Benefits of Scleral Lens in the Management of Irregular Corneas and Dry Eye Syndrome After Refractive Surgery

Objectives: To evaluate the utility of the SPOT scleral lens (Oxygen Permeable Scleral Lens of Thonon; LAO, Thonon-les-Bains, France) in the management of the irregular cornea after refractive surgery. Method: We included 19 patients (35 eyes) with irregular corneas after refractive surgery. Patients were fitted with scleral lenses after the failure of conventional contact lenses adaptation. The ophthalmologic examination included measurement of best-corrected visual acuity (BCVA), slitlamp examination, and evaluation of ocular aberrations (Objective Scattering Index [OSI] and higher-order aberration [HOA]). Result: Scleral lens fitting increases significantly the BCVA from 0.33 (±0.25) to 0.08 (±0.13) LogMAR ( P <0.001). There was also a significant decrease in Ocular Surface Disease Index from 66.2±22.8 to 42.4±18.9 ( P <0.001). Ocular aberrations (OAs) are also significantly reduced by the scleral lenses, the mean OSI goes from 7.2 (±4.2) to 3.0 (±1.8) ( P <0.001), OA from 2.58 (±1.34) to 1.98 μm (±2.31) ( P =0.035), and HOA from 0.94 (±0.51) to 0.48 (±0.23) ( P =0.0018). Conclusion: Fitting with scleral lenses improves patients' optical and ocular surface problems. Scleral lens restores BCVA and the quality of life. Fitting with scleral lenses is an alternative to further surgery on these fragile eyes and is sometimes the only viable treatment option for the patient.