History of Scleral Lenses: From 16th-Century Sketches to Modern Vision Care
Scleral lenses have been around in concept since the early 1500s and in physical form since the late 1800s, making them one of the oldest forms of vision correction technology ever developed. Understanding the history of scleral lenses helps explain why this modality has experienced such a dramatic resurgence in modern optometry, and why patients with complex vision needs are turning to them more than ever.
Key Takeaways
Scleral lenses were first conceptualized by Leonardo da Vinci in the early 16th century and physically manufactured in 1887.
The evolution of materials, from blown glass to PMMA to gas-permeable plastics, drove major leaps forward in comfort and safety.
Gas-permeable scleral lenses, introduced in 1983, eliminated the oxygen transmission problem that had limited earlier designs.
The FDA approved GP scleral lenses in 2001, opening the door to widespread clinical use across the United States.
Modern scleral lenses are now a leading solution for keratoconus, severe dry eye, and irregular corneal conditions.
Specialty practices like the Texas Contact Lens Institute in Plano, TX have made scleral lens fitting a core clinical service.
The Earliest Concepts: Leonardo da Vinci and the 16th Century
Most people associate Leonardo da Vinci with the Mona Lisa or the Vitruvian Man, but few know that he was also the first person to conceptualize a device that would eventually become the modern scleral lens. In the early 1500s, da Vinci sketched diagrams showing how placing a water-filled bowl over the eye could theoretically alter how light reached the retina. He wasn't building anything you could fit in someone's eye, but the optical principle he described laid the intellectual groundwork for centuries of development that followed.
The idea remained largely theoretical for more than 300 years. It wasn't until the late 1800s that the technology, materials, and medical understanding existed to produce an actual physical lens. That gap between concept and execution is a testament to how far ahead of his time da Vinci really was, and you can explore more about these origins on our home page.
The First Physical Lenses: Glass Shells in the 1880s
The practical history of scleral lenses begins in 1887, when Fredrich A. Müller and Albert C. Müller produced the first blown glass scleral shells. These were not corrective lenses in the refractive sense. They were protective shells designed to sit over the entire surface of the eye, covering both the cornea and the sclera (the white part of the eye). The primary indication was managing ocular surface disease, particularly protecting eyes damaged by conditions like lagophthalmos, where the eyelid cannot fully close.
Just two years later, in 1889, three separate figures made significant contributions almost simultaneously:
Adolf Eugen Gaston Fick described the use of scleral lenses with optics incorporated to correct vision, effectively turning a protective shell into a corrective device.
Eugene Kalt described contact lenses as orthopedic appliances for treating keratoconus, a progressive corneal condition that causes the cornea to thin and bulge outward. This is notable because keratoconus remains one of the primary indications for scleral lens fitting today.
August Müeller created a scleral lens specifically to correct his own 14 diopters of high myopia, demonstrating that these lenses could address serious refractive error.
The NIH's historical records on contact lens development document this late-19th-century period as the foundational era for all contact lens modalities, not just scleral designs, and practitioners interested in adding this technology to their practice can review the services offered at specialty centers.
Material Innovation: From Glass to Plastic
Wearing blown glass on your eye was not a sustainable solution. The lenses were fragile, difficult to manufacture consistently, and could be genuinely dangerous if they cracked or shattered. The 20th century brought a series of material breakthroughs that addressed these limitations one by one.
In 1936, New York optometric scientist William Feinbloom developed a hybrid scleral lens that used a glass portion over the cornea combined with a plastic skirt around the periphery. This was a practical compromise that improved durability while maintaining the optical clarity of glass at the visual center.
By 1938, Obrig and Mullen had developed the first all-plastic scleral lenses using polymethylmethacrylate, commonly known as PMMA. This material was rigid, clear, and far more practical to manufacture than glass. PMMA became the dominant material for scleral lenses from the 1940s through the 1960s and represented a genuine leap forward in reproducibility and safety.
