PURPOSE: Higher order aberrations (HOAs) are a vision-limiting optical complication of keratoconus. Even with gas-permeable lenses, HOAs still manifest due to posterior corneal shape factors that accompany keratoconus. This analysis aimed to determine the effectiveness of HOA-correcting scleral lenses, specifically for the most problematic aberrations in patients with keratoconus: vertical coma, horizontal coma, and spherical aberrations.

METHODS: 15 eyes of 9 patients who were successfully fitted using a custom wavefront-guided scleral lens system (wfgSL; Zenlens Chroma) through July 2025 were retrospectively evaluated. HOAs were measured through a well-fitting, lower-order correcting, traditional scleral lens (tSL; Zenlens), and through the subsequent HOA-corrected lens (wfgSL) with the same fit parameters. Age, pupil size, and absolute root-mean square (RMS) values for vertical coma, horizontal coma, and spherical aberrations were documented for each patient/eye. This sub-analysis forms part of a wider study that received central institutional review board exemption.

RESULTS: This sub-analysis included 15 eyes (mean patient age: 57 years) with a mean pupil size of 6.21 mm. The mean HOA RMS values for the tSL were vertical coma 0.700 (n=15 eyes), horizontal coma 0.355 (n=15 eyes), and spherical aberrations 0.384 (n=15 eyes). The mean HOA RMS values for the wfgSL were vertical coma 0.176, horizontal coma 0.076, and spherical aberrations 0.093. The mean percentage RMS improvement for each type of aberration assessed was vertical coma 74.9%, horizontal coma 78.6%, and spherical aberrations 75.8%.

CONCLUSIONS: This wfgSL was effective at reducing HOAs in patients with keratoconus. Mean percentage RMS improvement in three major HOAs (vertical coma, horizontal coma, and spherical aberrations) exceeded 74%. Practitioners should recognize the potential of this lens in improving the vision of their patients with keratoconus.