens, but the epithelium is too fragile or compromised for contact with a moving GP lens and a scleral is deemed to be a poor option, fitting a soft lens under the GP (piggybacking) can be a reasonable option (Figure 5). Piggybacking a soft lens provides a barrier between the moving GP lens and fragile spots on the cornea.
To piggyback properly, it is wise to remember a few key points. To start, the power of the soft lens impacts the base curve of the corneal GP needed. In cases of very steep or very flat corneas, it is helpful to choose a soft lens with a shape that will help normalize the surface. For example, if a patient has a very steep cornea, fitting a high minus soft lens will create a flatter surface, which allows for fitting a GP with a much flatter base curve. This strategy can also make the lens fit more stable.
The power of the soft lens does influence the refractive power of the system as whole, but that impact is only about 20% of the soft lens power.16 So, if a –5.00 D soft lens is applied under a GP, the GP power will ultimately have to change by 1 D to compensate for the soft lens.
When piggybacking, a daily disposable soft lens eliminates the need for 2 lens cleaning regimens. Silicone hydrogel materials provide the best oxygen permeability through the 2-lens system.
Scleral Lenses
Scleral lenses have been used since the early 20th century, initially made from glass and later from polymethylmethacrylate (PMMA). Their popularity declined with the rise of smaller, more breathable corneal GP lenses, but advancements in GP lens materials during the late 20th and early 21st centuries led to a resurgence. Today, scleral lenses are widely used for managing corneal irregularities, severe dry eye, and other ocular conditions.11,13,15,17
One of the most significant improvements is the development of advanced materials that enhance oxygen permeability while preserving structural integrity. Manufacturers have introduced new polymers that improve breathability, reducing the risk of hypoxia-related complications and promoting long-term corneal health.
These materials also offer enhanced wettability, ensuring better tear film stability and all-day comfort. Beyond material innovations, the greatest areas of growth and future potential lie in digital and artificial intelligence (AI)-driven fitting technology, advanced optical profiles for higher-order aberration (HOA) correction, and maximizing the fluid reservoir’s therapeutic benefits for severe ocular surface conditions.
Customization and digital fitting technologies: The fitting process for scleral lenses has become increasingly precise, thanks to digital innovations provided by corneal topography, anterior-segment optical coherence tomography, and, more recently, 3D printing and AI-driven algorithms—so-called “precision fitting” (similar in concept to precision medicine). Practitioners can design lenses with unprecedented accuracy, tailoring the sagittal depth, limbal clearance, and landing zone to each patient’s unique ocular anatomy.
Impression-based and 3D-printed lenses have become more common, although they do not necessarily reduce chair time or remakes,18 likely due to the complexity of the cases that are selected for these approaches. Indeed, image- or impression-based lenses are usually used in cases in which other lens designs have failed, reportedly being used in fewer than 10% of cases.19 Access to scleral topography may help practitioners better identify which patients need these highly customized devices.
HOA correction has gained significant traction in recent years, particularly in the field of scleral lenses, for patients who have residual aberrations. Patients who have irregular corneas due to KC, post-refractive surgery complications, or corneal scarring often have residual HOAs that are still present after conventional lens fitting (Figure 6).
With the integration of aberrometry-driven fitting techniques and advancements in manufacturing precision, HOA-correcting scleral lenses have emerged as a game changer, providing patients with sharper vision, reduced visual disturbances, and enhanced overall visual performance. As awareness and accessibility increase, this technology is poised to become a standard option for individuals struggling with persistent visual aberrations.
Scleral lenses and ocular surface diseases: Scleral lenses have become an integral part of managing ocular surface diseases (Figure 7),20 particularly for patients who have severe dry eye syndromes17 such as Stevens-Johnson syndrome21 and graft-vs-host disease.22 More practitioners are taking advantage of customized fluid-ventilated designs, optimizing tear exchange beneath the lens to promote corneal healing and reduce inflammation.
Additionally, scleral lenses are increasingly being used as drug delivery devices, housing a fluid reservoir that can facilitate distribution of anti-inflammatory, anti-infective, and anti-VEGF medications, which have been successfully used for scleral lens patients.23-25 This innovation has the potential to improve treatment adherence and provide targeted relief for patients who have chronic ocular conditions.
New advancements in tear fluid reservoir management have also emerged, with lenses being designed to attempt optimization of fluid dynamics to prevent midday fogging, a common complaint among scleral lens wearers (particularly those who have ocular surface diseases). Specialized surface treatments are available to provide hydration and deposit resistance to lenses, ultimately resulting in clear vision and preventing discomfort associated with dryness.
Conclusion
Looking to the future, there are several areas of anticipated innovation and technological advancement. Smart lens technology is on the horizon, with research focusing on sensors that monitor ocular data such as intraocular pressure and tear composition. These advancements could provide real-time health data, offering proactive eyecare solutions.
Furthermore, the integration of smart systems like virtual reality and retinal projection are emerging in development phases. As technology continues to evolve, custom contact lenses are expected to address even more complex visual needs, further enhancing the quality of life for wearers worldwide.
References
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15. Messer B, Fosso T, Kuzniar J. Contact lens wear after corneal transplantation. Contact Lens Spectrum. 2023;38(10):34-36,38,40,41. clspectrum.com/issues/2023/october/contact-lens-wear-after-corneal-transplantation
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21. Heur M, Bach D, Theophanous C, Chiu GB. Prosthetic replacement of the ocular surface ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome. Am J Ophthalmol. 2014;158(1):49-54. doi: 10.1016/j.ajo.2014.03.012
22. Theophanous C, Irvine JA, Parker P, Chiu GB. Use of prosthetic replacement of the ocular surface ecosystem scleral lenses in patients with ocular chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2015;21(12):2180-2184. doi: 10.1016/j.bbmt.2015.07.027
23. Lim M, Jacobs DS, Rosenthal P, Carrasquillo KG. The Boston Ocular Surface Prosthesis as a novel drug delivery system for bevacizumab. Semin Ophthalmol. 2009;24(3):149-155. doi: 10.1080/08820530902802013
24. Rosenthal P, Cotter JM, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. Am J Ophthalmol. 2000;130(1):33-41. doi: 10.1016/s0002-9394(00)00379-2
25. Laballe R, Vigne J, Denion E, Lemaitre F, Goux D, Pisella PJ. Preclinical assessment of scleral lens as a reservoir-based ocular therapeutic system. Cont Lens Anterior Eye. 2016;39(5):394-396. doi: 10.1016/j.clae.2016.04.008
