Higher order aberrations and visual outcomes of scleral lenses for ocular surface disease

To evaluate the impact of scleral lenses on higher-order aberrations (HOAs), visual function, and symptomatology in eyes with ocular surface disease (OSD).

Nineteen eyes with OSD were fitted with scleral lenses. Corrected distance visual acuity (CDVA), contrast sensitivity (CS), and HOAs were measured at baseline prior to scleral lens (SL) wear, immediately after application (Day 1), and after one month of lens wear. An i-Trace aberrometer was used to measure HOAs over a 4.5 mm pupil diameter and subjective symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire.

Significant improvements in CDVA and CS (both p < 0.001) were observed following scleral lens application on Day 1, and CDVA continued to improve up to 1 month with an additional gain of 0.1 logMAR (p = 0.03). Significant reductions in HOAs were observed between baseline and the Day 1 SL measurement for: RMS HOA 1.56 to 0.20 µm (p < 0.001), coma 0.71 to 0.12 µm (p < 0.001), secondary astigmatism 0.17 to 0.06 µm (p < 0.05), and trefoil 0.50 to 0.11 µm (p < 0.001). Spherical aberration showed a modest but statistically significant reduction from baseline 0.16 µm to 0.03 µm by 1 month (p = 0.03). No significant differences were observed between the initial and 1-month SL visits for any aberration parameter (p > 0.05). OSDI scores improved significantly from 47 ± 19 to 17 ± 9 (p < 0.001), indicating notable symptom relief.

Scleral lenses significantly improved visual function and reduced HOAs in eyes with OSD, while also offering sustained symptomatic relief. These findings support the dual optical and therapeutic role of scleral lenses in the management of OSD.