AFFILIATED EYE SURGEONS | SPECIALTY CONTACT LENSES
Specialty Contact Lenses for Keratoconus & Irregular Corneas in Northern New Jersey
When standard glasses or soft contacts can't give you the vision you need, specialty lenses can. Expert scleral, RGP, and custom lens fitting from a
dedicated corneal team — at three convenient
locations in Morris and Essex counties.
Vision Correction When Standard Lenses Fall Short
For most people, glasses or standard soft contact lenses provide all the vision correction they need. But for patients with keratoconus, corneal transplants, irregular astigmatism, severe dry eye, or other complex corneal conditions, standard lenses simply cannot deliver clear, functional vision—no matter how many times the prescription is updated.
Specialty contact lenses—including scleral lenses, rigid gas-permeable (RGP) lenses, and hybrid designs—are engineered to overcome these challenges. By vaulting over or conforming to the irregular corneal surface, they create a smooth optical surface that corrects distorted vision in ways that glasses or soft lenses cannot.
At Affiliated Eye Surgeons, specialty contact lens care is led by
Dr. Sanjai Jalaj, our fellowship-trained corneal specialist, working closely with
Dr. Mariam Elias, who specializes in specialty contact lens fittings. Together, they provide comprehensive evaluation, custom lens design, fitting, and ongoing management for patients with keratoconus, irregular corneas, post-surgical vision changes, and other complex corneal conditions—helping patients achieve clearer, more comfortable vision when traditional options are no longer effective.
Who Needs Specialty Contact Lenses?
Specialty contact lenses are appropriate for a wide range of patients — not just those with keratoconus. If any of the following apply to you, a specialty lens evaluation may significantly improve your vision and quality of life:
- Keratoconus — the most common indication for specialty lenses. As the cornea becomes increasingly irregular, scleral or RGP lenses vault over or conform to the distorted surface to restore functional vision.
- Post-corneal transplant (DALK or PKP) — transplanted corneas are often irregular in shape and difficult to correct with glasses or soft lenses. Scleral lenses are the gold standard for vision correction in post-transplant patients.
- Post-LASIK or post-PRK complications — patients who developed irregular astigmatism, central islands, or other optical complications following laser refractive surgery can often achieve dramatically better vision with scleral lenses than with glasses or soft lenses.
- Irregular astigmatism from any cause — corneal scarring, trauma, infection (e.g. herpes simplex keratitis), or prior surgery can all create irregular corneal surfaces that specialty lenses address effectively.
- Pellucid marginal degeneration — a cousin of keratoconus involving inferior peripheral corneal thinning, often requiring specialty lens fitting for functional vision correction.
- Severe dry eye disease — scleral lenses maintain a continuous fluid reservoir between the lens and the cornea, providing constant lubrication and protecting the ocular surface. For patients with severe dry eye who cannot tolerate any other lens type, sclerals can be transformative.
- High prescriptions that soft lenses cannot adequately correct — very high myopia, hyperopia, or astigmatism may be better corrected optically with a rigid lens design.
Specialty Lens Options We Offer
There is no single specialty lens that is right for every patient. Our fitting process begins with a thorough evaluation of your corneal shape, prescription, eye health, and lifestyle — and ends with a lens design that is precisely matched to your individual needs. Here are the specialty lens options available at Affiliated Eye Surgeons:
Scleral Lenses — The Gold Standard for Irregular Corneas
Scleral lenses are large-diameter rigid gas-permeable lenses (typically 16 to 24mm in diameter) that vault entirely over the corneal surface and land only on the sclera — the white of the eye. The space between the back of the lens and the cornea is filled with preservative-free saline solution, creating a smooth, stable fluid lens in front of the cornea.
This design makes scleral lenses uniquely effective for conditions like keratoconus: no matter how irregular or cone-shaped the cornea becomes, the scleral lens presents a perfectly smooth optical surface to incoming light — delivering sharp, stable vision that glasses or soft lenses simply cannot match.
Key advantages of scleral lenses:
- Exceptional optical quality — corrects irregular astigmatism and higher-order aberrations that no other lens can address
- Highly comfortable — no corneal contact means no irritation from lens edges pressing on a sensitive, distorted corneal surface
- Therapeutic benefit for dry eye — the fluid reservoir provides continuous corneal lubrication throughout wear
- Stable vision throughout the day — scleral lenses don't shift or decenter, unlike soft or smaller RGP lenses
- Suitable for post-surgical and post-transplant eyes — fits even the most complex corneal shapes
Rigid Gas-Permeable (RGP) Corneal Lenses
RGP lenses are smaller (approximately 9 to 10mm in diameter) rigid lenses that rest directly on the cornea. Because of their rigid surface, they vault over minor corneal irregularities and provide excellent optical clarity — significantly better than soft lenses for irregular corneas.
