Scleral lenses reduce need for surgical intervention in severe keratoconus

This retrospective case series suggests that scleral contact lens correction may significantly reduce the rate of transplant surgery in patients with severe keratoconus.

Study design

This retrospective, single-site case series included keratoconus patients with a maximal keratotomy of 70 D or greater. The Microlens rigid scleral lens was fitted by a trained optometrist and ophthalmologist team.

Outcomes

The authors identified 75 eyes for inclusion. Nine had unsuccessful fittings, while 15 eyes did not undergo fitting either because they opted for corneal or hybrid lens wear (3 eyes) or underwent corneal transplantation (12 eyes).

Of the 51 eyes that were successfully fitted for scleral lenses, 7 were lost to follow-up, and 4 could not tolerate the lenses. At a mean of 30 months, all 40 remaining eyes showed better vision with the lenses than with spectacles: The mean BCVA with the scleral lenses was 0.66 decimal fraction, whereas the BCVA with spectacles was 0.13.

Limitations

The retrospective nature of the study introduces challenges in interpreting the results. Without comparing directly to corneal transplantation, conclusions regarding superiority cannot be made. The authors did not highlight the complications associated with scleral contact lens wear.

Clinical significance

The authors demonstrate the successful use of scleral contact lenses in an advanced keratoconus population. They make a valid argument that a scleral contact lens trial may help to validate these findings. Even in seemingly advanced disease, a scleral contact lens can still achieve success and avoid potential complications associated with surgical interventions such as graft-related risks.