Scleral contact lenses have been largely superseded by corneal contact lenses, but they still retain a role as a treatment of choice for a small group of patients who have tried other types of contact lens wear without success and who are not good candidates for surgery. We performed a cross sectional survey of 44 patients attending clinics at Moorfields Eye Hospital who were successful long-term scleral contact lens wearers and reviewed their indications. Twenty-one patients had been fit to improve visual acuity, 20 for therapeutic indications, and three for cosmetic reasons. Scleral lenses were most useful were with patients with ocular surface disorders, such as Stevens-Johnson syndrome, and for visual rehabilitation of patients with grossly irregular corneal topography. All patients were benefiting from scleral contact lens wear, and none had serious complications as a result of the scleral lens wear. We conclude that all ophthalmic departments should have access to these lenses.