Medical policy: Gas Permeable Scleral Contact Lens and Therapeutic Soft Contact Lens

Policy number: MP 6.031

Effective date: 4/1/2026

Policy

Corneal liquid bandage is a term that refers to both rigid gas permeable scleral contact lenses (RGP-ScCLs) and therapeutic soft contact lenses (TSCLs). Corneal liquid bandages cover the cornea and sometimes the adjacent portion of the white of the eye (sclera). These lenses are used in the treatment of acute or chronic corneal pathology such as persistent epithelial defects (PEDs). Corneal liquid bandage lenses are distinct from soft contact or gas permeable lenses used to correct refractive errors.

Rigid gas permeable scleral lens

Rigid gas permeable scleral lens may be considered medically necessary for individuals who have not responded to topical medications or standard spectacle or contact lens fitting, for the following conditions:

• Corneal ectatic disorders (e.g., keratoconus, keratoglobus, pellucid marginal degeneration, Terrien’s marginal degeneration, Fuchs’ superficial marginal keratitis, post-surgical ectasia);
• Corneal scarring and/or vascularization;
• Irregular corneal astigmatism (e.g., after keratoplasty or other corneal surgery);
• Ocular surface disease (e.g., severe dry eye, persistent epithelial defects, neurotrophic keratopathy, exposure keratopathy, graft vs. host disease, sequelae of Stevens Johnson syndrome, mucus membrane pemphigoid, post-ocular surface excision, post-glaucoma filtering surgery) with pain and/or decreased visual acuity.

Therapeutic soft contact lenses (TSCLs)

Hydrophilic soft contact lenses may be considered medically necessary to treat surgical or congenital aphakia.

The use of therapeutic soft contact lenses used as a corneal bandage may be considered medically necessary when applied and removed by the physician for the treatment of the following, but not limited to, conditions:

• Acute or chronic corneal pathology;
• Permanent keratoprosthesis;
• After removal of congenital cataracts in an infant;
• Bullous keratopathy;
• Dry eyes;
• Corneal ulcers and erosion;
• Filamentary keratitis; PEDs resulting from penetrating keratoplasty;
• Keratoconus; or
• Neurotrophic corneas resulting from herpes simples/zoster keratitis, congenital corneal anesthesia, familial dysautonomia, Seckel’s syndrome, diabetes, acoustic neuroma surgery, trigeminal ganglionectomy, or trigeminal rhizotomy.

Cross-references

• MP 2.028 Eye Care
• MP 1.044 Implantation of Intrastromal Corneal Ring Segments
• MP 5.062 Computer Assisted Corneal Topography
• MP 6.058 Intraocular Lenses, Spectacle, Correction and Iris Prosthesis
• MP 9.011 Corneal Surgery

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO - Refer to FEP Medical Policy Manual.

Description/background

Types of corneal liquid bandage lenses

Corneal liquid bandages are utilized in a large variety of ophthalmic disorders and are considered one of various treatment options. The choice of lens depends on the clinical effect best suited to the cornea, though typically TSCLs are tried first.

Gas permeable scleral contact lens

Gas permeable scleral contact lenses, which are also known as ocular surface prostheses, are formed with an elevated chamber over the cornea and a haptic base over the sclera. Scleral contact lenses are being evaluated in patients with corneal disease, including keratoconus, Stevens-Johnson syndrome, chronic ocular graft-versus-host disease, and in patients with reduced visual acuity after penetrating keratoplasty or other types of eye surgery.

Scleral contact lenses create an elevated chamber over the cornea that can be filled with artificial tears. The base or haptic is fit over the less sensitive sclera. Scleral contact lenses have been proposed to provide optical correction, mechanical protection, relief of symptoms, and facilitation of healing for a variety of corneal conditions. The main benefit of scleral lenses is that they can be designed to accommodate any degree of corneal steepness or irregularity.

Specifically, the scleral contact lens may neutralize corneal surface irregularities and, by covering the corneal surface in a reservoir of oxygenated artificial tears, functions as a liquid bandage for corneal surface disease. This may be called prosthetic replacement of the ocular surface ecosystem (PROSE).

In the United States (US), scleral contact lenses were previously most often made of a rigid plastic. However, in recent years, gas permeable polymer plastic (e.g., fluorosilicone-acrylate polymer) has been used to make these lenses, which are now referred to as RGP-ScCLs. RGP-ScCLs are promoted for daily use and, in some instances, extended use in the treatment of PEDs.

