Clinical Scorecard: Which Lens Wins in Keratoconus?

At a Glance

Key Highlights

• Both lens types significantly improved best-corrected visual acuity (BCVA).
• RGP lenses showed lower surface regularity index and irregular astigmatism index.
• Topographic indices like CSI and IAI are valuable for lens fitting decisions.
• SLs are beneficial for eyes with apical scarring or highly decentered cones.
• Study suggests incorporating topographic indices into fitting algorithms.

Guideline-Based Recommendations

Diagnosis

• Use topographic indices for diagnosing keratoconus and predicting visual improvement.

Management

• Consider RGP lenses for patients with lower CSI values and SLs for those with apical scarring.

Monitoring & Follow-up

• Regularly assess visual acuity and keratometric values post-lens fitting.

Risks

• Potential selection bias and overrepresentation of advanced keratoconus in study.

Patient & Prescribing Data

36 eyes from 28 patients with moderate to severe keratoconus.

SLs are particularly advantageous for patients with apical scarring.

Clinical Best Practices

• Incorporate topographic indices into contact lens fitting algorithms.
• Utilize fluorescein staining for SL fitting to ensure proper lens fit.

References

• Comparison of visual acuity outcomes and topographic differences: rigid gas-permeable lens versus mini-scleral lenses for moderate-to-severe keratoconus.
• RGP fitting philosophies for keratoconus.