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Improving patient outcomes with mini-scleral contact lens fitting in keratoconus – an initial cohort

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First Author: E.Law UK

Co Author(s):    I. Sexton   J. Myerscough                 

Abstract Details

Purpose:

Contact lens fitting in corneal ectasia can be challenging, and complex topography can result in issues with stability and comfort with traditional contact lens modalities. However, new generation mini-scleral contact lenses, vault the cornea entirely and thus offer a stable fitting solution. This study explores visual outcomes and patient satisfaction in an initial cohort of keratoconic and post-keratoplasty patients with a new generation mini-scleral contact lens.

Setting:

Southend University, NHS Hospital

Methods:

60 eyes of 45 subjects were fitted with the Comfort 15 Mini-scleral contact lens. All eyes were keratoconic and 9 eyes had previously undergone DALK or penetrating keratoplasty. Unaided and best spectacle corrected distance visual acuity (BSCDVA) were assessed prior to fitting. Kmax, Keratometric astigmatism, axis and coma were measured using the Oculus Pentacam HR. Following fitting best corrected VA was recorded. Patients were asked to score their satisfaction with both vision and comfort at follow up visits

Results:

Unaided vision (Mean ± SD) was 0.90 ± 0.37 LogMAR and Best spectacle corrected VA was 0.32 ± 0.24 LogMAR. Kmax (Mean ± SD) was 60.93 ± 8.11 with range 47.8D to 76.4D. Following mini-scleral fitting, VA improved to 0.14 ± 0.10, with average improvement of 2.5 lines. Larger improvements up to 0.7 LogMAR (7 lines) were seen in patients with lower spectacle corrected VA. Patient satisfaction was high both in comfort and visual acuity. Only 4 patients discontinued wear after initial 3 month period (3 had excellent unaided vision in fellow eye, and 1 patient was unable to insert the lenses unassisted).

Conclusions:

Excellent patient satisfaction and visual outcomes in both keratoconus and post-keratoplasty patients were reported. Patient comfort and satisfaction scores were high, and there was no increase in clinic time required for fitting compared to traditional RGP fitting. No patients discontinued wear due to comfort. Mini-scleral contact lenses should be routinely considered when fitting patients with corneal ectasia.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation