Problem solving in complicated corneal conditions: scleral lenses and their fitting with new modern measurement methods

Purpose:
The case report describes the follow up fitting with scleral contact lenses for visual rehabilitation in advanced keratoconus and the influence of the scleral fitting characteristics on the daily wearing time as well as the wearing comfort of the contact lenses. 

Material and Methods: 
Scleral contact lenses were fitted using Scheimpflug images and analysis of optical coherence tomography cross-sectional images. Based on this data an optimization of the contact lens design could be performed.  

Results: 
In the present case, a significant improvement in visual acuity, daily wearing time and wearing comfort was achieved due to scleral lens re-fitting with individual scleral lens sagittal height calculation and custom fitting according to corneo-scleral profile measurement data. 

Conclusion: 
Scleral lenses can be a good alternative to other contact lens treatments to achieve visual rehabilitation in complex corneal situations. Analysis of the corneo-scleral profile by Scheimpflug technique and accurate evaluation of the sagittal height are of great benefit, in addition to the assessment of the fitting and landing zone of scleral lenses by anterior segment OCT. This results in significant time savings for the fitting and leads to a more physiologically compatible contact lens treatment result.