Case Report: Front surface eccentricity of scleral lens: Its impact on visual quality in eyes with higher-order aberrations induced by refractive surgery

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Purpose To report the impact of front surface eccentricity (FSE) of scleral lenses (SCLs) on the visual performance of eyes exhibiting refractive surgery-induced higher-order aberrations (HOAs) Method A female teenager presented to the clinic with blurring of vision and dependency on spectacles even after undergoing Small Incision Lenticule Extraction (SMILE) in both eyes (BE). Her presenting uncorrected high contrast distance visual acuity (HCDVA) was 20/60 in the right eye (RE) and 20/40 in the left eye (LE). On examination, the cornea showed a ring-shaped area of ablation with faint scarring and a well-apposed lenticule-extraction site. Subjective refraction improved the HCDVA to 20/20p in RE and 20/25 in LE but the patient was not happy with the quality of vision. Ocular aberrometry revealed an increase in total HOAs as the underlying cause of unsatisfactory vision. Result A contact lens trial was recommended for BE to enhance visual quality. Rigid corneal lenses (RCLs) were tried, but the patient was intolerant to them. Large diameter SCLs of different FSEs (0, 0.6, and 0.8) were tried to reduce these aberrations. SCL with FSE 0 yielded the most favourable visual outcome, which was confirmed subjectively on ocular aberrometry. Conclusion With this case report, we hypothesize that the eccentricity of SCL can be selected according to the asphericity (at 6 mm) of the posterior corneal surface. This case also re-emphasizes the impact of SCL with varying FSEs on reducing HOAs and enhancing visual quality in eyes where conventional RCLs yield suboptimal results.