The modern scleral contact lens (ScCL) has evolved from the very first contact lens fitted 128 years ago. Originally manufactured in glass and oxygen impermeable plastics, these lenses are available today in high Dk gas permeable materials that allow permeation of oxygen, reducing many of the complications that were seen with older generation ScCL. However, as with any new contact lens modality, the modern ScCL brings with it a new set of complications and fitting limitations.