Wavefront-Guided Optics Improve Vision, Correct HOAs in Scleral Lens Wearers

A lens with wavefront-guided optics may present a viable alternative to traditional scleral lens wear.

Wavefront-guided optics can correct residual higher order aberrations (HOAs) and improve overall vision quality in patients who experience distorted vision and photic disturbances with conventional scleral lens wear, according to a poster presented at an American Optometric Association 2023 ePosters Virtual Event from June 13-14, 2023 in Washington, DC. However, allowing a 1- to 2-week neuroadaptation period and fine tuning the prescription post correction may enable the best outcomes, according to the report.

The research team, which included Clark Chang, OD, of Wills Eye Hospital and Jenny Wong, OD, of the Contact Lens Institute of Nevada, detailed a case report of a woman (age, 33 years; White) presenting with a history of dry eye and keratoconus in both eyes. The patient previously underwent corneal crosslinking in the right eye and corneal implantation removal due to reduced best-corrected visual acuity (BCVA).

Previous scleral lens fittings without the wavefront-guided optics yielded poorer BCVA compared with corneal gas permeable lenses. However, the patient reported a growing intolerance for the corneal gas permeable lens and reduced BVCA compared with her historical BCVA before corneal implantation. The patient’s BCVA with habitual gas permeable lenses was 20/70 and diagnostic scleral lens refraction improved BCVA to 20/50. The patient reported improved tolerance, but BCVA worsened to 20/100 at follow up. Aberrometry taken over scleral lens revealed significant residual HOAs with root-mean-square (RMS) of 1.06µm in the right eye (6.3mm pupil diameter).

Wavefront-guided scleral lenses are an effective method of correcting residual HOA and improving overall vision quality in patients experiencing distorted vision and photic disturbances with conventional scleral lenses.

The researchers performed aberrometry and found significant residual HOAs in the right eye. The team added a set of orientation dot markings to a scleral lens worn by the patient to help align the wavefront-guided correction profile over the patient’s visual axis. The investigators remeasured the patient, produced a wavefront-corrected scleral lens, and compared the visual performance of the lens with wavefront-guided optics with the original scleral lens.

The patient reported extreme initial blur (visual acuity, 20/200) at the lens dispense visit, but reported subjective visual acuity improvement after 1 week of wear. BCVA was 20/25 at a 2-month follow-up evaluation, which improved to 20/20 with a sphero-cylinder over-refraction (PL -0.25 x145). The patient experienced a 37% improvement in HOA RMS simulated at 6.3 mm pupil diameter in the right eye compared with the scleral lens she initially wore (0.67 vs 1.06 µm) and reported significantly improved vision quality in both normal and low light conditions.

“Wavefront-guided scleral lenses are an effective method of correcting residual HOA and improving overall vision quality in patients experiencing distorted vision and photic disturbances with conventional scleral lenses,” according to the poster presenters. “However, clinicians should be mindful of the importance of neuro-adaptation and the clinical sequencing of finalizing [the lower order aberration] Rx after first incorporating HOA profile.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Chang C, Brown N, Wong J. Case report: effects of neuroadaptation and pupil size in custom wavefront-guided scleral lens correction. Poster presented at: American Optometric Association 2023 ePosters Virtual Event; June 13-14, 2023; Washington, DC.