Wavefront-guided scleral lenses (WFGSLs) are indicated to effectively reduce residual higher-order aberrations (HOAs) and improve subjective visual quality in patients who have corneal ectasia, particularly keratoconus.¹ Compared with conventional SLs, WFGSLs may also improve visual acuity and contrast sensitivity, in some cases approaching levels seen in eyes without corneal ectasia.¹ Optimal outcomes depend on stable lens positioning and ample time for visual adaptation.¹

A recent study evaluated the impact of HOAs and visual acuity outcomes in patients who have keratoconus fitted with WFGSLs.² Thirteen patients who have keratoconus (22 eyes) were fit with WFGSLs employing a commercially available aberrometer to decrease residual uncorrected HOAs with traditional scleral lenses.

Lenses were evaluated at the most recent examination, after at least 48 weeks of adaptation to WFGSLs. Total higher-order root-mean-square (HORMS), individual Zernike terms across maximal, 5-mm, and 3-mm pupil sizes, best-corrected visual acuity (BCVA), corneal tomography, and patient-reported lens preference were compared with outcomes obtained using the patients’ previous conventional scleral lenses.

For all pupil sizes (P<.05), WFGSLs demonstrated significant reductions of HORMS and individual Zernike terms (Z7, Z8, Z11, Z17, and Z18). When 5 mm pupil data was analyzed, mean HORMS improved 53% (0.59±0.30 μm vs 0.28±0.14 μm, P<.001).

There were 2 Snellen lines of improvement of BCVA (0.18±0.16 vs –0.040±0.090 logMAR, P<.001). All patients favored WFGSLs over the traditional SLs. No adverse events were observed.

This study confirmed thatWFGSLs provide efficient management for residual HOAs as demonstrated by the significant decrease in HORMS and separate Zernike terms (Z7, Z8, Z11, Z17, and Z18) for various pupil sizes. Similarly, WFGSLs BCVA was significantly improved and was preferable compared to conventional SLs by all patients in this cohort.

WFGSL may provide an effective visual rehabilitation option for patients with keratoconus who do not achieve satisfactory vision with conventional scleral lenses. This may potentially reduce the need for surgical intervention.

References

1. Gelles JD, Su B, Kelly D, et al. Visual improvement with wavefront-guided scleral lenses for irregular corneal astigmatism. Eye Contact Lens. 2025 Feb 1;51(2):58-64. doi: 10.1097/ICL.0000000000001152

2. Masoud OH, Chang CY, Meghpara BB, Syed ZA. Outcomes of wavefront-guided scleral lenses in keratoconus patients. Optom Vis Sci. 2026 Aug;103(8):e70092. doi: 10.1002/ovs2.70092

Melissa Barnett, OD, FAAO, FSLS, practices at Baker Optometry. She also is an International Coaching Federation (ICF) associate certified coach. She has received remuneration from ABB, AbbVie, Alcon, Azura, Bausch + Lomb, BCLA, Bruder, Cloudbreak Pharma, Dompé, Epion, OCuSOFT, ScienceBased Health, STAPLE Program, Tarsus, Tenpoint Pharmaceuticals, and Théa Pharma.

 This content is sponsored by Contamac.