Management of keratoconus: comparative visual assessments

We compared the visual performance of keratoconus patients whose vision had been corrected with one of the following: RGP lenses alone, penetrating keratoplasty, or epikeratoplasty. Despite similar Snellen visual acuities with optimal correction, significant differences in visual performance were found in the three groups. Visual performance was assessed by measuring contrast thresholds for electronically-generated sinusoidal gratings and by measuring contrast thresholds in the presence of a glare source. These measurements were carried out on six bilateral keratoconus patients such that three eyes were corrected with RGP lenses alone, five eyes were corrected by penetrating keratoplasty, and four eyes by epikeratoplasty. There were statistically significant differences in the visual responses for the three correction types (ANOVA, F2,45 = 5.755, P = 0.0059), with the epikeratoplasty procedure providing the poorest results. Visual performance was further affected in the presence of a glare source. Statistically significant group differences were again found (ANOVA, F2,45 = 7.593, P = 0.0014), with the penetrating keratoplasty eyes being the most affected. These differences were spatial frequency dependent (p = 0.0293), the effect being most marked at medium spatial frequencies. These findings provide a ranking of the quality of vision provided by each management strategy.