Management of Keratoconus with Scleral Contact Lenses
Scleral contact lenses have always been considered suitable for the correction of irregular astigmatism in keratoconus, as they are able to neutralize irregularities with the tear film meniscus that form with the cornea, while maintaining high levels of comfort. Most of clinical studies on scleral contact lenses in keratoconus report a significant improvement of visual acuity, although this improvement is more limited in advanced keratoconus. The follow-up of all these clinical studies is short in the great majority of cases, being generally of less than 1 year. Therefore, longer-term studies are necessary to know the true behavior of the scleral lens over time and to characterize the possible complications that may appear in the long term. Most of designs of scleral contact lenses that are currently available are rotationally symmetrical, with spherical geometry in the optical zone. The fitting criteria are different depending if the contact lens has a sclero-corneal or fully scleral design. In the case of corneo-scleral lenses, the fitting process is commonly guided by keratometry or topography, with very variable criteria for a good fitting among designs. Concerning fully scleral lenses, the fitting is guided by sagital height.
KeywordsScleral contact lens Keratoconus Corneo-scleral contact lens Fully scleral contact lens Corneal topography Sagital height Optical coherence tomography
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