This article was originally published in a sponsored newsletter.

Numerous publications have reported the benefits of scleral lenses, even in advanced keratoconus (KC).^1-5 As the severity of KC progresses, spectacles do not provide adequate visual acuity, and specialty contact lenses, including scleral lenses, are required for vision restoration. Even for patients who would otherwise necessitate a penetrating keratoplasty, scleral lenses can often be successful and may defer or even avoid surgical intervention.¹
 
A retrospective study evaluated the success and failure rates of the use of scleral lens correction in severe keratoconus.¹ Patients who have keratoconus were prescribed scleral lenses in 51 of 75 eyes with maximal keratometry values ≥ 70D (determined by Scheimpflug tomography sagittal curvature map) examined between Jan. 1, 2010 and Dec. 31, 2014 were included in the study. In patients who had severe keratoconus, 40 of 51 eyes were successfully managed with long-term scleral lens wear and did not need to undergo corneal transplantation. In this study, the indication for keratoplasty was more than halved in the keratoconus population.
 
Another study assessed the association of scleral lenses on the risk for keratoplasty for people who had keratoconus.²Electronic health records were examined between Aug. 1, 2012, and Dec. 31, 2018. The study was comprised of patients who had keratoconus or corneal ectasia without a history of corneal transplantation. Out of 2,806 eyes, 36.2% wore contact lenses (7.2% soft, 33.9% GP, and 22.7% scleral). In this study of all eyes, 3.2% underwent keratoplasty. Thus, contact lens wear significantly reduced the risk of corneal transplantation. Keratoplasty was not associated with sex, insurance, or maximum keratometry measurements.

A case series of patients who had advanced late-stage keratoconus was reported with K_max values ranging between 102 diopters and 163 diopters and with the thinner corneal thickness ranging from 122 microns to 273 microns, measured by anterior segment optical coherence tomography (AS-OCT).³ All patients were successfully fitted with scleral lenses.
 
Since corneal transplantation may have numerous complications such as graft rejection and massive irregular astigmatism, it should be performed only if necessary.^4,5 The authors suggest fitting scleral lenses prior to proceeding to any type of keratoplasty and to communicate with the surgeon about the level of best-corrected vision that can be achieved without surgery. Avoiding surgery offers numerous additional quality-of-life and financial benefits for patients who have keratoconus.

REFERENCES

1. Koppen C, Kreps EO, Anthonissen L, Van Hoey M, Dhubhghaill SN, Vermeulen S. Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus.Am J Ophthalmol. 2018 Jan;185:43-47.

2. Ling, J, Shahzad M, Stein J, Rahman M, Poliskey J, Woodward MA. Impact of Scleral Contact Lens Use on the Rate of Corneal Transplantation for Keratoconus.Cornea. 2021 Jan:40:39-42.

3. Kollros L, Lu N, Hillen M, Torres-Netto EA, Hafezi F. Scleral contact lenses fitted to extremely steep corneas.J Fr Ophtalmol. 2023 Feb;46:e70-e74.

4. Rahman I, Carley F, Hillarby C, Brahma A, Tullo AB. Penetrating keratoplasty: indications, outcomes, and complications.Eye. 2009 Jun;23:1288-1294.

5. Khattak A, Nakhli FR, Al-Arfaj KM, Cheema AA. Comparison of outcomes and complications of deep anterior lamellar keratoplasty and penetrating keratoplasty performed in a large group of patients with keratoconus.Int Ophthalmol. 2018 Jun;38:985-992.

Melissa Barnett, OD, FAAO, FSLS, is the Director of Optometry at the University of California, Davis in Davis, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, Johnson & Johnson Vision, Ocusoft, ScienceBased Health, Shire, Tarsus, and Visus Therapeutics.