Comparative Evaluation of Scleral Lens Treatment in Ocular Surface Diseases: A Prospective Study.

Abstract

Purpose: This study evaluated the clinical efficacy and patient-reported outcomes of scleral lens wear across different ocular surface diseases, providing evidence for individualized fitting and management strategies.

Methods: Patients with keratoconus, ocular surface trauma, postkeratoplasty, and dry eye were fitted with scleral lenses using OCT-guided customization. All participants underwent baseline examinations before and after lens wear, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), and Ocular Surface Disease Index (OSDI) assessment. Patient-reported outcomes, including quality of life, comfort, visual clarity, handling, cleanliness, and satisfaction, were collected via a standardized questionnaire.

Results: BCVA improved significantly in all groups after scleral lens wear, with the postkeratoplasty group showing the least improvement. OSDI scores decreased significantly across the groups. CCT increased after lens wear, indicating mild corneal thickening. The postkeratoplasty group exhibited significantly greater tear reservoir thickness at the superior and superonasal locations compared to the keratoconus and dry eye disease groups. Subjective ratings of handling, cleanliness, and satisfaction revealed no significant differences across the four groups. However, the trauma group reported less improvement in quality of life, and the postkeratoplasty group experienced lower comfort levels compared to the keratoconus group. Overall, 51.3% of patients reported experiencing midday fogging.

Conclusions: Scleral lenses offer effective visual rehabilitation and symptom relief across diverse ocular surface diseases, with consistently high levels of patient-reported satisfaction. Future research should focus on individualized fitting strategies, address challenges such as midday fogging, and evaluate long-term safety and efficacy to guide wider clinical applications. Trial Registration: ClinicalTrials.gov identifier: NCT06555367.