Scleral lenses improve the lives of patients and practitioners who fit them. Scleral lens selection and follow-up care are reviewed by identifying key areas of concern. Common scleral lens problems and troubleshooting techniques are discussed. Care and handling of scleral lenses including solutions and advanced techniques are described. In-office management tips for scleral lens practitioners are discussed. We will also review advancements in scleral lenses and how they can be fully customizable for each patient.