Premium scleral lenses: Significant HOA improvement in complex radial keratotomy case

(Image credit: Adobe Stock / ©Yakobchuk Olena)

Scleral lenses are not new and not the first choice for most contact lens wearers, but they occupy an important space in the refraction correction toolbox for patients who might not be able to tolerate or benefit from conventional lenses, according to Nathan Schramm, OD, FSLS, and Xifeng Xiao, PhD. The authors described a patient who achieved significant visual improvement using premium wavefront-guided scleral lenses.

Schramm is in private practice in Costa Mesa, California, and Xiao is an employee of Wavefront Dynamics, Inc.

Scleral lenses have been found to be useful to correct the vision of patients with corneal diseases such as keratoconus, keratitis, severe dry eye, severe refractive errors, and corneal damage. They also, because of their size, help keep medications in place on the ocular surface.

Schramm and Xiao have identified another potential use for this technology, ie, correction of complex radial keratotomy cases.

They described the case of a 72-year-old woman who had undergone radial keratotomy that involved 16 and 8 incisions in the right and left eyes, respectively. She had posterior chamber intraocular lenses in both eyes with open capsules and macular mottling in the right eye. Use of sphero-cylindrical and standard wavefront guided scleral lenses had been attempted but the vision never reached 20/20.

Instead, Schramm and Xiao opted to use ≥10th Zernike wavefront-guided scleral lenses that can correct eyes with significant higher order aberrations (HOAs) caused by radial keratotomy that induced scarring and corneal shape irregularities.

Premium performance

In contrast to the standard wavefront-guided lenses, Schramm and Xiao showed that while the sphero-cylindrical lens and the standard WFG lens corrected, respectively, the lower order aberrations and to the 6^th Zernike order in the patient’s right eye, the premium wavefront-guided lens corrected the HOAs to the 12^th Zernike order. Improved vision also was achieved in the left eye in which the sphero-cylindrical lens and the standard wavefront-guided lens, respectively, again corrected the lower order aberrations and to the 6^th Zernike order, while the Premium WRG lens corrected the HOAs to the 10^th Zernike order. The crispness of the simulated Es in both cases improved and especially so in the right eye with the Premium wavefront-guided lens.

The investigators commented, “With the assistance of high-resolution dynamic wavefront aberrometer, accurate aberration measurements can be made, allowing for the design of than ≥ 10th order Zernike-corrected HOA lenses to enhance vision in eyes that underwent radial keratotomy. Both the subjective and objective assessments demonstrated significant vision improvement, highlighting the potential of this approach for complex radial keratotomy cases.”