Specialty Lenses · Irregular & Post-Surgical Corneas · COVE New Albany

Scleral lenses for irregular and post-surgical corneas, in New Albany, Ohio.

When LASIK, RK, a transplant, or trauma changed your cornea's shape, sclerals create a smoother optical surface in its place.

If surgery was supposed to simplify your vision and instead left you chasing clarity, you are not starting from zero here. When the front surface of the eye isn't shaped the way it used to be (because of LASIK that didn't go as planned, RK from decades ago, a corneal transplant, an injury, or a scar), glasses and standard contacts can't always give you back the vision you had. Scleral contact lenses can. They vault over the irregular surface and create a smoother optical surface in front of it.

Many patients who'd been told they were "uncorrectable," or who'd been living with ghost images, halos, and fluctuating vision for years, gain more functional, stable vision in their sclerals. At COVE, every fit is custom-designed off your specific corneal topography, with two lens platforms we know and trust: Zenlens® and WAVE ScleraLens®.

Schedule an irregular cornea consultation.
01
The Condition

When the cornea isn't shaped like it used to be.

The cornea is the clear front window of the eye. Its job is to be smooth and uniformly curved. That's how light gets focused cleanly onto the retina. When something disrupts that shape, vision degrades in ways that no glasses prescription can fully correct, no matter how strong.

The irregular corneas we see most often at COVE come from one of four sources:

  • Refractive surgery that didn't deliver what was promised. LASIK ectasia, problematic PRK outcomes, the older RK procedure from the 1980s and 1990s.
  • Corneal transplants. Penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), endothelial transplants: all leave the cornea with edges, sutures, or asymmetric curvature that glasses can't accommodate.
  • Trauma and scarring. Foreign body injuries, chemical burns, severe infections that left a scar, sports impact, surgical complications.
  • Pellucid marginal degeneration and other irregular dystrophies. Less common than keratoconus but managed similarly.

The common thread is that the cornea no longer focuses light cleanly, and the patient is left with vision that fluctuates, ghosts, splits, or simply will not sharpen.

Scleral lenses are the most effective solution we have for this entire category of problems.

02
The Solution

Why scleral lenses work for irregular corneas.

A scleral lens is a large, gas-permeable contact lens that vaults entirely over the cornea and rests on the white of the eye. The space between the lens and your cornea is filled with preservative-free saline. The lens is designed to vault the cornea rather than rest on its surface.

That design solves the irregular-cornea problem in three ways at once:

i.   Optics

The optical problem

Light entering a scleral lens passes through a smooth front surface. The irregular cornea underneath is no longer the primary optical surface. The lens is. This is why patients with severe astigmatism, scarring, or distortion that glasses couldn't correct often gain meaningfully sharper vision in sclerals.

ii.   Comfort

The contact problem

Traditional rigid (RGP) contact lenses sit directly on the cornea. On an irregular surface, especially a post-surgical one with sutures, edges, or scar tissue, that contact is uncomfortable, unstable, and risky. Sclerals vault the cornea entirely. There's no contact between lens and cornea.

iii.   Protection

The protection problem

A vulnerable cornea (post-transplant, post-trauma, scarred) benefits from being shielded from blinking friction and environmental irritation. The saline reservoir is also a continuous protective bath, which often improves comfort and surface health alongside the optical correction.

Cross-section diagram showing how a scleral lens vaults over the cornea and rests on the white of the eye
A scleral lens clears the cornea entirely and holds a reservoir of fluid against the eye all day.
03
Indications

Who this page is for.

i.   Post-LASIK

Post-LASIK ectasia or unhappy outcome

LASIK works well for the vast majority of patients. For a small subset, the cornea progressively thins after surgery (post-LASIK ectasia), or the visual quality never matches what was hoped for. Sclerals can restore vision in eyes that have become uncorrectable in glasses after surgery, and we coordinate cross-linking referrals when ectasia is progressing.

ii.   Post-RK

Post-RK (radial keratotomy)

RK was a popular surgery in the 1980s and 90s. Many patients did well for years, but the radial cuts can leave the cornea with diurnal fluctuation, glare, and progressive shifts decades later. Sclerals stabilize the optics and are often a major improvement for this group.

