Optimization of contact lens fitting in keratectasia patients after laser in situ keratomileusis

Purpose: To evaluate the clinical outcomes of contact lens fitting in eyes with keratectasia after laser in situ keratomileusis (LASIK) to optimize the performance of the contact lenses. Setting: Contact Lens Clinic, Seoul National University Hospital, Seoul, Korea. Methods: Six eyes of 4 patients with keratectasia were examined. Keratectasia was diagnosed based on abnormal topographic findings, progressive myopic changes, and uncorrected visual acuity with glasses. A multicurve lens or reverse-geometry lens (RGL) was selected based on the anterior elevation map. The base curve radius and peripheral parameters were determined based on the axial map and the evaluation of the fluorescein pattern of the lens. The contact lens fitting characteristics and visual acuity were evaluated. Patients were interviewed about their level of comfort, daily contact lens wear time, and glare. Results: Multicurve lenses and RGLs were fitted in 4 eyes and 2 eyes, respectively. The base curve radius of the multicurve lenses ranged from 7.2 to 7.5 mm; the alignment curve radius of RGLs was 7.6 mm in both cases. The radii of peripheral curves were customized to enhance tear interchange. Visual acuity improved to 20/30 or better in all eyes. All patients were completely satisfied with the comfort of the fitting. The mean daily wearing time was 12.7 hours. One patient reported tolerable glare in the eye after being fitted with an RGL. Conclusion: Proper contact lens fitting based on topographic data and slitlamp evaluation allowed good visual rehabilitation and comfortable extended daily wear in patients with keratectasia after LASIK.