Scleral Lenses for High Hypermetropia

Hypermetropia, or long-sightedness, is usually well corrected with glasses or standard soft lenses. At higher levels, though, some patients find standard lens options less comfortable or less visually consistent — often because of how a strong plus-powered lens sits and centres on the eye, particularly if the eye shape is also slightly atypical.

Understanding high hypermetropia

Hypermetropia occurs when the eye is slightly shorter than average, or the cornea slightly flatter, causing light to focus behind the retina rather than directly on it. Mild to moderate hypermetropia is common and easily corrected. High hypermetropia is less common and presents specific fitting challenges, largely because the corrective lens itself needs to be more strongly curved and thicker at its centre, which affects how it behaves on the eye.

Why high hypermetropia can be more complex to fit

Strong plus-powered lenses are thicker centrally, which can affect lens centring, movement and comfort, especially in soft lens designs. This can make consistent, sharp vision harder to achieve for some patients with higher prescriptions.

How scleral lenses can help

A custom-designed scleral lens can be tailored specifically to the power needed and the shape of the individual eye, offering a stable fit that isn’t affected by blinking or lens movement in the way soft lenses can be. This tends to be considered only once simpler options — glasses, or standard soft lenses — haven’t given comfortable, consistent vision, rather than as a routine first step.

Design considerations specific to high hypermetropia

Because plus-powered lenses are thickest at the centre rather than the edge, scleral lens design for high hypermetropia involves particular attention to how central thickness affects the fluid reservoir depth and overall lens profile. This is balanced against oxygen delivery to the cornea and overall comfort, in the same way thickness is balanced for high myopia, just with the thickness distributed differently across the lens.

Who this typically suits

• High hypermetropia where standard soft lenses haven’t given stable, comfortable vision
• High hypermetropia alongside other corneal irregularity
• Patients who’ve found standard lenses uncomfortable due to lens thickness or poor centring

What to expect from fitting

Fitting for high hypermetropia without other corneal irregularity follows the standard scleral lens process — corneal and scleral topography, diagnostic lens fitting to confirm the specific power and central thickness profile suits your eye comfortably, and anterior OCT imaging to check the final fit sits correctly. As with high myopia, the underlying cornea being regular in these cases often makes for a somewhat more straightforward fitting than cases involving significant corneal disease.

Why hypermetropia is sometimes under-recognised

High hypermetropia can be less immediately obvious to patients than high myopia, since young hypermetropic patients often compensate naturally through their eye’s own focusing ability, only noticing significant blur as this compensating ability reduces with age or increasing prescription. This means some patients reach a high hypermetropic prescription somewhat later than equivalent myopic patients might notice their own condition, which is worth being aware of if your prescription has been increasing steadily over recent examinations.

Hypermetropia and presbyopia together

Because hypermetropia and presbyopia both affect near focusing ability, patients with high hypermetropia often notice near vision difficulties somewhat earlier in life than patients with normal or myopic vision, since their eye’s natural focusing reserve is already being used to compensate for the hypermetropia itself. This is worth discussing if you’re finding both distance and near vision increasingly difficult, since it may point toward considering a multifocal scleral lens design rather than a single-vision correction.

What high hypermetropia patients often report

• Improved comfort from reduced lens movement compared with high-power soft lenses
• Better and more consistent centring of the correction throughout the day
• More stable vision overall, particularly for patients who found soft lenses shifted noticeably with blinking

As always, this is an option to consider once simpler solutions haven’t worked, not an automatic first step.

What the assessment process involves

As with the other high-prescription conditions covered in this cluster, assessment for high hypermetropia begins with a full discussion of your visual history and any previous lens experiences, followed by corneal and scleral topography to establish baseline measurements, and diagnostic lens fitting to confirm the design suits both your prescription and your comfort. Anterior OCT imaging is used to check the final fit sits correctly, completing the same thorough process used across every scleral lens fitting at the practice, regardless of the underlying reason for the fitting.

Considering your options fully

If you’re weighing up scleral lenses for high hypermetropia, it’s worth discussing all reasonable alternatives at your assessment, including continued soft lens wear with adjustments to fit or material, corneal RGP lenses, or glasses, so you can make an informed decision based on a full picture of what’s available rather than considering scleral lenses in isolation.

Bringing your lens history to your assessment

As with the other high-prescription conditions in this cluster, bringing details of your previous lens experiences — what you’ve tried, what worked and what didn’t — helps direct your assessment efficiently toward the aspects of fitting most relevant to your specific situation.

High hypermetropia without accompanying corneal disease, like high myopia and high astigmatism, tends to be one of the more predictable scleral lens fittings, since the underlying cornea being assessed is regular rather than irregular.

Life with a stable scleral lens for high hypermetropia

Patients who move to scleral lenses for high hypermetropia commonly describe improved comfort compared with thick, high-powered soft lenses, along with more reliable centring that keeps vision sharp and consistent rather than fluctuating slightly through the day. As with the other high-prescription conditions covered in this cluster, this stability is often the main practical benefit patients notice once a good fit has been achieved.

Making an informed decision

If your current glasses or soft lenses are giving you genuinely satisfactory vision, there’s no particular reason to consider scleral lenses simply because your prescription is high. If you’re finding your correction unsatisfactory despite a high prescription being the presumed explanation, an assessment will clarify whether scleral lenses are likely to offer a meaningful improvement for your specific eyes.

A final consideration

As with high myopia, having a high hypermetropic prescription alone isn’t a reason on its own to pursue scleral lenses — many patients with significant long-sightedness manage perfectly well with standard correction throughout their lives. This article is intended for the smaller group who’ve found standard options genuinely inadequate and are looking for a more stable alternative worth exploring with a proper assessment, rather than deciding based on prescription strength alone.

High Hypermetropia FAQs

Do all patients with high hypermetropia need scleral lenses?

No — most high hypermetropia is corrected well with glasses or standard soft lenses. Scleral lenses tend to be an option where standard lenses haven’t given stable, comfortable vision, rather than a first-line choice.

Can scleral lenses correct hypermetropia and astigmatism together?

Yes — scleral lenses can be designed to correct hypermetropia, astigmatism, or both together in a single custom lens.

Is fitting different for hypermetropia compared with myopia?

The core process is the same — corneal topography, diagnostic lenses and anterior OCT to confirm the fit — with the lens power and thickness profile adjusted for the specific prescription.

Are scleral lenses for hypermetropia more likely to cause discomfort due to central thickness?

Central thickness is carefully balanced during design to maintain comfort and oxygen delivery, so this isn’t typically a significant issue with a properly fitted lens — but it’s one of the factors we account for specifically when designing lenses for high hypermetropia.

Book a Scleral Lens Assessment

Call the practice on 0141 943 3300 to arrange a scleral lens consultation.