Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus

Am J Ophthalmol. 2018 Jan:185:43-47. doi: 10.1016/j.ajo.2017.10.022. Epub 2017 Nov 16.


Purpose: To investigate the success and failure rates of scleral lens correction in severe keratoconus.

Design: Retrospective case series.

Methods: Study population comprised patients with keratoconus who attended the keratoconus clinic at the Antwerp University Hospital, Belgium, between January 1, 2010, and December 31, 2014. The included eyes had maximal keratometry values ≥ 70 diopters, as measured using the sagittal curvature map that was obtained by Scheimpflug tomography. The exclusion criteria included amblyopia, mental retardation, and concomitant ocular disease that limited their visual potential.

Results: Scleral lens fitting was proposed for the 75 eyes included in the study. Eight eyes underwent transplant surgery because of insufficient visual acuity with the lenses, lens intolerance, and issues with handling the lenses. Twelve eyes did not have lenses fitted because of good visual acuity in the other eye or a contraindication for lens wear. Three eyes were successfully fitted with corneal or hybrid lens wear. Scleral lenses were prescribed in 51 of 75 eyes. The mean gain in visual acuity (lens vs spectacle-corrected visual acuity) was 0.54 ± 0.18 (decimal fraction, Snellen eye chart). Seven eyes were lost to follow-up, 4 eyes abandoned wearing the scleral lens because of an inability to handle the lenses, and 40 eyes wore the lenses at their last follow-up visit, with a mean follow-up interval of 30.15 ± 12.83 months.

Conclusions: Forty of the 51 eyes with severe keratoconus that would otherwise have undergone transplant surgery were successfully treated with long-term scleral lens wear. In this way, the indication for keratoplasty was more than halved in our keratoconus population.

MeSH terms

  • Adult
  • Contact Lenses*
  • Corneal Topography*
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoconus / diagnosis
  • Keratoconus / physiopathology
  • Keratoconus / surgery*
  • Keratoplasty, Penetrating / methods*
  • Male
  • Middle Aged
  • Refraction, Ocular / physiology*
  • Retrospective Studies
  • Sclera
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Visual Acuity*