BACKGROUND:

Zenlens, a custom scleral lens (SL), utilizes integrated design flexibility and customization options to achieve a precise fit in patients with a variety of corneal conditions. Customization options include Bi-Elevation and MicroVault technology: Bi-Elevation involves creating two sagittal depth values inside the vaulting chamber to enable accurate and uniform landing on an asymmetrical sclera, and MicroVault technology allows the lens to precisely vault over a peripheral obstruction.

Case Summary

We report the case of a 35-year-old white female with keratoconus in both eyes, with no other ocular comorbidities, who had undergone corneal crosslinking 2 months before SL fitting. At baseline, best-spectacle-corrected visual acuity was 20/50 (OD) and 20/70 (OS); keratometry readings were 50.8×58.6 (OD) and 44.5×52.9 (OS); refractive error was +0.50–6.00 × 084 (OD) and –1.00–4.00 × 089 (OS). Optimal fit was achieved within three revisions. Final lens parameters were 16-mm diameter prolate lenses; horizontal visible iris diameter 11.8 mm (OD) and 11.9 mm (OS); base curve 6.81 mm (OD) and 7.6 mm (OS); lens power –7.00–1.50 × 120 (OD) and –2.25–1.00 × 150 (OS). Toric peripheral curves were added to both final lenses (Steep 6/Steep 4 [OD] and Steep 4/Steep 7 [OS]). Bi-Elevation was added to the lenses for both eyes and optimized within 2–3 revisions, to eliminate residual lens movement and improve lens position/centering. Final sagittal depths were 4650/4800 µm (OD) and 4400/4600 µm (OS). After finalizing lens movement and position, to accommodate a pinguecula, a single MicroVault was fitted (OD) in the final revision: decentration 8 mm; axis 325; diameter 2.5 mm and depth 250 µm. Adequate lens clearance and centration were demonstrated, with no lens impingement, minimal conjunctival impression rings, and no edge lift. At Week 4, best-corrected visual acuity was 20/20, with a comfortable wearing time of 16 hours. No ocular symptoms were reported. The patient was advised to return for a routine follow-up in 6 months to assess corneal stability.

CONCLUSION:

This case report provides real-world evidence of Zenlens outcomes for a patient with keratoconus. This custom SL improved vision with full day comfortable wearing time and no ocular symptoms.