RGP corneal lenses are a good option for earlier-stage keratoconus or mild irregularity where the cone is not yet steep enough to make corneal contact uncomfortable. They are easier to insert and remove than scleral lenses and adapt to somewhat more quickly. However, for patients with more advanced keratoconus or significant corneal sensitivity, the direct corneal contact of RGP lenses can become uncomfortable, and scleral lenses are often the better choice.
Hybrid Lenses
Hybrid lenses combine a rigid gas-permeable center — which provides the optical clarity of an RGP lens — with a soft silicone hydrogel skirt around the periphery, which improves comfort and stability compared to a standard RGP lens.
Hybrid lenses are well suited for patients with mild to moderate keratoconus or irregular astigmatism who want better comfort than a standard RGP but have not yet progressed to needing a scleral lens. They are also a good option for patients who are transitioning from soft lenses and find RGP adaptation challenging.
Piggyback Systems
A piggyback system involves wearing a soft contact lens underneath an RGP lens. The soft lens acts as a cushion between the rigid lens and the corneal surface, improving comfort for patients who find RGP lenses irritating but who are not yet candidates for scleral lenses.
Piggyback fitting requires careful attention to oxygen transmissibility — two overlapping lenses can restrict oxygen to the cornea if not properly selected. This is a fitting approach best managed by an experienced specialist.
Orthokeratology (Ortho-K)
Orthokeratology lenses are specially designed rigid lenses worn overnight to temporarily reshape the cornea while sleeping, providing clear vision during the day without the need for glasses or contact lenses. Ortho-K is primarily used for myopia control in children and young adults.
Note: Ortho-K is not appropriate for patients with keratoconus or corneal irregularity, as further corneal reshaping in an already-irregular or weakened cornea is contraindicated. It is listed here for patients with standard myopia seeking a daytime-glasses-free option.
What to Expect: The Specialty Lens Fitting Process
Fitting specialty contact lenses — particularly scleral lenses for keratoconus — is not a single-appointment process. It requires a careful, iterative approach that takes into account your corneal topography data, your prescription, the shape and diameter of your sclera, and your individual response to trial lens designs.
Here is what a typical specialty lens fitting journey looks like:
- Comprehensive evaluation (Visit 1) — Corneal topography and tomography maps your corneal shape in detail. A full refraction and anterior segment examination assess your prescription, corneal health, and tear film. We review your history of lens wear, prior fittings, and any relevant medical records.
- Trial lens fitting (Visit 1-2) — Based on your corneal maps and prescription, a trial scleral or specialty lens is selected and placed on the eye. We assess vault height (how much clearance exists between the lens and the cornea), limbal clearance, landing zone, and the initial over-refraction (how much additional prescription correction is needed on top of the lens).
- Refinement visits (Visits 2-4) — Lens parameters are modified based on initial fitting data. Vault, diameter, base curve, and prescription are adjusted iteratively until the fit is optimal and vision is maximized. Most patients require 2 to 4 fitting visits before final lens parameters are confirmed.
- Lens ordering and dispensing — Once the final parameters are confirmed, the custom lenses are ordered. At the dispensing visit, we train you on proper insertion, removal, and care of your specialty lenses.
- Follow-up care — Annual or biannual evaluations assess corneal health under the lens, monitor for any changes in corneal shape, and ensure the fit remains optimal as your cornea and prescription evolve over time.
Why Choose Affiliated Eye Surgeons for Specialty Contact Lenses?
Fellowship-Trained Corneal Specialist
Dr. Sanjai Jalaj brings fellowship-level corneal expertise to every specialty lens fitting. His training and clinical focus on corneal diseases — including
keratoconus, corneal ectasia, and post-surgical corneal management — means that your lens fitting is guided by the same physician who understands the full clinical picture of your condition. This integration of medical and optical care is rare and valuable.
Advanced Corneal Diagnostic Technology
Successful specialty lens fitting begins with accurate corneal measurement. We use Scheimpflug corneal tomography and topography to generate the precise three-dimensional corneal maps that guide our lens design decisions. Every parameter of your specialty lens — vault height, diameter, base curve, peripheral curves — is derived from data, not guesswork.
Full Spectrum of Specialty Lens Designs
We fit the complete range of specialty lens designs — mini-scleral, full scleral, standard and custom RGP, hybrid, and piggyback systems — so we are never limited to a single approach. The right lens for your eye is the one that provides the best combination of vision, comfort, and corneal health — and we have the expertise to find it.
Experience With Complex and Referred Cases
Many of our specialty lens patients come to us after unsuccessful fitting attempts elsewhere. Patients with advanced keratoconus, post-transplant eyes, or complex post-surgical corneas who have been told that nothing more can be done often discover that a different fitting approach — or simply more experienced hands — makes a significant difference. If you have struggled with specialty lens fitting in the past, we welcome the opportunity to take a fresh look.
