Visual Improvement With Wavefront-Guided Scleral Lenses for Irregular Corneal Astigmatism

Area of Science:

• Ophthalmology
• Optometry
• Corneal Science

Background:

• Irregular corneal astigmatism (ICA) presents challenges for vision correction.
• Traditional scleral lenses (tSLs) offer some correction but may not fully address higher-order aberrations.
• Wavefront-guided scleral lenses (wfgSLs) aim to provide more precise correction by incorporating individual aberration data.

Purpose of the Study:

• To compare the efficacy of wavefront-guided scleral lenses (wfgSLs) versus traditional scleral lenses (tSLs) in patients with irregular corneal astigmatism (ICA).
• To evaluate improvements in visual acuity (VA) and higher-order root mean squared (HORMS) aberrations.
• To assess patient subjective preference between the two lens types.

Main Methods:

• A single-center, randomized, double-blind, crossover clinical trial was conducted.
• Participants with ICA (including keratoconus, post-refractive ectasia, post-keratoplasty) were fitted with both tSLs and wfgSLs.
• Measurements included VA and HORMS under scotopic conditions; patient preference was recorded post-crossover.

Main Results:

• wfgSLs reduced average HORMS by 56% compared to tSLs (0.29±0.18 µm vs 0.68±0.31 µm, P <0.001).
• wfgSLs improved average VA by 0.12±0.11 logMAR (P <0.01), with 71% of eyes showing at least one line improvement.
• Seventeen out of 18 patients (94%) preferred wfgSLs over tSLs.

Conclusions:

• wfgSLs are effective in reducing HORMS and improving VA in patients with ICA.
• Patient subjective preference strongly favors wfgSLs over tSLs.
• These findings support the clinical feasibility and generalizability of wfgSLs.