iii.   Transplant

Post-corneal transplant (PK, DALK)

Transplants restore corneal clarity, but the new graft rarely sits at the same curvature as the surrounding tissue. Sutures, edge mismatch, and asymmetric astigmatism are common. Sclerals can help transplant patients reach more functional, stable vision once the graft has settled.

iv.   Trauma

Corneal scarring or trauma

Old foreign-body injuries, chemical burns, severe infections, sports impact, surgical complications: anything that left a scar on the cornea. Sclerals replace the scarred surface optically and protect it from further mechanical irritation.

04
The Fitting

How a scleral fit for an irregular cornea works.

Off-the-shelf sclerals do not exist for irregular corneas. Every fit is a custom design built around your specific corneal shape. Irregular corneas often take more iterations to get right than healthy-eye fits. The fitting fee covers all of those iterations.

  1. 01
    Routine eye exam plus corneal topography. The Oculus Keratograph 5M maps the surface of your cornea down to the micron, including post-surgical edges, scar contours, and asymmetric curvature.
  2. 02
    Anterior segment OCT. Cross-sectional imaging that lets us see exactly how the lens will sit, where the saline reservoir lands, and how the lens edge interacts with the conjunctiva.
  3. 03
    Lens platform selection. Zenlens® (diagnostic-trial workflow) or WAVE ScleraLens® (built directly from your topography map). Irregular corneas often benefit from the WAVE workflow because a stock trial lens may not represent the post-surgical or scarred surface well.
  4. 04
    Custom lens design. The lab manufactures to our specifications.
  5. 05
    Dispense and refinement. Most irregular-cornea fits take 2–4 lens revisions to land on the final design, sometimes more for complex transplants or extensive scarring. The fitting fee covers all revisions; you do not pay per iteration.
Corneal topographer used to map irregular corneas for scleral lens fitting at COVE in New Albany
Every irregular-cornea fit starts with a detailed map of your cornea, not a guess off a paper prescription.
2–4
lens revisions for a typical irregular-cornea fit, all covered by one fitting fee
2
lens platforms in-house: Zenlens® and WAVE ScleraLens®
6–18 mo
the typical post-transplant window when patients are ready to be fit
05
The Platforms

Why two lens platforms: Zenlens® and WAVE ScleraLens®.

Most scleral practices fit one lens line. We use both, deliberately, because they're built around fundamentally different design philosophies, and irregular corneas are exactly where that flexibility matters most.

i.   Diagnostic-trial

Zenlens®: diagnostic-trial workflow

A diagnostic lens from our trial set goes on your eye. We evaluate the fit in real time (vault, landing on the sclera, edge clearance), then refine the order based on what we see. Strong choice for less-extreme irregular corneas where a stock trial lens still represents the eye reasonably well.

ii.   Topography-driven

WAVE ScleraLens®: built from your map

No diagnostic trial. The lens is designed in CAD/CAM software directly from your corneal topography and manufactured to that exact design from the ground up. WAVE has been doing topography-driven scleral design since 1999. This is often the right call for severely distorted post-surgical corneas, advanced ectasia, and complex scarring: cases where a stock trial lens won't represent the final fit.

Topography-built scleral design is less commonly offered than the diagnostic-trial workflow most practices use. WAVE has been making lenses this way for more than twenty-five years. Having both platforms in-house lets us pick the right tool for your specific cornea, not the only tool we happen to carry.

i.  PLATFORMS

Two scleral platforms in-house

Zenlens® and WAVE ScleraLens®.

ii.  IMAGING

Fit from your corneal map

Mapped on the Oculus Keratograph 5M plus anterior segment OCT.

iii.  INCLUDED

All fitting revisions included

You do not pay per iteration.

06
Bigger Picture

A note for corneal transplant patients.

Transplants need time to settle before we fit a scleral lens. A penetrating keratoplasty (PK) graft typically needs 6–12 months of stabilization, sometimes until sutures are removed (often 12–24 months post-surgery). DALK and endothelial transplants follow their own timelines.

