Profilometry-Guided Freeform Scleral Lenses for High Scleral Toricity
Overview
A 64-year-old male with mild keratoconus and high scleral toricity was successfully fitted with profilometry-guided freeform scleral lenses after standard designs failed. The customized lenses provided 20/20 vision and comfortable wear for over 14 hours, improving upon previous gas-permeable lenses.
Background
Scleral lenses offer a valuable option for vision correction, especially in keratoconus, but fitting can be challenging due to variations in scleral shape. Traditional diagnostic lenses may not accommodate high scleral toricity, leading to poor fit and discomfort. Profilometry allows detailed mapping of the scleral surface, enabling customized lens designs that better match individual anatomy. This case highlights the utility of freeform lens designs guided by profilometry data in managing complex scleral toricity.
Data Highlights
Parameter
Right Eye (OD)
Left Eye (OS)
Refraction
-3.75 -0.50 x 060
-7.50 sph
BCVA
20/25-
20/50-
Scleral Toricity (16.5-mm chord)
718 µm (with-the-rule)
990 µm (with-the-rule)
Corneal Toricity
Mild with-the-rule
Mild against-the-rule
Final Visual Acuity with Freeform Lenses
20/20
20/20
Wear Time
14+ hours without discomfort or fogging
Key Findings
High scleral toricity (718 µm OD, 990 µm OS) was identified via profilometry despite mild corneal toricity.
Standard scleral lens designs failed to achieve proper fit due to inability to accommodate scleral shape.
Initial standard lenses caused poor seal, discomfort, and fogging within 1 hour of wear.
Freeform lenses provided near-perfect fit, 20/20 vision OU, and comfortable wear for over 14 hours.
Using freeform design initially could reduce chair time, visits, and improve patient experience.
Clinical Implications
Profilometry-guided freeform scleral lenses are a valuable option for patients with high scleral toricity where standard lenses fail. Early use of such customizable designs can improve fit, comfort, and visual outcomes while reducing fitting time and patient visits. Eye care providers should consider scleral profilometry in complex cases to guide lens design.
Conclusion
This case demonstrates that freeform scleral lenses designed from detailed profilometry data can successfully manage challenging high scleral toricity, providing excellent vision and extended comfortable wear. Incorporating this technology early in the fitting process may optimize outcomes and patient satisfaction.
References
Sturm M, 2024 -- Profilometry-Guided Scleral Design for Highly Toric Sclera
Lisa Greene, OD, discusses how modern multifocal designs and materials support presbyopic patients throughout their day more seamlessly than ever before.
