Contact lens fitting to correct irregular astigmatism after corneal refractive surgery

Purpose: To study a technique of contact lens fitting and its visual results in patients with irregular astigmatism induced by corneal refractive surgery. Setting: Department of Cornea and Refractive Surgery, Instituto Oftalmologico de Alicante, Alicante, Spain. Methods: This prospective noncomparative study comprised 29 eyes with irregular astigmatism after corneal refractive surgery. Different types of contact lenses were used to correct the astigmatism: hard, gas permeable, hybrid, and toric hydrophilic. Preoperative and postoperative data were analyzed for proper fitting including the preoperative keratometeric reading and corneal ablation zone. Results: Proper contact lens fitting was achieved in 23 eyes (79.3%). In 6 eyes (20.7%), fitting was not possible despite an improvement in best corrected visual acuity (BCVA). Of the eyes with proper fitting, 14 (60.9%) had rigid gas-permeable lenses (9.80 mm), 6 (26.1%) had hydrophilic lenses (14.00 mm), and 3 (13.0%) had hybrid lenses (14.3 mm). Comparing the BCVA with that with spectacles, 23 eyes (79.3%) gained 2 lines or more of BCVA, 4 (13.8%) gained 1 line, and 2 (6.9%) maintained the same acuity as with spectacles. No eye lost lines of BCVA. Conclusions: Results indicate that contact lens fitting is a good-and sometimes the only-alternative for patients with induced irregular astigmatism. Rigid gas-permeable contact lenses provided the best visual performance and patient tolerance. (C) 2002 ASCPS and ESCRS.