Purpose: Scleral lens practice has attracted more interest in the contact lens literature over the last five years than over the last five decades put together. In the mid 1980s, traditional scleral lens designs were modernised in response to the introduction of gas permeable materials with the emergence of new clinical methods, but essentially preserving the objective of scleral bearing and corneal clearance. More recently, new scleral lens styles have been developed more from a perceived need to increase the diameter of corneal lenses. A myriad of limbal, and para-limbal lens designs, mini, semi and full diameter sclerals are available to the practitioner, and once again the essential fitting processes are under scrutiny. The size has become a critical feature, but the comparative attributes of the various styles do not seem to be well understood. Conforming to the traditional scleral lens fitting concept may not be possible if the diameter is insufficient to allow scleral bearing and the traditionally desired prerequisite of clearance well beyond the limbus. There has to be a bearing surface somewhere, the characteristics and location determined in a large part by the diameter. This presentation discusses the impact of bearing surfaces within and just beyond the limbus for scleral lenses of various diameters and designs.
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