Outcomes of wavefront-guided scleral lenses in keratoconus patients

This study investigated the change in higher order aberrations (HOAs) and visual acuity with wavefront-guided scleral lenses (WFGSLs) in the management of patients with keratoconus.

A total of 22 eyes from 13 patients with keratoconus were fit with WFGSLs utilizing a commercially available aberrometer to further reduce residual HOAs uncorrected via traditional scleral lenses (tSLs). The outcomes for total higher order root mean square (HORMS) and individual Zernike terms at various pupil sizes (maximal, 5 mm, 3 mm), best corrected visual acuity (BCVA), tomography, and subjective patient preference at the most recent visit, representing a minimum of 48 weeks of WFGSL adaptation, were compared to the prior traditional SLs.

WFGSLs resulted in significant reductions of HORMS and individual Zernike terms (Z7, Z8, Z11, Z17, and Z18) for all pupil sizes (p < 0.05 for all). When analyzing data from a 5 mm pupil, mean HORMS improved 53% (0.59 ± 0.30 μm vs. 0.28 ± 0.14 μm, p < 0.001). BCVA was significantly improved by 2 Snellen lines (0.18 ± 0.16 vs. -0.040 ± 0.090 logMAR, p < 0.001). All patients subjectively preferred WFGSLs over the traditional SLs. No adverse events were observed.

WFGSLs provide effective management for residual HOAs as evidenced by the significant reductions observed in HORMS and individual Zernike terms (Z7, Z8, Z11, Z17, and Z18) for various pupil sizes. Correspondingly, WFGSLs significantly improve BCVA and are preferred over traditional SLs by all patients in this cohort. Therefore, WFGSL provides a valid alternative vision rehabilitation solution to help diminish the need for surgery in keratoconus patients who do not achieve adequate visual outcomes via traditional SLs.