A 27-year-old female presented for a contact lens evaluation. She had a known history of keratoconus managed with scleral lenses. She reported decreased vision and reduced comfort with her current lenses, which were 3 years old. Her last comprehensive eye examination had also been approximately 3 years prior at another clinic.

Exam Findings

Best-corrected vision with her habitual scleral lenses was 20/60 OD and 20/50 OS. Slit lamp evaluation revealed minimal to no central fluorescein pooling. Anterior segment optical coherence tomography (AS-OCT) confirmed inadequate central clearance with significant apical bearing over areas of corneal scarring. The scleral lenses were no longer providing appropriate vault over the cornea. New lenses with increased sagittal depth were ordered, resulting in improved vision and comfort.

Discussion

Patients who have keratoconus require ongoing monitoring to assess both corneal stability and the scleral lens fitting relationship. Changes in corneal shape over time can alter lens clearance and lead to mechanical stress, discomfort, reduced vision, and potential scarring. Follow-up intervals vary by disease severity and progression but typically range from every 6 to 12 months in patients who have progressive corneal ectasia.

Conclusion

Regular follow-up is essential to determine when interventions such as corneal cross-linking may be indicated and to reduce the risk of long-term complications, including corneal transplantation. In this case, it remains unclear whether the observed corneal scarring was due to keratoconus progression or chronic apical bearing from an inadequately fitting scleral lens.