Challenges of Scleral Lens Practice in Yemen: Insights from a Tertiary Referral Eye Center in Sana'a.

While scleral lenses provide effective visual rehabilitation and excellent wearing comfort for patients with complex ocular surface diseases and irregular corneas, evidence regarding their delivery in resource-limited settings remains scarce. This narrative commentary highlights the major challenges of establishing and maintaining scleral lens services in Yemen, based primarily on clinical experience at a tertiary eye center in Sana'a. In our setting, healthcare infrastructure, supply chains, and access to specialized eye care are compromised. Here, we discuss the impact of financial constraints, restricted access to advanced fitting technologies, interrupted supply chains, misconceptions, and lack of patient awareness, as well as the difficulties in ensuring continuity of care and long-term follow-up. To address these challenges, we describe flexible, context-specific strategies, including individualized patient management and comprehensive patient education, to facilitate scleral lens care despite significant resource limitations. Ultimately, we delineate practical recommendations tailored to enhancing practitioner training, improving patient education, expanding access to scleral lens services through regional and international collaboration, and developing clinical frameworks and context-appropriate referral pathways. Although grounded in the experience of Yemen, the perspectives conveyed can inform policymakers, eye care providers, and clinicians operating under similar challenges in other resource-limited settings.