Scleral lenses for correction of irregular astigmatism: advances and limitations

Purpose of review In this review, we will address advances and limitations in the field of scleral lenses pertaining to the correction of irregular astigmatism. Recent findings There are reports on the benefits of scleral lenses for eyes with irregular astigmatism, particularly regarding improvement of visual acuity and the reduction of higher-order aberrations. Innovations such as wavefront-optimized and wavefront-guided optics can improve vision in keratoconus. Customized haptics, topographic and profilometric-based fitting, and impression-based design can achieve fit in problematic eyes with ectasia, after penetrating keratoplasty, and with corneal scarring. Challenges persist, including resource requirements for practitioners, patient difficulty with insertion and removal, and limitations to lens wear, including midday fogging and corneal edema. Risks such as graft failure persist. Summary Scleral lenses have emerged as a useful tool in the management of irregular astigmatism, reducing the need for penetrating keratoplasty. By vaulting the cornea and resting on the sclera, scleral lenses neutralize corneal astigmatism, while providing a stable and comfortable surface for advanced optics. Over the past two decades, the use of scleral lenses has increased, reflecting advances in fitting systems, expanded access, greater adoption by clinicians, broader patient eligibility, and improved clinical outcomes.