WHAT ARE SCLERAL LENSES WITH PRISM?

Scleral lenses with prism are a specialized type of custom-designed scleral lens created to help patients who experience double vision (diplopia) caused by eye misalignment.

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In some people, the eyes do not perfectly coordinate or point to the exact same place. Even a small amount of misalignment—horizontal, vertical, or diagonal—can cause the brain to receive two different images instead of one. This leads to symptoms such as:

• Double vision

• Eyestrain

• Headaches

• Difficulty reading or focusing

• Fatigue, especially at the computer

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Prism is a precise optical adjustment built into the lens that gently shifts the image entering one eye so that it lines up with the image from the other eye. By doing this, the brain can fuse the two images into one clear, single picture.

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Why Combine Prism With a Scleral Lens?

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Scleral lenses provide a large, stable optical surface and rest on the white part of the eye (the sclera). That stability makes them an excellent platform for incorporating prism—especially in patients who:

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• Already wear scleral lenses for dry eye, keratoconus, post-surgical irregularities, or corneal disease

• Cannot wear glasses with prism due to comfort, lifestyle needs, or optical limitations

• Need a precise, stable prism effect that stays aligned all day

• Have irregular corneal shapes that make traditional soft lenses or glasses less effective

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In a scleral lens, prism can be added without affecting comfort, and the lens remains in a consistent orientation, allowing the prism to stay exactly where it needs to be.

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What Conditions Do Prism Scleral Lenses Help Correct?

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Prism scleral lenses are used to manage double vision caused by ocular misalignment, including:

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• Vertical heterophoria (one eye sits slightly higher)

• Horizontal deviations such as esophoria or exophoria

• Cranial nerve palsies (ex: CN IV palsy causing vertical diplopia)

• Post-surgical or post-trauma alignment issues

• Strabismus in adults (where prism can help achieve single vision for daily tasks)

• Decompensated binocular vision from fatigue, illness, or neurological changes

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They can be used for constant or intermittent double vision depending on the severity and stability of the deviation.

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How Do They Work?

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A prism scleral lens bends light in a specific direction so that the image entering the eye is optically shifted. This allows:

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• The brain to fuse the two images

• Alignment symptoms to decrease

• The patient to achieve comfortable, single vision

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The amount and direction of prism are customized for each patient through precise clinical measurements.

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What Patients Experience

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Most patients report:

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• Reduced or eliminated double vision

• Clearer, more stable single vision

• Less eye strain and fatigue

• Better comfort during reading and computer work​

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Because scleral lenses provide moisture and stability, patients often also experience relief if they have underlying dry eye or corneal irregularities.