Keratoconus Patient Satisfaction and Care Burden with Corneal Gas-permeable and Scleral Lenses

SIGNIFICANCE: Scleral lenses (SLs) are increasingly being considered as the initial correction for patients with keratoconus. In this study, keratoconus patients report higher levels of comfort and visual satisfaction with SL compared with corneal gas-permeable lenses (GPs). PURPOSE: This study aimed to compare patient satisfaction and care burden associated with GP and SL for the management of keratoconus. METHODS: An electronic survey was distributed by the National Keratoconus Foundation from October 2016 to March 2017. Age at diagnosis, initial and current treatment, lens complications, access to care, lens handling time, and annual out-of-pocket treatment costs were collected. Vision, lens comfort, and ease of use satisfaction were rated from 1 to 5. RESULTS: A total of 422 responses were received, including 75 bilateral GP and 76 bilateral SL wearers. Scleral lens wearers had greater satisfaction with vision (3.2 +/- 1.1 [SL] vs. 2.6 +/- 1.1 [GP]; P < .001) and comfort (3.3 +/- 1.0 [SL] vs. 2.2 +/- 1.2 [GP]; P < .001) but similar ease of use satisfaction in both groups (2.8 +/- 1.1 [SL] vs. 2.7 +/- 1.1 [GP]; P <.90). Both groups reported issues with cloudy or foggy vision (GP, 63%; SL, 58%) and contact lens discomfort (GP, 77%; SL, 67%). Although GP wearers reported more issues with lens movement or loss (40 [GP] vs. 18% [SL]), they had fewer difficulties with halos (53 vs. 72% [SL]) and lens handling (40%) compared with SL wearers (63%). Gas-permeable lens (48%) and SL (45%) wearers spend 6 to 10minutes daily handling their lenses. Sixty percent of GP wearers reported annual out-of-pocket cost expenses less than U.S.$1000, whereas only 41% of SL wearers reported the same. CONCLUSIONS: Scleral lens wearers with keratoconus report greater satisfaction with vision and comfort than do GP wearers, although both groups reported cloudy vision and lens discomfort.