BACKGROUND:

Scleral lenses (SLs) can benefit patients with a range of ocular conditions, including high or irregular astigmatism. Customization of toric peripheral curves can enable accurate landing on an asymmetrical sclera and aid in troubleshooting poor comfort, edge compression, or edge impingement.

Case Summary

We present three case studies demonstrating the use of a custom SL (Zenlens) with modifiable toric peripheral curves, among other customizable parameters, in patients with high or irregular astigmatism and comorbid corneal conditions. Case 1: patient with Salzmann nodular degeneration and irregular astigmatism (OS); best-spectacle-corrected visual acuity (BSCVA), 20/80; keratometry, 42.5D@135 / 46.5D@025; baseline refractive error, +2.00−5.00×084. Best-corrected visual acuity (BCVA) improved to 20/20 with an SL customized using toric peripheral curves (Steep 1 / Steep 5) to accommodate scleral irregularities. Case 2: patient with irregular astigmatism and peripheral corneal and scleral scarring from a ruptured globe repair (OS); BSCVA, 20/40; keratometry, Flat 42.8D / Steep 44.5D; baseline refractive error, −3.50+2.00×180. BCVA improved to 20/20 with an SL customized with peripheral elevation to accommodate the scar and toric peripheral curves (Flat 2 / Steep 1) to accommodate scleral irregularities. Case 3: existing SL user with high astigmatism and suspected keratoconus (OU); BCVA 20/20 (OD and OS); keratometry, 42.0D@014 / 45.5D@104 (OD) and 42.25D@158 / 47.0D@068 (OS); baseline refractive error, −2.50−3.25×014 (OD) and −3.25−3.50×158 (OS). The SL was customized with toric peripheral curves (Standard / Steep 1 [OS] and Flat 3 / Steep 5 [OD]) to accommodate scleral irregularities, two distinct sagittal depth values to accommodate limbal asymmetry, and a peripheral elevation. In all cases, final fit was achieved with 2–3 revisions, resulting in a BCVA of 20/20, good lens clearance, centration, and rotational stability, with no conjunctival impression rings or edge lift. A comfortable wearing time of 8–14 hours and high levels of satisfaction were reported.

CONCLUSION:

This case series demonstrates the utility of toric peripheral curve customization options with Zenlens as a viable vision correction option in patients with irregular astigmatism and a variety of corneal complexities and ocular comorbidities.