Keratoconus Contact Lenses: Which Type Is Best for You?
FIG 1. NORMAL CORNEA
FIG 2. KERATOCONUS
The best contact lens for keratoconus is the one that gives you useful vision, a healthy fit and comfort you can sustain through your day. Scleral, corneal RGP, hybrid and selected soft lens designs can each have a role. No lens type is automatically best for every person or every stage of keratoconus.
Scleral lenses can be particularly helpful when other designs are unstable or uncomfortable, but corneal RGP and hybrid lenses remain useful options. Standard soft lenses may work in mild cases, while custom soft designs can suit selected eyes. Your optometrist assesses the corneal shape, vision with trial lenses, eye health, handling and everyday needs before recommending a design.
Contact lenses improve vision; they do not stop keratoconus progressing. Monitoring is still needed, and your ophthalmologist may recommend cross-linking separately. This guide compares the main keratoconus contact lenses to help you prepare for an individual fitting assessment.
What is keratoconus?
Keratoconus changes the shape and thickness of the cornea, which can cause blurred or distorted vision. An Australian study found keratoconus in approximately 1 in 84 participants in its sample of 20-year-old adults in Western Australia. This is a finding from that study population, not a prevalence estimate for every Australian age group. 1
It often becomes apparent in the teenage years or early adulthood. Progression can continue beyond age 30, so regular monitoring remains important even when vision seems stable. 2
Comparing Keratoconus Contact Lenses
| Lens type | How it helps | Comfort and handling | When it may suit |
| Scleral | Vaults over the cornea, with a fluid reservoir beneath the lens. | Can offer good stability and comfort; insertion, removal and care need training. | A range of corneal shapes, including eyes where other designs give poor comfort, stability or vision. |
| Corneal RGP | A smaller rigid lens masks corneal irregularity with a regular optical surface. | Lens awareness and movement vary; adaptation and fit matter. | Eyes achieving good vision and a healthy, stable fit; not restricted to backup use. |
| Soft | Standard or custom soft designs correct vision to different degrees. | Often familiar to handle; comfort and visual performance must both be assessed. | Mild cases or selected eyes suited to custom keratoconus designs. |
| Hybrid | Combines a rigid centre with a soft skirt. | May improve stability or comfort for some wearers; requires specific care and handling. | Selected eyes where the combination provides useful vision and an appropriate fit. |
These are general characteristics, not a ranking. Trial fitting is needed to compare vision, comfort and eye health. 3
Scleral
How it helps:
Vaults over the cornea, with a fluid reservoir beneath the lens.
Comfort and handling:
Can offer good stability and comfort; insertion, removal and care need training.
When it may suit:
A range of corneal shapes, including eyes where other designs give poor comfort, stability or vision.
Corneal RGP
How it helps:
A smaller rigid lens masks corneal irregularity with a regular optical surface.
Comfort and handling:
Lens awareness and movement vary; adaptation and fit matter.
When it may suit:
Eyes achieving good vision and a healthy, stable fit; not restricted to backup use.
Soft
How it helps:
Standard or custom soft designs correct vision to different degrees.
Comfort and handling:
Often familiar to handle; comfort and visual performance must both be assessed.
When it may suit:
Mild cases or selected eyes suited to custom keratoconus designs.
Hybrid
How it helps:
Combines a rigid centre with a soft skirt.
Comfort and handling:
May improve stability or comfort for some wearers; requires specific care and handling.
When it may suit:
Selected eyes where the combination provides useful vision and an appropriate fit.
These are general characteristics, not a ranking. Trial fitting is needed to compare vision, comfort and eye health. 3
Scleral Lenses
FIG 3. SCLERAL LENS
Scleral lenses are large-diameter, gas permeable lenses that rest on the sclera (the white of the eye) and vault over the cornea. Scleral lenses can provide good comfort and stable vision in a suitable fit. Because they are rigid and hold their shape, they do not mould to the irregular cornea shape caused by keratoconus.
Scleral lenses can also be an option after a corneal graft. Given the lens vaults over the graft, scleral lenses can be a comfortable solution to restoring vision. However, not all corneal grafts can tolerate a scleral lens, and our optometrists can discuss this further with you.
Design and Function of Scleral Lenses
Before insertion, the lens is filled with sterile, preservative-free saline. This fluid reservoir sits between the lens and the cornea and helps neutralise the irregular shape caused by keratoconus, which can give clearer and more stable vision.
