Scleral contact lenses: Visual outcomes and tolerance. A prospective study about 98 eyes

To assess the improvement in visual acuity (VA), tolerance and quality of life of patients after scleral contact lens (SCL) fitting.

We carried out a prospective observational study conducted from April 2016 to August 2017. Patients fitted with SCL were included. For the purpose of this study, we analyzed VA and quality of life score (NEI-VFQ25) after 6 months of use.

We identified 98 eyes of 56 patients; the major indication for SCL fitting was keratoconus in 64.3%; the other indications were post-penetrating keratoplasty, other irregular astigmatism, severe ametropia and ocular surface disease. The mean follow-up was 10.71 months. The mean daily wearing time was 9.89±1.63 hours. Best corrected Visual acuity "BCVA" (baseline 1.11±0.37 in the right eye and 1.13±0.42 LogMar in the left eye) improved to 0.19±0.20 and 0.23±0.38 LogMar respectively in the right and left eyes after SCL wear (P=0.000). The scores on the various subscales of the NEI-VFQ 25 questionnaire were significantly higher 6 months after SCL fitting, with a mean score of 87.28±9.87 with SCL versus 39.94±11.33 without these lenses (P=0.000). In our group, no complications related to the SCL wear occurred, except for the occurrence of "loose conjunctival tissue" at the inferior limbus in one patient.

Our results complement those of several large series published on this subject. The best visual acuities were reported after correction of irregular astigmatism, in particular keratoconus. Therefore, SCL fitting has become an alternative or a precursor to penetrating keratoplasty in patients with advanced keratoconus. In the case of ocular surface disease, in addition to the improvement in VA, the comfort and recovery of the homeostasis of the ocular surface is greater, with fewer wearing complications. Hence, their inclusion in the therapeutic arsenal for severe ocular surface disease alongside the conventional treatment options.

SCL have proven their efficacy and safety in the optical correction of irregular corneas and in the management of ocular surface problems. Additional studies are needed to compare the many lenses currently available and assess optimal fitting strategies for each type of scleral lens for easier fitting procedures and better wearing comfort.