Timing the fit

We coordinate with your corneal surgeon on the timing. Fitting too early risks pushing on a graft that isn't ready; waiting too long leaves you in poor vision longer than necessary. Most transplant patients land in the right window between 6 and 18 months post-op, but it's a case-by-case judgment.

Once we're in the fitting phase, sclerals are often the most effective vision correction available for transplant eyes. Glasses and soft contacts rarely match what a custom scleral can deliver on an asymmetric graft.

07
Wear & Comfort

What it actually feels like.

Day One

First insertion

First insertion is the hardest moment. You're using a small plunger or scleral ring, holding a lens full of saline, tilting your head. We spend as much time as you need teaching this. Once the lens is on, vision usually clears within a minute. Most patients describe day-one comfort as a mild awareness that fades.

Week One

Settling in

Insertion gets faster. Comfort holds through 8–12 hours of wear. For patients coming from years of fluctuating, ghosting, post-surgical vision, this is usually the moment they realize sclerals are different. Vision is finally stable from morning to night.

Month One

Steady vision

Insertion takes seconds. Vision is stable. We see you back at one week, one month, three months, and six months to confirm the fit and check the corneal surface, especially important for transplant and post-surgical patients.

08
Cost & Coverage

What scleral lenses for irregular corneas cost at COVE.

Irregular and post-surgical fits are a medical-necessity scleral fit. For most patients with major vision insurance, total out-of-pocket lands much lower than the sticker price.

Medical necessity

Irregular cornea scleral fit

Usually covered
when the MNCL benefit applies; the fitting and lenses are billed separately

Includes corneal topography, anterior segment OCT, lens design, dispense visit, and the full follow-up schedule. All lens revisions during the fitting period are included. You do not pay per iteration.

Insurance and pricing notes
  • If you have VSP or EyeMed, your out-of-pocket is usually just a small copay. Most VSP and EyeMed plans include a Medically Necessary Contact Lens benefit that applies to post-surgical, transplant, ectasia, and scarred-cornea fits. When it does, the fitting and the lenses are largely covered. Coverage rules vary by plan, and qualification depends on diagnosis criteria we'll work through at the appointment. Call us with your insurance card; we verify what we can in advance.
  • Coverage rules vary by plan, but documented post-surgical or post-traumatic irregular astigmatism is exactly the kind of diagnosis the medically necessary benefit was built for.
  • All scleral lens costs are FSA and HSA eligible.
  • We recommend annual lens replacement.
09
The Practice

Why patients with irregular corneas come to COVE.

Dr. Matthew Karres has years of clinical experience designing and fitting specialty contact lenses at COVE: scleral, gas-permeable, multifocal, and orthokeratology fits. His research interests within specialty contacts are focused on scleral lens solutions, including for irregular and post-surgical corneas. Irregular and post-surgical corneas are exactly the cases that depth was built for.

What that means in practice:

  1. i.
    Topography-driven custom design from day one. Every fit at COVE starts on the Oculus Keratograph 5M and is informed by anterior segment OCT. We don't fit off a paper prescription; we fit off your actual corneal map.
  2. ii.
    Two trusted lens platforms. Zenlens® (diagnostic-trial workflow) and WAVE ScleraLens® (built directly from your topography map). Different irregular corneas call for different platforms; having both lets us pick the right tool for your specific eye.
  3. iii.
    Coordinated care with your surgeon. For transplant patients, post-LASIK ectasia, and complex scarring, the right lens fit depends on close communication with the surgical team. We do that as a matter of course.
  4. iv.
    We don't pass off the hard cases. Severe ectasia, post-PK eyes with high asymmetric astigmatism, RK fluctuation, complex scars: these are the fits we're known for. When the cornea is hard, we keep iterating until it's right.
Wide-field retinal imaging camera used at COVE in New Albany to screen the back of the eye
A complex cornea doesn't mean we look only at the front of the eye. Every visit includes wide-field retinal imaging, so the health of the whole eye (not just the fit) stays monitored, especially important for post-surgical and transplant patients.
Dr. Matthew Karres, OD, optometrist at COVE in New Albany, Ohio
Dr. Matthew Karres
Doctor of Optometry, The Ohio State University. Years of clinical experience fitting scleral and specialty lenses, with research interests in scleral lens solutions.
The COVE irregular-cornea commitment

Irregular corneas are demanding fits. Post-surgical eyes are even more so. We expect that. We design every case shooting for great vision and comfort on the first try, and when we miss, we keep iterating at no extra fitting fee until we land it.

