Profilometry-Guided Scleral Lenses Improve Visual Acuity and Reduce Ocular Aberrations in Irregular Corneas: A Retrospective Case Series

Objectives: Scleral lenses (SLs) represent a key treatment for visual rehabilitation in patients with irregular corneas, such as keratoconus (KC), pellucid marginal degeneration (PMD), and postlaser in situ keratomileusis (LASIK) ectasia. This study evaluates the impact of profilometry-guided SLs on visual acuity (VA) and ocular aberrations in these patients. Methods: Medical records of 23 eyes from 23 patients with KC, PMD, and post-LASIK ectasia were reviewed. All patients were fitted with profilometry-guided SLs. High-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA), and aberrometry parameters (Strehl ratio, higher-order root mean square (HO-RMS), coma, spherical aberration, and trefoil) were analyzed before and during SL wear. Results: HCVA improved significantly from 0.62±0.09 logMAR at baseline to 0.03±0.01 logMAR with SL wear (P<0.05). LCVA also showed significant improvements (P<0.05). HO-RMS decreased from 2.70±0.54 D to 1.00±0.20 D (P<0.05), with notable reductions in coma (1.31±0.21 D to 0.49±0.04 D) and trefoil (1.26±0.29 D to 0.34±0.09 D). Conclusions: Profilometry-guided SLs significantly improve VA and reduce higher-order aberrations in patients with irregular corneas, offering an effective nonsurgical solution for enhancing vision quality in these complex cases.