At the 2026 Global Specialty Lens Symposium (GSLS), Langis Michaud, OD, MSc; Josh T. Lotoczky, OD; and Cherie Nau, OD, discussed pressing questions and issues in modern scleral lens practice. Here, CLS reveals key takeaways from the general session.

1. Managing patient expectations before fitting is a must.

Dr. Michaud notes that experiences vary widely depending on a patient’s visual history and baseline correction. For long-term rigid lens wearers, scleral lenses can be transformative in terms of comfort, but not always in visual performance. To prevent dissatisfaction, he stressed the need to educate the patient before lens delivery.

In contrast, patients who are new to scleral lenses and have poor vision with glasses typically have more modest expectations and are easier to satisfy. Still, Dr. Michaud underscores that certain expectations remain unrealistic regardless of experience. For example, a monocular patient seeking perfect vision at all distances or a patient who sees “20/20⁺ in glasses” is unlikely to be satisfied with scleral lenses, he shares. Overall, managing expectations before fitting is critical by setting clear boundaries around what scleral lenses can and cannot achieve to assist in long-term patient satisfaction.

2. The growing use of scleral lenses requires a parallel evolution in clinical surveillance.

A key takeaway is a shift from static fitting success toward dynamic, longitudinal assessment, recognizing that corneal physiology, inflammation, and optic nerve health may change over time—even in patients who appear clinically stable.

“For patients who wear scleral lenses, not only does the fit and vision with the lens need to be monitored, but general eye health should not be overlooked,” says Dr. Nau. “The eye should be examined after scleral lens removal, and a full dilated exam should be completed as indicated. Scleral lens wearers should be instructed on the importance of follow-up with lens wear to maintain health and vision.”

3. Scleral lenses are dynamic devices whose anatomic and physiologic effects continue throughout the day, with important implications for fitting strategy and patient monitoring.

Dr. Lotoczky shared a clinical image (Figure 1) that emphasizes the need for further research on scleral lens wear.

“Throughout the 8 hours of wear, the lens appears to have mildly compressed the conjunctiva, and we see a difference in the lens clearance,” says Dr. Lotoczky of the image. “In addition, visible changes can be observed with the naked eye in the position of the iris and crystalline lens, as well as in the anterior chamber angle. Further research is needed to determine why these changes occur in some patients—whether they are driven by suction forces, mechanical effects, or a combination of both.”