Comparing Keratoconus Lens Options: Pros and Cons of RGP, Hybrid and Scleral Lenses

“Which lenses are right for me?” 

It’s one of the first questions people ask after discovering specialist contact lenses can restore their vision with keratoconus. And it’s a sensible question, because choosing between RGP, hybrid and scleral lenses isn’t always straightforward. 

Each type has genuine advantages and real limitations. What works brilliantly for one person might prove frustrating for another. Understanding the practical differences – not just the technical specifications – helps you make an informed decision rather than simply accepting whichever lenses your optician happens to stock. 

At Bellamy Eyecare in Leicester and Irthlingborough, we fit all types of specialist lenses for keratoconus. Over 25 years, we’ve learned which lenses suit which situations and, importantly, we’re honest about the trade-offs involved. 

Why this decision matters more than you might think 

The lens type you choose affects your daily life in ways that extend well beyond how clearly you can see. Comfort, how easy they are to put in and take out, how long you can wear them, daily cleaning routines, cost and whether they’ll still work as your keratoconus changes – all of this varies significantly between lens types. 

Getting this decision right saves you months of frustration, wasted money on lenses that don’t work for you and potentially means better control of your keratoconus if unsuitable lenses stop you wearing them consistently. 

The three main types explained simply 

Before comparing them in detail, here’s what makes each lens type different: 

1. RGP (Rigid Gas Permeable) lenses – often called “hard lenses” are small, firm lenses slightly larger in size than your pupil. They sit directly on your cornea. They’ve been used for keratoconus for decades and work brilliantly for mild to moderate cases. 

2. Scleral lenses – are much larger, about the size of a 5p coin. Instead of sitting on your cornea, they arch right over it and rest on the white part of your eye. They’re increasingly popular for moderate to severe keratoconus and can do things RGP lenses can’t. 

3. Hybrid lenses – have a firm centre (like an RGP lens) surrounded by a soft outer edge (like a normal soft contact lens). They’re trying to give you sharp vision from the firm centre with comfort from the soft edge. They sit somewhere between the other two options. 

Vision quality: which lenses help you see sharpest? 

• For pure clarity, RGP lenses are hard to beat. The firm surface creates really sharp vision and many people with mild to moderate keratoconus can see 20/20 or better with properly fitted RGP lenses. If your vision has been getting increasingly blurred, the crisp, clear sight with RGP lenses often comes as a genuine surprise. 

• Scleral lenses give vision that’s just as good – and sometimes better. Because they’re bigger, they can create a larger clear viewing area. And because they barely move when you blink, your vision stays sharp all day. With RGP lenses, you might notice slight vision wobbles as the lens moves with blinking. If your keratoconus has progressed beyond mild, or if you’ve found RGP lenses don’t sit properly on your eye, scleral lenses often give you better day-to-day vision even though technically both lens types can achieve similar sharpness. 

• Hybrid lenses usually give good vision for mild to moderate keratoconus, though often not quite as sharp as the other options. The join between the firm centre and soft edge can sometimes create slight blurriness. If you need absolutely perfect vision for demanding work, hybrid lenses might not quite get there. 

Bottom line for vision: RGP and scleral lenses are roughly equal. RGP lenses have a slight edge for mild keratoconus, scleral lenses work better for moderate-to-severe cases. 

Comfort: what they actually feel like 

Let’s be honest about RGP lenses – you’ll know they’re in your eyes when you first start wearing them. Most people describe the feeling as anywhere from “a bit odd but OK” to “genuinely uncomfortable.” You can feel them with each blink. 

The encouraging news is that most people are able to adapt within one to two weeks. After that, long-term RGP wearers usually forget they’re wearing lenses. However, some people never fully adapt. If your eyes are particularly sensitive, RGP lenses might never feel comfortable. 

Many people find scleral lenses surprisingly comfortable right from day one. Because they don’t touch your cornea at all, and rest on a much less sensitive part of your eye, there’s often very little sensation. The liquid sitting between lens and cornea also keeps your eye constantly moisturised, which can actually feel soothing. 

If comfort matters most to you, or if you’ve tried RGP lenses before and couldn’t tolerate them, scleral lenses usually solve that problem. A few people find the larger size makes them more aware of the lens initially but this normally settles within days. 

