Ask a room of independent ODs which specialty category they expect to grow in their practice and most of them point at the same thing. Not custom soft. Not myopia management. Scleral.
The specialty-fitting sentiment data backs them up. In the most recent Contact Lens Spectrum prescribing survey, 58% of practitioners named scleral as their highest-growth specialty category for the year ahead, up from 46% the year before. Custom soft came in second at 23%, and 54% of respondents expected overall contact lens practice growth.1 That is a meaningful shift in where the optimism is concentrated. It is also the cleanest answer right now to a question the audience keeps asking: where does the independent practice grow when commodity replacement keeps moving online?
The honest answer is that it grows where online retailers cannot follow. Scleral is the most accessible version of that answer for most independent practices.
Why the optimism has moved here
Specialty fitting has always been the part of the contact lens practice that online channels cannot touch. Custom fits, complicated corneas, and the chair time it takes to dial them in are not problems an algorithm and a fulfillment center can solve. The new wrinkle is that the patient pool that benefits from scleral keeps widening.
Three things have stacked on top of each other.
The first is product breadth. Scleral portfolios keep expanding, with one U.S. launch designed to correct higher-order aberrations alongside refractive error.2 That widens the candidate list from severe irregular cornea cases into refractive patients who have simply never seen comfortable vision with a soft lens.
The second is practice economics. The total market value of eye exams is up about 14% year over year while exam volume is down about 4.5%, which works out to roughly $17 more per exam.3 Practices are seeing fewer patients but each visit is worth more. Specialty fitting is one of the few places where the value-per-visit math compounds with the time spent. A 90-minute scleral consult is paid like 90 minutes of work, not like a fast refraction.
The third is the cultural shift in how ODs are talking about their own role. The advisory framing, where the OD is the fitter and curator rather than the order-taker, keeps gaining weight in industry publications and conference talks. Scleral is the version of that work that pays the most clinically and economically per chair-hour. None of the optimism in the survey data is hypothetical. It is practitioners describing the part of their schedule they actually want more of.
The patient the practice is not yet fitting
Most independent practices already have the scleral candidate sitting in the chart system. They just have not pulled the list yet.
A short pull usually finds the same four kinds of patients. The dry-eye patient who has tried three soft modalities and "just stopped wearing contacts." The patient who walked out of a previous practice with a keratoconus mention in the chart and has been wearing glasses uneasily ever since. The post-LASIK or post-surgical patient whose vision is technically correctable but not satisfying. The 50-something former wearer whose presbyopia and dry-eye picture together have made every prior modality a near-miss.
That list is not exotic. It is in every practice. What separates the practices that build a scleral book from the ones that talk about it for a year is the move from "I should look into scleral" to "I am pulling the chart list this week."
The version of this point we keep coming back to with partner practices is simple. Scleral is not a new specialty to learn from scratch. It is permission to call back the patients you already lost and offer them something different. That call list is the wedge.
What "adding scleral" actually looks like
The reason scleral conversations stall in independent practices is that the imagined version of "adding it" sounds like a capital project. A new diagnostic, a new fitting set, a new chair, a week of training, a relationship with a new lab.
The realistic version is smaller. A single doctor in the practice takes ownership of the first wave of cases. A diagnostic relationship with one specialty lab gets opened. Two or three fitting sets get borrowed or rented before any are bought. The first eight to twelve patients are pulled from the chart list described above. Documentation and billing for those first cases get standardized while the volume is still small enough to standardize, and the patient education materials get a consistent template.
What practices tend to underestimate is the documentation side. Scleral notes, follow-up protocols, and patient education materials need to be consistent the first time so the second wave can run without the lead doctor’s full attention. That part is operational, not clinical, and it is the part that determines whether the practice has a scleral capability in 18 months or just a few cases on the lead doctor’s calendar.
The encouraging signal in the survey data is that the practitioners growing the fastest are the ones treating scleral as a system inside the practice, not as a single doctor’s hobby. The work that turns specialty fitting into a category is the same operational work that turns a daily disposable program into a category. We have written before about the seam where new daily disposable wearers drop out, and the underlying lesson is the same here: the modality only grows if the practice’s process treats it as a category, not as a clinical one-off.
How it connects to the daily disposable book
It is worth saying out loud, because we write about daily disposables here constantly. Scleral and daily disposables are not competitors inside a practice. They are anchors at opposite ends of the same shelf.
Daily disposables anchor the volume side. They are how the practice keeps the routine refractive patient in the loop, ordering at home, comfortable in the modality, and showing up annually for the re-fit. The 30-second handoff we walked through in an earlier piece is what turns that book into something the practice actually owns.
Scleral anchors the value side. It is the patient who is paying meaningfully more per visit, who is not price-shopping the lens online, and whose relationship with the practice cannot be replicated by a fulfillment company. Specialty patients are also some of the most loyal patients in the practice because the only place they have ever had comfortable vision is the chair they are sitting in.
A practice with both is set up well. The daily disposable book absorbs the patients who would have leaked to online retailers. The specialty book absorbs the chair time and value that exam-volume pressure is putting on the rest of the schedule.
A note from the DCL team
The scleral momentum is real, the patient list is sitting in the chart system, and the operational moves are smaller than most practices think. None of that is the hard part. The hard part is starting the call list this month instead of agreeing it sounds like a good idea for next quarter.
If the practice already has the call list and the fitting relationship and is ready to scale the back-office side, that is the conversation Dr. Contact Lens was built for: tracking the candidates, standardizing the patient communication, and keeping the daily disposable book healthy underneath it. If the call list has not been pulled yet, that is the place to start. We compare versions of both lists with practices every week, and the difference between the practices growing scleral fastest and the ones still thinking about it is which week the list got pulled.
If a quick second set of eyes on what your scleral candidate list might look like would be useful, get in touch. We will compare notes.
Sources
- Contact Lens Spectrum, "Contact Lenses 2025" prescribing survey (January / February 2026 issue). 58% of practitioners named scleral as their highest-growth specialty category for 2026, up from 46% for 2025; custom soft second at 23%; 54% expecting overall contact lens practice growth. Survey reports practitioner expectations, not outcomes. https://www.clspectrum.com/issues/2026/january-february/contact-lenses-2025/
- Healio Optometry, "Zenlens Chroma HOA scleral contact lenses launched in US." Bausch + Lomb’s U.S. launch of a scleral lens designed to reduce halos and glare and correct advanced higher-order aberrations, one example of the ongoing specialty scleral portfolio expansion. https://www.healio.com/news/optometry/20250521/zenlens-chroma-hoa-scleral-contact-lenses-launched-in-us
- The Vision Council, Market inSights, Q2 2025. Exam market value up 14% versus Q2 2024 while exam volume declined 4.5% year over year. As reported by OptikNow. https://www.optiknow.ca/2025/09/05/vision-council-market-insights-q2-2025/