The BostonSight^® Scleral daily wear contact lenses are manufactured with a large diameter RGP lens design that vaults over the cornea and rests on the conjunctiva overlying the sclera. Unlike a traditional rigid gas-permeable contact lens, it is a specially designed, fluid-ventilated, gas-permeable scleral contact lens. It is designed to maintain a hydra-free reservoir of oxygenated aqueous fluid over the corneal surface at a neutral hydrostatic pressure. Since air bubbles are avoided, the fluid reservoir functions as a corneal liquid bandage that offers unique therapeutic benefits for the management of severe ocular surface disease, in addition to its traditional role of masking irregular corneal astigmatism.

Therapeutic soft contact lenses (TSCLs)

TSCLs are disposable plastic lenses made of polymer material that are hydrophilic to absorb or attract a certain volume of water and which cover the entire cornea. These soft lenses are worn directly against the cornea and are prescribed for the treatment of acute or chronic corneal pathology such as PEDs. Many types of soft tissue lenses are available for therapeutic use (e.g., Focus^® Night & Day^® Lens). The cause of the PED should dictate which type of lens is used.

Rationale

Summary of evidence

Gas permeable scleral contact lenses, which are also known as ocular surface prostheses, are formed with an elevated chamber over the cornea and a haptic base over the sclera. Scleral contact lenses are being evaluated in patients with corneal disease, including keratoconus, Stevens Johnson syndrome, chronic ocular graft-versus-host disease (GVHD), and in patients with reduced visual acuity after penetrating keratoplasty or other types of eye surgery.

There have been several prospective and retrospective studies that enrolled more than 100 patients. The largest series was a retrospective review of more than 538 patients with more than 40 different clinical indications who were fitted with the Boston Ocular Surface Prosthesis. These case series report an improvement in health outcomes in patients who have failed all other available treatments. These uncontrolled studies are suggestive of benefit, but the lack of controlled trials precludes a definite conclusion on treatment benefit.

Clinical input was obtained and supports the medical necessity of the gas permeable scleral contact lens in cases of corneal ectatic disorders, corneal scarring and/or vascularization, irregular corneal astigmatism, and ocular surface disease with pain and/or decreased visual acuity when all other available treatments have failed.

For patients with ocular surface diseases who have not responded adequately to topical medications, there is a lack of alternative treatments. For patients with corneal ectatic disorders and irregular astigmatism who have failed standard contact lens, the alternative of corneal transplant surgery is associated with risks. Therefore, the gas permeable scleral contact lens may be considered medically necessary in these patient populations.

Definitions

Aphakia is a condition in which part or all of the crystalline lens of the eye is absent, due to a congenital defect or because it has been surgically removed, as in the treatment of cataracts.

Bullous keratopathy refers to blistering of the cornea, accompanied by corneal swelling.

Congenital refers to something which is present at birth.

Cornea is the transparent anterior portion of the sclera (the fibrous outer layer of the eyeball), about one sixth of its surface: the first part of the eye that refracts light.

Filamentary keratitis is a condition characterized by the formation of epithelial filaments of varying size and length on the corneal surface.

Keratitis refers to inflammation and ulceration of the cornea, which is usually associated with decreased visual acuity.

Keratoconus is a conical protrusion of the center of the cornea with blurring of vision, but without inflammation. This occurs most often in persons aged 20 to 60 and is often an inherited disease.

Keratoprosthesis refers to replacement of the central area of an opacified cornea by plastic.

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as permitted by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the member’s benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Covered, medically necessary, rigid gas permeable scleral contact lenses

Covered when medically necessary, therapeutic soft contact lenses (TSCLs)

References

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2. Stason WB, Razavi M, Jacobs DS, et al. Clinical benefits of the Boston Ocular Surface Prosthesis. Am J Ophthalmol. Jan 2010;149(1):54-61. PMID 19878920
3. Baran I, Bradley JA, Alipour F, et al. PROSE treatment of corneal ectasia. Cont Lens Anterior Eye. May 24 2012;35(5):222-227. PMID 22633003
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15. BostonSight SCLeral package insert.
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21. Lipson MJ. Overview of contact lenses. In: UpToDate, Jacobs DS, Givens G (Eds), UpToDate, Waltham, MA. Updated September 10, 2024. Literature review current through October 2025.
22. American Academy of Ophthalmology (AAO). Preferred Practice Patterns: Corneal Ectasia. 2023