Hybrid lenses were specifically designed to feel better than RGP lenses. The soft outer edge means less sensation against your eyelids, so they feel more like regular soft contact lenses. However, results vary a lot. Some people find them brilliantly comfortable. Others get edge awareness or discomfort where the firm and soft parts join. Some people fitted with hybrid lenses stop wearing them within six months, often because they’re not comfortable enough. 

Bottom line for comfort: Scleral lenses win. Hybrid lenses might work as an alternative if scleral lenses aren’t right for you. 

Putting them in, taking them out, and daily care 

• RGP lenses are small and straightforward to handle once you’ve practiced a few times. Getting them in and out takes less than a minute per eye once you’re used to it. Cleaning is simple too – simply rub with solution, rinse and store. Your whole daily routine takes five minutes. If you want the quickest, easiest daily routine, RGP lenses win. The downside is that because they’re so small, they’re easier to drop down the sink or lose. Many people keep spare lenses just in case. 

• Scleral lenses need a bit more effort. You have to fill the lens bowl with sterile saline solution, carefully position it on your eye without spilling, and make sure it’s sitting properly. Your first few attempts might feel clumsy. Most people get the hang of it within a few days to a week, though the process does take 5-10 minutes morning and evening. If you have arthritis, shaky hands or find fiddly tasks difficult, scleral lens insertion might be challenging (though tools exist to help). On the plus side, the larger size makes them easier to handle and harder to lose than RGP lenses. 

• Hybrid lenses handle similarly to normal soft contact lenses, so they’ll feel familiar if you’ve worn soft lenses before. However, they’re more fragile than the other options and can tear where the firm centre meets the soft edge. You’re more likely to need replacement due to damage than with other lens types. 

Bottom line for handling: RGP lenses for speed and simplicity, scleral lenses for ease of handling once you’ve learned how. 

Which lenses suit which stage of keratoconus? 

Mild keratoconus 

RGP lenses work brilliantly for most people with mild keratoconus. They’re economical, give you excellent vision and are generally the first choice unless there’s a specific reason to try something else. Scleral lenses also work well but might be more than you need when simpler options do the job. Hybrid lenses can work but don’t usually offer any real advantage over RGP lenses for mild cases. 

Our advice: Start with RGP lenses unless you’re particularly sensitive or have other reasons to try scleral lenses. 

Moderate keratoconus 

RGP lenses still work for many people with moderate keratoconus, especially if the cone-shaped bulge is fairly central and not too steep. However, scleral lenses increasingly become the better choice as keratoconus gets worse. They cope with steeper, more irregular corneas more successfully. Hybrid lenses might work if the cone isn’t too pronounced but fitting becomes trickier and success less certain. 

Our advice: Try RGP lenses first if your optician thinks they’ll fit successfully. If fitting is difficult or vision and comfort aren’t good enough, move to scleral lenses. 

Advanced keratoconus 

RGP lenses often struggle with advanced keratoconus. They might not sit properly on very steep corneas or might be uncomfortable because they move around too much. Scleral lenses are usually the best – and often only – option that works. Because they vault right over your cornea, they can accommodate even very steep, irregular shapes successfully. Hybrid lenses rarely work well for advanced cases because they’re too difficult to fit properly. 

Our advice: For advanced keratoconus, scleral lenses are typically your best option. 

You can read more about keratoconus stages here. 

Cost: what you’ll actually pay 

• RGP lenses typically cost £200-£250 per lens, so £400-£500 for a pair. They last 12-18 months, sometimes longer if you look after them really well. Over five years, they usually cost least – provided they work for you. 

• Scleral lenses run £200-£300 per lens, so £400-£600 for a pair. The more complex fitting also means higher fees for your optician’s time. They last 12-18 months, occasionally up to two years. Despite costing more, they might actually represent better value if they’re the only lenses that give you comfortable, usable vision for your level of keratoconus. 

• Hybrid lenses sit in the middle at £200-£275 per lens. However, they need replacing every 6-12 months and they’re more likely to get damaged and need replacing early. Over time, they often end up costing more than either of the other options because you’re replacing them more frequently. 

