Do visual performance and optical quality vary across different contact lens correction modalities in keratoconus?

Purpose: While several advanced contact lens (CL) designs are commercially available for vision correction in keratoconus, their visual performance and optical quality, relative to each other and controls remains unclear. This prospective, crossover study tested the hypothesis that these CL designs would have a differential impact on visual performance and optical quality in subjects with advanced keratoconus, but not in early to moderate disease states.

Methods: Spatial vision (logMAR acuity and contrast sensitivity), depth vision (stereoacuity) and optical quality (higher-order wavefront aberrations) were measured on 28 bilaterally mild to advanced keratoconics (age: 20-28yrs; 15 males), novice to CL wear, and in 10 age-matched controls using well-established psychophysical and aberrometry techniques. All data were collected on keratoconic subjects with their spectacles and with conventional RGP, Kerasoft®, Rose K2® and Scleral RGP® CL's in randomized order, atleast a week apart from each other.

Results: All outcome variables deteriorated with keratoconus severity and improved with CL wear, relative to spectacles (p < 0.05). This improvement was smaller for Kerasoft CL (p < 0.05) and higher but comparable for the other three CL designs (p = 0.3), across all disease severity. Visual functions and optical quality outcomes never reached control levels for any correction modality (p < 0.05).

Conclusion: Visual performance and optical quality in keratoconus does not appear to improve commensurately with the sophistication of CL design across disease severity. Non-visual factors like quality of CL fit, wearing comfort and cost may therefore drive the choice of CL dispensed in keratoconus more than the performance efficacy of these lenses.