Visual Rehabilitation of Bilateral Keratoconus With Customized Scleral Lenses: A Case Report

The clinical management and visual rehabilitation of a 24-year-old female with bilateral keratoconus (OD > OS) successfully fitted with scleral lenses is presented. A comprehensive ophthalmic evaluation was performed, including keratometry, corneal topography using Pentacam imaging, and objective and subjective refraction. Objective refraction revealed +3.00 -5.00 × 105 in OD and +1.50 -3.00 × 080 in OS. The final spectacle prescription was +2.00 -4.50 × 105 in OD, achieving a visual acuity of 6/9- (20/30-), and +0.75 -3.00 × 080 in OS, achieving 6/6- (20/20-). Diagnostic scleral lenses were selected based on sagittal depth, guided by Kmax values. Baseline unaided visual acuity was 6/24 (20/80) in the right eye (OD) and 6/18 (20/60) in the left eye (OS), with near vision of N6 in both eyes (OU), since the patient had no current spectacles. With scleral lenses, best-corrected visual acuity improved to 6/6 (20/20) in both eyes (OU). Topographic analysis revealed advanced ectatic changes in OD (Kmax: 70.80 D; enhanced ectasia score: 17.99 D). The lenses demonstrated appropriate vault, limbal clearance, and uniform scleral alignment, ensuring stable centration, comfort, and protection of the ocular surface. Scleral lenses provided effective visual rehabilitation in advanced keratoconus, restoring 6/6 (20/20) vision bilaterally while preserving corneal health. This case highlights the clinical value of scleral lenses as a reliable approach for managing irregular corneas and progressive ectasia.