The Scleral Lens Vault: HOA Sclerals for “20/Unhappy” Patients

In the contact lens industry, practitioners often celebrate the “20/Happy” patients but can sometimes be frustrated by “20/Unhappy” irregular cornea patients.

By: JAMIE KUZNIAR, OD

Contact Lens Spectrum May 1, 2025 Vol 40, Issue May 2025 Page(s): 32

Clinical Report: The Scleral Lens Vault: HOA Sclerals for “20/Unhappy” Patients

Overview

This report discusses the benefits of wavefront-guided scleral lenses for patients with irregular corneas who experience visual disturbances despite achieving 20/20 vision. The findings indicate significant improvements in visual acuity and reductions in higher-order aberrations (HOAs) for these patients.

Background

Higher-order aberrations (HOAs) can significantly impact visual quality in patients with irregular corneas, leading to symptoms such as ghosting and halos. Traditional scleral lenses may not fully correct these aberrations, leaving some patients dissatisfied with their vision. The introduction of wavefront-guided scleral lenses offers a promising solution for these patients by providing a more customized optical correction.

Data Highlights

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Key Findings

Wavefront-guided scleral lenses can significantly improve visual acuity in patients with irregular corneas.
A 71-year-old male patient with keratoconus showed a 58% improvement in HOARMS OD and 80% improvement OS after fitting with wavefront-guided lenses.
93.3% of patients with irregular astigmatism preferred their vision with wavefront-guided optics over traditional optics.
Wavefront-guided lenses reduce glare and halos, particularly in low light conditions.
Customization of scleral lenses using wavefront aberrometry can address specific visual symptoms related to HOAs.

Clinical Implications

Practitioners should consider wavefront-guided scleral lenses for patients with irregular corneas who report visual disturbances despite achieving good visual acuity. This approach can lead to improved patient satisfaction and quality of life by addressing residual higher-order aberrations.

Conclusion

Wavefront-guided scleral lenses represent a significant advancement in the management of irregular corneas, offering tailored solutions that enhance visual outcomes for patients who are otherwise dissatisfied with their vision.

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