Unique hard scleral lens post-LASIK ectasia fitting.

Area of Science:

• Ophthalmology
• Biomedical Engineering

Background:

• Corneal ectasia, including post-LASIK, involves progressive corneal thinning and steepening, leading to vision impairment.
• Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) devices, a type of scleral lens, are vital for vision salvage when other treatments fail.
• Patient symptoms include glare, ghosting, and reduced visual acuity.

Observation:

• A case report details the use of a PROSE device in an Indian patient with post-LASIK corneal ectasia.
• The patient presented with a larger palpebral aperture, steeper cornea, and significant scleral toricity.
• A smaller-diameter PROSE device with a flatter haptic was chosen due to scleral toricity, deviating from the typical recommendation for steeper corneas.

Findings:

• Scleral toricity can influence PROSE device vault and haptic fit, potentially altering the corneal-contact lens relationship.
• Even with appropriate device selection, scleral toricity may contribute to persistent symptoms after extended wear.
• Adaptation to the PROSE device can lead to changes in vault due to haptic settling on the sclera.

Implications:

• Understanding the scleral profile is crucial for optimizing PROSE device fitting and patient outcomes in complex cases.
• This case highlights the need for individualized PROSE device selection considering not only corneal but also scleral topography.
• Further research into scleral topography's impact on scleral lens wear is warranted to improve management of corneal ectasia.