This is one of the most critical questions for patients considering impression-based or conventional scleral
lenses who also have one or more cataracts.
The short answer: It’s *usually* best to perform cataract surgery before starting your scleral lens fitting.
Here’s why:
The Anatomy of Scleral Lenses
An impression-based scleral lens is a perfect negative replica of your eye’s surface at a single point in
time. The mold taken of your eye to create the lens captures the exact topography, curvature, and limbal
shape of your cornea and sclera—down to microscopic detail.
This level of precision is what makes impression-based lenses so comfortable and stable. But that same
precision is also a vulnerability: the lens fits exactly what existed on the day the mold was taken. If your
eye changes shape afterward, the lens no longer fits.
The same applies to conventional scleral lenses, which are fit to specific cornea parameters; if those
parameters change, the lenses will not be as successful.
What Cataract Surgery Changes
Cataract surgery removes your natural, cloudy lens and replaces it with a clear intraocular lens (IOL).
Even though modern incisions are small (2-3mm), surgery changes the eye in three major ways that
directly impact scleral lens fit:
- Corneal Shape (Surgically Induced Astigmatism)
The incisions heal and subtly reshape the cornea. Studies show that even uncomplicated cataract surgery
can induce 0.5 to 1.5 diopters of corneal astigmatism that wasn’t there before. This changes the front
surface of the eye—the very surface your impression-based scleral lens vaults over. - Limbus Location
Healing can pull or shift the limbus (the border between the cornea and the sclera). Scleral lenses land on
the sclera just beyond the limbus. If the limbus moves even a fraction of a millimeter, the lens’s landing
zone may no longer align with healthy tissue. - Overall Ocular Topography
The eye is a fluid-filled sphere. Removing the internal lens changes internal fluid dynamics and can
slightly alter the scleral contour—the shape of the “white” of the eye where your lens rests. This change is
subtle but meaningful when you’re dealing with a mold that captures micron-level precision.
Scleral lenses require a completely customized fit to provide superior comfort and potentially sharper
vision. Any post-surgical change to the eye’s surface undermines that custom fit.
The Recommended Protocol for (Most) Patients
Most patients needing cataract surgery and custom contact lenses usually follow the plan below:
Step 1: Cataract Evaluation First
See your cataract surgeon before doing anything with scleral lenses. Be very clear: “I plan to wear
conventional or impression-based scleral lenses after surgery. How will this affect my IOL choice and
surgical approach?”
Step 2: Choose the Right IOL With Your Ophthalmologist
Work with your ophthalmologist to determine the best IOL for your unique eyes and vision goals.
Multifocal IOLs can sometimes interact unpredictably with scleral lens optics—but that doesn’t mean
they’re always off the table. Your surgeon and scleral lens fitter should collaborate to weigh the trade-offs.
Many patients do well with a monofocal IOL targeted for distance, but the right choice depends on your
anatomy and lifestyle. Let your ophthalmologist guide you.
Step 3: Surgery & Full Healing
Undergo cataract surgery, then wait at least 3 to 6 months for:
- The eye to fully heal
- Refractive error to stabilize (no changes in glasses prescription)
- Corneal shape to settle completely
- Any residual inflammation to resolve
Do not rush this step! A mold for an impression-based scleral lens taken too early will capture a healing,
changing eye—and will be obsolete within weeks.
Step 4: Verify Stability Before Molding
Before scheduling your appointment to start fitting scleral lenses, confirm that your post-op refraction has
been stable for 2-3 consecutive months. Your eye doctor can check this by comparing your glasses
prescription over time.
Once stability is confirmed, then your scleral lens Doctor will let you know it’s ok to proceed with the fitting
process for your custom scleral lens.
Quick Reference: The Typical Sequence for Planning Cataract Surgery and Scleral Lens Fittings:
| Step | Action | Timing |
|---|---|---|
| 1 | Cataract evaluation with surgeon | Start here |
| 2 | Choose IOL with your ophthalmologist | Before surgery |
| 3 | Cataract surgery | Day 0 |
| 4 | Full healing and stabilization | 3–6 months |
| 5 | Verify stable refraction | Monthly checks |
| 6 | Schedule impression for scleral lens or evaluation for conventional scleral lens | After stability confirmed |
Special Considerations for Urgent Cataracts
What if your cataract is already advanced and you cannot wait 3-6 months after surgery to get back into
scleral lenses?
➡️Stage the Eyes
If both eyes need cataract surgery and scleral lenses, consider doing one eye at a time. Have surgery on
Eye #1, heal for 3-6 months, get the Scleral for that eye’s lens, then move to Eye #2. This staggered
approach keeps you functional throughout the process.
👉The Bottom Line: Plan Ahead
The best option for patients is transparency and planning. Tell both your cataract surgeon and your scleral
lens Doctor about the other. A coordinated team ensures:
- The right IOL is chosen
- Surgery is performed with scleral lens fitting in mind
- You wait the appropriate healing time (3-6 months minimum)
- You don’t waste money on a lens that won’t fit after surgery
Points to Remember:
If you fit a scleral before cataract surgery, your custom lens will almost certainly not fit after your eye
heals. You will need a completely new lens and fitting —double the cost, double the time.
But if you do cataract surgery first, heal fully, then fit your scleral lens? You get a lens that fits the most
recent version of your eye for years to come.
Resources:
Here are some of the Cataract Surgeons we share patients with in the Phoenix Metro region:
Horizon Eye Specialist and Lasik Center
Tozer/Lee Eye Center
Eye Consultants and Surgeons of Arizona