However, PMMA had a significant problem: it did not transmit oxygen. The cornea needs a steady supply of oxygen to remain healthy, and a non-permeable lens sitting over the entire ocular surface caused corneal edema (swelling due to oxygen deprivation) in many patients. This limitation became a serious clinical obstacle and was one of the key reasons scleral lens use declined significantly in the mid-20th century as smaller, softer corneal lenses began to emerge.
The American Optometric Association's contact lens overview provides helpful context on how material science has shaped contact lens development across all categories, and you can find additional information by visiting the meet the doctor page to learn more about the clinical expertise available.
The Modern Resurgence: Gas-Permeable Materials Change Everything
The turning point in the history of scleral lenses came in 1983 when Australian practitioner Don Ezekiel published the first clinical reports on using gas-permeable (GP) materials to manufacture scleral lenses. GP materials allowed oxygen to pass through the lens itself, directly addressing the corneal edema problem that had plagued earlier designs. This was not a minor incremental improvement. It fundamentally changed what scleral lenses could do and who could safely wear them.
Ezekiel's GP scleral lenses were later manufactured by Gelflex, an Australian company, and this design ultimately received approval from the U.S. Food and Drug Administration (FDA) in 2001. That FDA clearance marked the official opening of the modern scleral lens era in the United States and triggered a wave of clinical interest that continues to grow today.
The reasons for the resurgence go beyond just better oxygen transmission. Modern manufacturing techniques, particularly computer-aided lathe cutting, allow for a level of precision and reproducibility that was impossible with earlier methods. Each lens can now be customized to the exact topography of an individual patient's eye, which matters enormously when you're fitting eyes with irregular corneal surfaces.
If you're a practitioner considering adding this modality to your practice, reviewing the services offered by established specialty lens centers is a useful starting point for understanding the clinical scope of modern scleral lens fitting.
What Modern Scleral Lenses Treat Today
The clinical applications of scleral lenses in contemporary practice go well beyond what the Müllers could have imagined in 1887. Today, they are a primary tool for managing:
Keratoconus: The most common indication, as first identified by Kalt in 1889. The lens vaults over the irregular cornea and provides a smooth refractive surface.
Corneal ectasia: Including post-surgical irregularity following procedures like LASIK.
Severe dry eye disease: The fluid reservoir between the lens and the cornea provides continuous hydration throughout the day.
Pellucid marginal degeneration: A condition similar to keratoconus affecting the peripheral cornea.
Post-corneal transplant fitting: When the transplanted cornea heals with irregular topography.
High degrees of myopia, hyperopia, or astigmatism that cannot be adequately corrected with standard soft lenses.
The Scleral Lens Education Society is the leading professional organization in the United States dedicated to advancing scleral lens education and research, and their clinical resources reflect how broad the indications have become.
How Lens Design Has Continued to Evolve
Modern scleral lens design is built around four primary zones: the optical zone (over the cornea), the limbal zone (over the limbus), the landing zone (over the sclera), and the edge zone. Getting each of these zones right for an individual patient requires a sophisticated fitting process that combines corneal topography, optical coherence tomography (OCT), and in-office assessment.
The technology behind this fitting process has advanced significantly. Digital profilometry now allows practitioners to map the scleral surface itself, not just the cornea, which enables more precise landing zone alignment. Some newer designs use oblate, toric, or quadrant-specific geometry to accommodate the natural asymmetry of the scleral surface.
You can follow discussions on these advances on the blog at Texas Contact Lens Institute, where the clinical team shares updates on fitting techniques and patient outcomes.
Things to Know
The term "scleral" refers to the fact that the lens rests on the sclera (the white of the eye), not the cornea, which is what most standard contact lenses do.
Early glass scleral lenses required a mold to be taken of the patient's eye while they were conscious, a procedure that was as uncomfortable as it sounds.
PMMA lenses are still used in some rigid gas-permeable corneal lens designs today, but they are no longer used for scleral lenses due to the oxygen transmission issue.
