Wavefront-Guided Scleral Lens Correction in Keratoconus

Purpose To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics, and to provide a detailed discussion of the process used to design, manufacture, and evaluate wfgSCLs. Methods Fourteen eyes of seven subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. Results The wfgSCL provided statistically lower levels of both lower-order root mean square (RMS) (p < 0.001) and higher-order RMS (HORMS) (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p << 0.001). However, the wfgSCL does not provide less HORMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual HORMS wavefront error less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS, and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high-contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to keratoconic eyes. Conclusions Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease and can provide visual image quality equivalent to that seen in normal eyes. Longer-duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.