Despite a recent resurgence in popularity of scleral lenses, the literature to date is quite limited regarding challenges faced by practitioners. Practitioners may manage one or multiple challenges daily. This chapter explores different topics from the contributors’ personal perspectives. Authors were asked to write about their unique experiences and fitting philosophies for a variety of situations that scleral lens practitioners may encounter. Common topics are included, however not every possible challenge is covered.

Keywords: Asian, Conjunctival hypertrophy, Corneo-scleral topography, Elevations, Fuchs’, Graft rejection, Handling, Impingement, Impression molded, Modify, Molded, Neovascularization, Notch, Nystagmus, Pain, Pediatric, Pinguecula, Pterygium, Symblepharon, Wavefront.

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