Influence of Scleral Contact Lenses on Optical Coherence Tomography Parameters in Keratoconus Patients

Background: This study aimed to evaluate the influence of scleral contact lens (SCL) wear on optical coherence tomography (OCT) scan quality and structural measurements in patients with keratoconus. Methods: This retrospective observational study included 28 eyes of 28 keratoconus patients. All participants underwent a comprehensive ophthalmologic evaluation, including corneal topography and spectral-domain OCT (Optopol REVO 60). Two OCT measurement sessions were performed on the same day: one without SCLs and one after a 30-75 min adaptation period with Mini Misa^® scleral lenses. Recorded parameters included corneal and epithelial thicknesses, ganglion cell-inner plexiform layer (GCIPL) thickness, retinal nerve fiber layer (RNFL) thickness, and device-reported quality index (QI). Correlation analyses between topographic values, age, and OCT parameters were also conducted. Results: The mean age of participants was 32.96 ± 13.72 years. SCL wear significantly decreased anterior segment QI (6.76 ± 1.73 vs. 5.57 ± 2.34, p = 0.019) but improved posterior segment QI in both the ganglion (2.52 ± 1.03 vs. 5.76 ± 2.17, p < 0.001) and disc (2.82 ± 0.94 vs. 4.39 ± 1.87, p < 0.001) modules. Central corneal thickness remained stable, while central epithelial thickness decreased slightly (50.53 ± 6.66 µm vs. 47.59 ± 7.20 µm, p = 0.007). RNFL and GCIPL thicknesses showed no significant changes, except for minor sectoral variations. Steeper keratometry values correlated with lower QI in both conditions. Conclusions: SCLs enhanced posterior OCT scan quality while reducing anterior segment image clarity. These findings suggest that SCLs not only provide visual rehabilitation but also facilitate more reliable posterior segment imaging in keratoconus patients, despite mild interference with anterior segment OCT metrics. Further prospective studies are warranted to validate these results.