Which lenses for which lifestyle? 

If you work at a computer all day, both RGP and scleral lenses work well. Scleral lenses might have a slight advantage because the constant moisture helps with the dry eyes that often come from staring at screens for hours. 

For sports and active lifestyles, scleral lenses are much more stable. RGP lenses can fall out with vigorous movement or if you get accidentally poked in the eye during sport. 

If you work outdoors or in dusty environments, scleral lenses are better. They seal against your eye so dust and debris can’t get underneath. With RGP lenses, particles can get under the lens, which is immediately painful. 

If you have arthritis, shaky hands or find fiddly tasks difficult, RGP lenses are simpler to handle. Scleral lens insertion might be challenging, though tools exist to help. 

When you have dry eyes as well as keratoconus, scleral lenses keep your cornea constantly moisturised with the liquid reservoir between lens and eye. This can dramatically improve comfort if you’re dealing with both conditions. 

If budget is tight, RGP lenses are usually the most economical option – provided they work for your stage of keratoconus. 

Questions to ask yourself before deciding 

1. How bad is your keratoconus? Mild cases have more options, moderate-to-severe cases often need scleral lenses. 

2. How important is immediate comfort? If you need maximum comfort straight away, scleral lenses usually deliver. If you can cope with a couple of weeks’ adjustment, RGP lenses work well. 

3. How much time can you spend on your daily lens routine? RGP lenses are quickest; scleral lenses take more time. 

4. What’s your budget? RGP lenses cost least if they’re suitable; scleral lenses cost more but might be necessary regardless of price. 

5. What do you do every day? Active lifestyle, dusty work environment or sports all point toward scleral lenses. 

6. Do you have dry eyes as well? Scleral lenses sort out both keratoconus and help with dry eyes at the same time. 

What if your first choice doesn’t work out? 

It’s fairly common to try one lens type and find it doesn’t suit you. Perhaps RGP lenses gave you perfect vision but felt too uncomfortable. Scleral or hybrid lenses might solve that. 

Maybe hybrid lenses felt comfortable but your vision wasn’t quite sharp enough. Scleral lenses might give you the clarity you need. 

Or perhaps you found scleral lens insertion too difficult. RGP lenses might work if you’re willing to adapt to the feeling. 

At Bellamy Eyecare, we work with you to find what actually works in your daily life, not just what looks good on paper. 

Why choosing an experienced optician matters 

Having access to all lens types only helps if your optometrist knows how to fit them properly and can tell you which will suit your specific situation. 

Over 25 years fitting keratoconus lenses, we’ve learned which lenses work for which eye shapes, how to overcome tricky fitting challenges, and how to get you the best possible vision and comfort regardless of which lens type you need. 

Our 45-minute appointments give us proper time to assess you thoroughly. You’ll see the same optometrist every visit, which means real continuity – they’ll understand your specific case inside out. 

And we’re honest about trade-offs. If RGP lenses would work but scleral lenses would work better, we’ll explain why. If hybrid lenses probably won’t suit your particular eye shape, we’ll tell you straight away rather than wasting your time and money. 

Moving forward 

The “best” keratoconus lens is whichever one works best for you, giving you clear vision in lenses you can comfortably wear for 12-16 hours every day. 

For some people, that’s economical RGP lenses giving crisp vision once you’ve adapted. For others, it’s comfortable scleral lenses that genuinely transform quality of life. And for some, hybrid lenses offer the perfect middle ground. 

The only way to know is proper assessment, trying the options that suit your situation and honest feedback about what works. 

If you’re struggling with keratoconus or aren’t happy with your current lenses, we’d welcome the opportunity to help. 

Contact us to arrange a specialist lens assessment at either our Leicester or Irthlingborough practice. 

Leicester Practice 156 Fosse Road North, Leicester, LE3 5ES Tel: 0116 2531750 

Irthlingborough Practice 24 High Street, Irthlingborough, NN9 5TN Tel: 01933 653226 

Written by Alan Bellamy, principal optometrist at Bellamy Eyecare in Leicester and Irthlingborough. Alan has more than 25 years of experience fitting RGP, hybrid and scleral lenses for keratoconus patients.