Here is a great guide to the beginner's guide to Fitting Scleral Contact Lenses written by Aimee Jacobs, O.D.

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This is a basic approach to fitting scleral lenses that you can tweek with time and experience. Remember to be patient with the process. Practice makes perfect!

Read the full article from newgradoptometry.com

Dr. Dexter's Take

I have always heard about the amazing benefits of scleral contacts lenses for patients with irregular corneas, severe dry eye, high prescriptions, and other ocular surface diseases, but I never felt super comfortable prescribing and fitting these lenses for my own patients. I never had the opportunity to fit a patient with scleral lenses as an optometry student or resident. My only experience with sclerals was that I maybe held one in my hand once in school... maybe. 

Well, last week I had the perfect candidate for scleral lenses walk into my office. He had irregular corneas secondary to keratoconus, he had previously underwent corneal collagen cross-linking surgery, he tried gas permeable contacts in the past (but could never get over the discomfort), and had poor best corrected vision with his spectacles. I brought up the idea of scleral lenses and he was open to it. I confessed that I had a fitting set, but never used it. After a long discussion, we both decided to go on a scleral lens fitting journey together! 

What an experience that was! I didn't realize how easy the scleral lens fitting process could be. After finding a lens that allowed an adequate amount of vault (confirmed by anterior segment OCT), evaluation of the secondary and peripheral curves, and an over-refraction, lenses were ordered for the patient. It was so easy, and the patient immediately appreciated the improvement in comfort and vision. A win, win! 
Moral of the story... don't be afraid of fitting scleral contact lenses (like me). This article from NewGradOptometry does a great job of breaking down the process, making it simple and straight forward.

Good Luck!