Rapidly Progressive Keratoconus in a Stable Scleral Lens Fit

A case report showcases successful scleral lens fitting amid rapid keratoconus progression in an older patient, emphasizing the need for continuous assessment.

By
Andrew Kemp, OD
October 1, 2025
3 min

Contact Lens Spectrum

Overview

Expand on the implications of successful scleral lens fitting despite rapid keratoconus progression.

Background

Keratoconus is a progressive corneal disease characterized by corneal ectasia and steepening, which can lead to visual impairment. Understanding the progression of keratoconus is crucial for timely interventions, such as corneal crosslinking. This case highlights the challenges of managing keratoconus in older patients, where rapid progression can occur unexpectedly.

Data Highlights

Eye	Keratometry Values (D)	Best-Corrected Acuity
Right	Not obtainable due to scarring	20/100
Left	47.00/56.75 to 52.25/63.00	20/30

Key Findings

A 35-year-old female patient with a history of keratoconus experienced rapid progression of the disease.
Keratometry values increased significantly in the left eye over 6 months, indicating worsening steepening.
Despite the progression, the sagittal depth of the cornea remained stable during the same period.
The patient reported improved comfort with the new InSight Scleral lenses compared to previous lenses.
Corneal crosslinking was discussed but not pursued due to financial constraints.

Clinical Implications

Regular follow-up is essential for patients with keratoconus, especially in older individuals where progression may be unexpected. Clinicians should consider the stability of scleral lens fits even in the presence of rapid corneal changes, and discuss financial options for interventions like corneal crosslinking.

Conclusion

This case underscores the importance of monitoring keratoconus progression and the potential for successful management with scleral lenses, even in rapidly changing conditions.