Integrated with Your Complete Corneal Care
For keratoconus patients especially, specialty lens fitting does not exist in isolation. It is part of a broader management plan that may include corneal cross-linking to halt progression, serial topography monitoring, and — for advanced cases — surgical planning. Having all of this coordinated within one specialized practice means your lens fitter and your corneal surgeon are the same team, with complete visibility into your corneal status.
Three Convenient Locations
Specialty lens fittings and all follow-up appointments are available at our offices in
Morristown,
West Orange, and
Denville — making it easy to stay consistent with the multiple visits that a successful fitting requires.
Frequently Asked Questions
What are specialty contact lenses?
Specialty contact lenses are custom-designed contact lenses prescribed for patients who cannot achieve adequate vision with standard soft lenses or glasses. They include scleral lenses, rigid gas-permeable (RGP) corneal lenses, hybrid lenses, and other custom designs. They are most commonly used for conditions that cause corneal irregularity — such as keratoconus, corneal transplants, or post-surgical complications — as well as for patients with severe dry eye disease or very high prescriptions that soft lenses cannot adequately correct.
What are scleral lenses and who needs them?
Scleral lenses are large-diameter rigid gas-permeable contact lenses that vault completely over the cornea and rest on the white of the eye (the sclera). The space between the lens and the cornea is filled with a reservoir of preservative-free saline, creating a smooth, stable optical surface that neutralizes corneal irregularity. Scleral lenses are the preferred treatment for keratoconus, post-corneal transplant eyes, severe dry eye, and other conditions causing irregular corneal surfaces. Because they don't touch the cornea, they are highly comfortable even for patients with very sensitive or distorted corneas.
Are specialty contact lenses covered by insurance?
Many insurance plans cover specialty contact lens fittings and the lenses themselves when they are medically necessary — meaning standard lenses cannot provide adequate visual correction due to an underlying condition such as keratoconus or corneal ectasia. Coverage varies significantly by plan. Medicare covers medically necessary contact lenses following cataract surgery. Our team will verify your specific benefits before your fitting appointment and provide a clear explanation of any out-of-pocket costs.
How long does it take to get fitted for scleral lenses?
Scleral lens fitting for conditions like keratoconus is not a single-visit process. The initial fitting appointment involves corneal topography mapping, trial lens selection, and assessment of the lens vault and fit. Most patients require 2 to 4 fitting visits before the final lens parameters are confirmed and the lenses ordered. The entire process from first appointment to wearing final lenses typically takes 4 to 8 weeks depending on corneal complexity.
Are scleral lenses comfortable to wear?
Scleral lenses are generally very comfortable, particularly for patients with keratoconus or other corneal irregularities. Because they rest on the smooth scleral tissue rather than the irregular cornea, they avoid the discomfort caused by standard RGP lenses sitting on a distorted corneal surface. The fluid reservoir also provides continuous lubrication, which is especially beneficial for patients with concurrent dry eye. Initial adaptation typically takes 1 to 2 weeks as patients adjust to inserting and removing the larger lens.
What is the difference between scleral lenses and regular RGP lenses?
Both scleral and RGP lenses are made from rigid gas-permeable material that provides optical clarity superior to soft lenses. The key difference is size and placement. Standard RGP corneal lenses are small (9-10mm) and rest directly on the cornea. Scleral lenses are significantly larger (16-24mm) and vault entirely over the cornea, landing only on the sclera. Sclerals are more comfortable for irregular corneas because they avoid contact with the distorted surface, but they require more complex fitting and a longer adaptation period.
Can I get scleral lenses if I have had a corneal transplant?
Yes. Scleral lenses are one of the most effective vision correction options for patients following corneal transplantation (DALK or PKP). After a transplant, the corneal surface is often irregular and standard glasses or soft lenses cannot achieve adequate correction. Scleral lenses vault over the transplanted cornea and create a smooth optical surface, often delivering the best visual acuity these patients can achieve. Fitting post-transplant eyes is technically demanding and requires an experienced specialist — it is a core part of our practice.
What conditions are treated with specialty contact lenses?
Specialty contact lenses are used for a wide range of conditions including: keratoconus and other corneal ectasias, post-corneal transplant eyes, irregular astigmatism from any cause, post-LASIK or post-PRK complications with residual irregular astigmatism, pellucid marginal degeneration, severe dry eye disease, high myopia or hyperopia that standard lenses cannot adequately correct, and corneal scarring from injury or infection.
Why should I choose Affiliated Eye Surgeons for specialty contact lenses?
Specialty contact lens fitting — especially for keratoconus and post-surgical corneas — requires advanced diagnostic equipment, specialized training, and extensive experience with complex cases. Our practice, built on the corneal expertise of Dr. Sanjai Jalaj, has fitted specialty lenses for hundreds of patients with irregular corneas, including patients referred from other practices after unsuccessful fitting attempts. We offer the full spectrum of specialty lens designs and our diagnostic technology — including corneal topography and tomography — guides precise, data-driven fitting decisions.
