Which Lens Wins in Keratoconus?  - Summary - MDSpire

Which Lens Wins in Keratoconus? 

  • By

  • Melissa Barnett, OD, FAAO, FSLS

  • January 1, 2026

  • 5 min

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Objective:

To compare visual outcomes between mini-scleral lenses and small-diameter rigid GP lenses in individuals with moderate-to-severe keratoconus, and to evaluate the clinical utility of corneal topographic indices in guiding lens selection.

Key Findings:
  • Both lens types significantly improved BCVA after fitting, with RGP lenses showing lower surface regularity index and irregular astigmatism index but higher center-surround index compared to SLs.
  • Lower center-surround index values were associated with greater visual improvement, indicating a potential predictor for lens selection.
Interpretation:

Cone location may be more influential than corneal steepness in predicting success with RGP lenses, highlighting the importance of topographic indices in lens fitting.

Limitations:
  • Retrospective design may limit findings.
  • Small sample size in SL group (n=6) reduces statistical power.
  • Potential selection bias due to all SL eyes having apical scarring, which may affect the generalizability of the results.
Conclusion:

Both mini SLs and small-diameter RGPs significantly improve BCVA in moderate to severe keratoconus, with topographic indices aiding in lens selection and predicting visual outcomes.

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