Clinical Scorecard: Scleral Lenses, Keratoconus, & Corneal Change

At a Glance

Key Highlights

• Scleral lenses cause mild corneal edema (~2%) in healthy eyes.
• Significant corneal thickness changes observed in keratoconus patients with ICRS.
• Visual acuity remained stable despite corneal morphological changes, but measurable reductions occur with corneal thickness increases of ~4-6%.
• Individualized fitting and monitoring are crucial for patient satisfaction.
• Corneal topography should be performed before and after lens wear.

Guideline-Based Recommendations

Diagnosis

• Perform corneal topography to assess keratoconus severity.

Management

• Use scleral lenses for vision correction in keratoconus patients, ensuring individualized fitting based on corneal topography.

Monitoring & Follow-up

• Regularly monitor corneal thickness and curvature changes, with follow-ups every 6-12 months.

Risks

• Potential for epithelial and stromal edema in patients with reduced endothelial cell density.

Patient & Prescribing Data

Scleral lenses are a safe long-term option for vision correction in keratoconus, but patients should be informed of potential risks.

Clinical Best Practices

• Encourage patients to report any transient visual changes after lens removal.
• Ensure lenses are fitted based on individual corneal topography.
• Educate patients about potential transient visual changes following lens removal.

References

• Serramito et al. (2026)
• Vincent et al. (2019)
• Hess & Garner (1977)