Profilometry-Guided Scleral Design for Highly Toric Sclera
By
Mark Sturm, OD
October 1, 2025
Clinical Scorecard: Profilometry-Guided Scleral Design for Highly Toric Sclera
At a Glance
Category Detail
Condition Mild keratoconus with high scleral toricity Key Mechanisms Scleral toricity impacting scleral lens fit; profilometry-guided freeform lens design to accommodate high toricity Target Population Patients with keratoconus and significant scleral toricity requiring stable, long-duration lens wear Care Setting Specialty eye care clinics with access to scleral profilometry and custom lens design
Key Highlights
High scleral toricity may not correlate with corneal toricity and can complicate scleral lens fitting. Standard scleral lenses may fail to fit properly in cases of extreme scleral toricity, causing discomfort and lens fogging. Profilometry-guided freeform scleral lenses enable precise customization, improving fit, comfort, and extended wear time. Guideline-Based Recommendations
Diagnosis
Perform scleral profilometry to assess scleral shape and toricity beyond corneal measurements. Use corneal tomography to evaluate anterior corneal toricity and keratoconus severity. Management
Start with diagnostic lenses closest to patient’s scleral shape but be prepared to customize for high toricity. Consider switching to profilometry-guided freeform scleral lenses when standard designs fail to achieve adequate fit. Aim for lens designs that provide stable fit, full-day comfort, and minimize fogging. Monitoring & Follow-up
Assess lens fit, seal, and patient comfort during follow-up visits. Monitor for lens fogging and discomfort, especially during extended wear. Adjust lens parameters based on patient feedback and profilometry data. Risks
Poor lens fit can lead to discomfort, lens seal issues, and reduced wear time. Inadequate customization may cause lens fogging and visual disturbances. Patient & Prescribing Data
64-year-old male with mild keratoconus and high scleral toricity
Profilometry-guided freeform scleral lenses provided near-perfect fit, 20/20 vision, and comfortable 14+ hour wear, outperforming previous GP lenses.
Clinical Best Practices
Utilize scleral profilometry early in the fitting process for patients with suspected high scleral toricity. Be prepared to switch lens designs if standard scleral lenses do not achieve optimal fit. Leverage freeform lens technology to customize lens geometry precisely to the patient’s scleral shape. Aim to minimize chair time and number of visits by selecting the most appropriate lens design initially. References