What we ask of you: come to your follow-ups, wear the lenses as we prescribe them, and tell us specifically what's bothering you when something feels off. The patients who get the best results are the ones who stay engaged with the process.

10

Patients who had given up on comfortable contacts are part of our 1,100+ five-star Google reviews. Reviewers with hard-to-fit prescriptions describe doctors who stay with the fit until it’s right, and appointments that don’t feel rushed.

“a next level experience”  ·  “very thorough and patient on everything”  ·  “I don’t trust anyone else with my eyes”

Read the reviews for yourself on Google →
Questions

Frequently asked questions.

Q.01 I had LASIK years ago and I'm not happy with my vision. Can sclerals help? +
Often, yes. Many post-LASIK patients have small amounts of irregular astigmatism, higher-order aberrations, or post-LASIK ectasia that glasses and soft contacts can't fully correct. Sclerals can restore the sharp vision LASIK was supposed to deliver. We're not here to second-guess your surgery; we're here to give you back your best vision now. Note: post-LASIK dry eye is also common, and sclerals help with that too. See our scleral lenses for severe dry eye page.
Q.02 I had a corneal transplant. When can I be fit for sclerals? +
Most transplant patients are ready 6–18 months after surgery, depending on graft stability and whether sutures are still in place. We coordinate timing with your corneal surgeon. Fitting too early risks pressure on a healing graft; waiting too long leaves you in poor vision longer than necessary. There's a right window for every transplant, and we work to find it.
Q.03 I had RK in the 90s and my vision is getting worse again. Is that normal? +
Yes, and you're not alone. Many RK patients did well for years and have started experiencing diurnal fluctuation, glare, and progressive shifts decades later. The radial cuts never fully healed back to a uniform shape, and the cornea continues to change with age. Sclerals can help stabilize your vision again.
Q.04 Will sclerals damage my graft or my surgical scar? +
A properly fit and monitored scleral lens is designed to vault over the cornea, so there is no direct lens-to-graft contact, and the saline reservoir provides a continuous protective bath. We monitor the corneal surface closely at follow-ups; if anything changes, we adjust the fit. We don't proceed without confirming the graft is stable and ready for a scleral.
Q.05 Will COVE coordinate with my surgeon? +
Yes, when it's helpful. Sclerals are commonly used for irregular-cornea correction, and many corneal and refractive surgeons refer their post-surgical patients to specialty fitters specifically for this. With your permission, we'll keep your surgical team in the loop and share fitting notes or topography records as needed.
Q.06 How long will the fitting take? +
The first consultation runs 60–90 minutes including imaging and either a diagnostic trial or topography capture for a WAVE design. Lens design and manufacturing typically take 1–2 weeks. Most irregular-cornea fits then take 2–4 lens revisions over the next 1–3 months to dial in the final design.
Q.07 Will my insurance pay for this? +
If you have VSP or EyeMed and your plan includes the Medically Necessary Contact Lens benefit, your out-of-pocket for the fitting plus lenses is usually just a small copay. Documented irregular astigmatism from prior surgery, transplant, or trauma is exactly the kind of diagnosis the benefit was built for. Coverage rules vary by plan; we run a benefits check before your consultation and work through whether your specific case qualifies together at the appointment.
Next Step

Schedule a consultation.

If your cornea isn't shaped the way it used to be, and your current vision correction isn't getting you back to where you want to be, sclerals are likely worth a conversation. The first step is a corneal topography scan and an honest discussion of what's realistic for your specific situation. We can do both at your next routine eye exam.

Related reading: our scleral lens hub  ·  sclerals for keratoconus  ·  sclerals for severe dry eye  ·  living with keratoconus: what scleral lenses do