The FDA classification for scleral lenses is Class II medical devices, meaning they require a valid prescription and should only be fitted by licensed eye care professionals.
Some patients describe the initial scleral lens fitting process as requiring multiple visits and adjustments before an optimal fit is achieved.
Modern scleral lenses typically need to be refitted or replaced every one to three years, depending on lens condition and changes in the patient's corneal or scleral topography.
Finding Scleral Lens Care in the United States
Not every optometry practice has the equipment or clinical experience to fit scleral lenses properly. Because the fitting process involves corneal topography, OCT imaging, and multiple trial lens assessments, it requires practitioners who specialize in this modality.
The Texas Contact Lens Institute, located at 6020 W Parker Rd Ste 260, Plano, TX 75093, is a specialty optometry practice with a 5.0-star rating focused specifically on this type of advanced contact lens care. Their services include scleral lens fitting, keratoconus management, orthokeratology, myopia management, dry eye treatment, and specialty contact lens fitting. You can visit the home page to learn more about what they offer, or visit the meet the doctor page to review the clinical background of their optometrist before scheduling an appointment.
Practitioners and clinics interested in building a referral relationship with a scleral lens specialty practice can explore the referrals page for details on how the process works. Patients who have questions or want to schedule a fitting can reach the practice by phone at +1 972-299-8675 or through the contact page on the Texas Contact Lens Institute website.
The Mayo Clinic's overview of contact lenses and eye health is also a useful resource for patients who want to understand what to expect during a specialty lens evaluation.
Frequently Asked Questions
Q: Who invented scleral lenses?
The concept is credited to Leonardo da Vinci in the early 1500s, but the first physical scleral lenses were made by Fredrich A. and Albert C. Müller in 1887.
Da Vinci's original idea involved using a water-filled device to neutralize the corneal surface optically. The Müllers manufactured actual blown glass shells for clinical use, primarily to protect diseased ocular surfaces rather than correct vision.
Q: Why did scleral lenses fall out of common use in the mid-20th century?
The primary reason was that PMMA plastic, the dominant material from the 1940s through the 1960s, did not allow oxygen to pass through to the cornea.
This caused corneal edema, which limited how long patients could safely wear the lenses. The rise of smaller soft contact lenses that were easier to fit also contributed to the decline.
Q: When were gas-permeable scleral lenses approved in the United States?
The FDA approved gas-permeable scleral lenses manufactured by Gelflex in 2001, following Don Ezekiel's foundational clinical work in 1983.
This approval opened the door to widespread clinical adoption in the U.S. and triggered the modern resurgence in scleral lens use that practitioners see today.
Q: Are scleral lenses only for people with keratoconus?
No. While keratoconus is one of the most common indications, scleral lenses are also used for severe dry eye, post-surgical corneal irregularity, pellucid marginal degeneration, and high refractive error.
Any condition that creates an irregular corneal surface or makes standard contact lens wear impossible or uncomfortable may be a candidate for scleral lens fitting.
Q: How is a scleral lens fitting different from a standard contact lens fitting?
A scleral lens fitting involves corneal topography mapping, OCT imaging, and multiple trial lens assessments to customize the lens to the exact shape of your eye.
The process typically takes several visits to achieve an optimal fit, and the lenses are individually manufactured based on your measurements. This level of customization is what makes them effective for complex conditions that standard lenses cannot address.
The Bottom Line on the History of Scleral Lenses
The history of scleral lenses is a story of gradual problem-solving across five centuries. Each era introduced new materials or techniques that addressed the limitations of what came before. From da Vinci's theoretical sketches to blown glass to PMMA to modern high-Dk gas-permeable designs, the lens has continually improved in safety, comfort, and clinical effectiveness.
If you're dealing with keratoconus, dry eye disease, or an irregular corneal surface that standard lenses haven't been able to address, a scleral lens evaluation
