Influence of scleral lenses on visual acuity and aberrations in patients with irregular cornea

Purpose: To analyze changes of functional parame¬ters and aberrations before fitting and after using rigid gas-permeable scleral lenses (RGPSCL) in patients with irregular cornea.Material and methods. 21 patients (29 eyes) with irregular astigmatism of various etiology were enrolled in this study. The patients could not achieve good visual aсuity in glasses, standard soft or rigid corneal contact lenses. Complex ophthalmologic examination was per¬formed: autorefractometry, visometry, biomicroscopy, computer corneal topography, aberrometry on “OPD-Scan II” (“Nidek”, Japan) before fitting scleral lenses and during the period of their wearing. Results and discussion. The results demonstrat¬ed significant visual acuity improvement after RGP¬SCL fitting in all observed patients. UCVA amounted to 0.1±0.18, BCVA in glasses amounted to 0.4±0.26, BCVA in RGPSCL amounted to 0.7±0.1. An increase of best-corrected visual acuity in RGPSCL was statistically significant in patients after keratoplasty, after intra-stromal corneal ring segments (ICRS) implantation, af¬ter refractive laser surgery (RLS) and in cases of mixed astigmatism. We have found that the correction of ker¬atoconus with the use of RGPSCL resulted in a decrease of the root mean square value (RMS), measured in the 3 mm and 5 mm zones by 2.5 times and 4 times, re¬spectively. In patients wearing RGPSCL after kerato¬plasty, statistically significant decrease in RMS was observed in the 3 mm zone (by 3.85 times) and in the 5 mm zone (by 2.99 times). In patients wearing RGPSCL after implantation of intrastromal corneal ring segment (ICRS), RMS in the 3 mm zone decreased by 1.5 times. In patients wearing RGPSCL after refractive laser surgery (RLS) RMS was 2.5 times lower in the 3 mm zone and 2.8 times lower in the 5 mm zone. In case of mixed astigmatism correction with RGPSCL, RMS increased by 1.6 times in the 3 mm zone and practically did not change in the 5 mm zone.Conclusion. The results obtained demonstrated significant visual acuity improvement in all observed patients. The sub-lens-space filled with tear forms a unified “cornea-tear-scleral contact lens” optic system that corrects unevenness of cornea, decreases amount of high-order aberrations (HOA) and provides a clear stable vision.