Scleral lenses for keratoconus require a precise fitting by an optometrist. Imaging and topography of the eye are typically used to customise the lens to the exact curvature of your eye. An initial scleral lens assessment costs approximately $300–$350, and a Medicare rebate may apply. Lenses start from $800 per lens, and a private health rebate may apply. See our scleral lens fitting and fees page for what is included and why the lens price varies.
Pros and Cons
Pros:
- Can provide clear vision for many irregular corneas
- Usually stable on the eye
- Can provide good comfort in a suitable fit
Cons:
- Requires consistent care and cleaning
- Some people need time to adapt to the lens as it is bigger, particularly with insertion and removal
Corneal RGP Contact Lenses
A Rigid Gas Permeable (RGP) lens is a hard contact lens which has oxygen-permeable polymers. Unlike soft contact lenses, which mould to the shape of the eye, corneal RGP lenses are “rigid” and maintain their shape as they sit over the cornea. This makes them a useful option for correcting vision in keratoconus. The breathable quality of the lenses still allows oxygen to pass through to maintain good eye health. Read more about custom RGP lenses.
Design and Function
Compared to scleral lenses, RGP lenses are smaller and sit directly on the cornea. They help to create a smooth surface by masking the irregular shape caused by keratoconus.
Corneal RGP lenses can provide clear vision and may be a practical option when the lens centres and fits well. Some people notice the lens more or find it less stable than a scleral lens. 4 Suitability depends on the individual cornea and trial fit, rather than a rule that RGP lenses are only appropriate when scleral lenses cannot be used.
Fig 4. RGP Contact Lens
Soft Lenses
Fig 5. Soft Contact Lens
Soft contact lenses are made of flexible plastics that fit the shape of your eye and allow oxygen to pass through. They are called “soft” lenses because they conform to the shape of your cornea.
Standard soft lenses can help in mild keratoconus but may not adequately correct more irregular corneas. Custom soft lenses designed for keratoconus may suit selected eyes. Your optometrist assesses whether the vision and fit are adequate for your needs. Replacement frequency depends on the prescribed design.
Hybrid Lenses
As the name suggests, hybrid lenses are a mix of RGP and soft lenses. They have a hard central portion and a soft skirt. Read more about hybrid contact lenses.
Hybrid lenses may offer a useful balance of vision, stability and comfort for selected eyes. They are not limited to mild keratoconus or backup use. Handling, care, replacement schedule and the ongoing health of the fit should be discussed during assessment.
Fig 6. Hybrid Lens
How do we choose a lens?
Lens choice depends on the corneal shape, vision achieved with trial lenses, eye health, comfort, handling and the activities you need to do. Corneal thickness is important to the overall assessment but does not, by itself, determine the lens type.
Topography maps corneal surface shape, while tomography also assesses the back surface and thickness. Lens fitting then checks how the chosen design behaves on the eye. The aim is to improve the optical surface while maintaining a healthy fit, not to reshape the keratoconic cornea.
Discuss your working day, sport, dry-eye symptoms and how easily you can insert, remove and clean a lens. Screen use may affect blinking and comfort; contact lenses do not protect against screen-related damage.
Progression is assessed separately from lens comfort. Good vision in lenses does not prove that keratoconus has stopped changing.
How to check lens fitting and comfort level
A fitting assessment includes vision testing, examination of the cornea, corneal imaging and trial lenses where appropriate. Follow-up checks assess the lens position, vision, comfort and the eye’s response to wear. Comfortable vision alone does not confirm a healthy fit.
Tell your optometrist about recurring fogging, discomfort or redness rather than assuming you must adapt to it. Remove the lens and seek advice for pain, increasing redness, light sensitivity or reduced vision. Sudden or severe symptoms need urgent assessment.
Conclusion
Choosing contact lenses for keratoconus is an individual process. A suitable lens should provide useful vision, manageable handling and a healthy fit. Regular reviews help maintain performance and monitor the condition, but lenses do not prevent progression. Lenses are one part of care; see our guide to keratoconus treatment options.
Book a keratoconus contact lens assessment at Vision Camberwell Optometrists to discuss which options suit your eyes and daily needs.
References
- Chan E, et al. Prevalence of Keratoconus Based on Scheimpflug Imaging: The Raine Study. Ophthalmology. 2021;128:515–521.
- Gokul A, Patel DV, Watters GA, McGhee CNJ. The natural history of corneal topographic progression of keratoconus after age 30 years in non-contact lens wearers. British Journal of Ophthalmology. 2017;101:839–844.
- National Keratoconus Foundation. Contact Lenses for Keratoconus. Accessed 5 October 2026.
- Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Contact Lens and Anterior Eye. 2020;43(6):543–552.
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