Scleral Lenses in the United States

Abstract There is growing acceptance of scleral lenses by ophthalmologists, optometrists, and patients in the United States. Options among mini‐scleral and scleral lenses will be reviewed. PROSE treatment (prosthetic replacement of the ocular surface ecosystem) as a therapeutic approach will be introduced. Success rate for PROSE treatment among patients with ectasia/astigmatism and in patients with ocular surface disease will be presented, as will experience with PROSE treatment in pediatric patients. Evidence for reversal of corneal scarring with PROSE treatment of ocular surface disease will be presented. Scleral lens and PROSE treatment are important alternatives to keratoplasty for corneal scarring and to tarsorrhaphy for exposure. Clinicians and researchers should be aware of scleral lens and PROSE treatment as important options for patients with ocular surface disease or contact lens intolerance, who may be at at higher risk of complications, contact lens dependence, or graft failure with penetrating keratoplasty.