Aims/Purpose: To evaluate the accuracy of corneal and scleral tomography analysis for determining the initial selection of a 16.5 mm scleral lens to enhance fitting outcomes and patient comfort.Methods: This single‐site, consecutive study fitted scleral lenses in 30 eyes in 16 patients (mean age 39.7 yrs., 11 males)). Patients underwent comprehensive evaluations, including detailed corneal and scleral tomography. Initial fitting used the manufacturer's standard protocol. Lens fitting was assessed with Anterior Segment OCT after 1 hour of wear, focusing on vaulting and overall fit. The required 300‐micron central sagittal vaulting was compared with tomography measurements at 10 mm, the limbal area, and 15 mm.Results: The group included 24 eyes with keratoconus, 2 with high regular astigmatism, and 4 with dry eyes. The mean HVID was 12.05 mm (SD = 0.33 mm, 95% CI: 11.92‐12.18 mm). The mean central corneal astigmatism was 2.91 D (SD = 1.74 D, 95% CI: 2.22‐3.60 D). Mean sagittal heights were 1869.3 microns (SD = 172.4, 95% CI: 1800.7‐1937.9) at 10 mm, 2727.7 microns (SD = 287.6, 95% CI: 2620.4‐2835.0) at the limbus, and 3970.5 microns (SD = 308.5, 95% CI: 3850.0‐4091.0) at 15 mm. The estimated ideal sagittal depth was 4321.8 microns (SD = 258.6, 95% CI: 4233.6‐4410.0). Sagittal height at 15 mm was the strongest predictor for ideal lens fitting (R2 = 0.9367). The multiple regression model, including all three measurements, showed a marginal improvement in accuracy (R2 = 0.947).Conclusions: The sagittal height at 15 mm is a highly effective predictor for initial scleral lens fittings, providing significant accuracy. This measurement can streamline the fitting process, reduce chair time, improve clinical outcomes, and increase patient comfort.
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