Effect Of Mini-Scleral Lenses On Anterior Corneal Surface Higher-Order Aberrations And Visual Function In Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: FP18.07 | Type: Free paper | DOI: 10.82333/x1tt-6847
Authors: Mr Léonard Kollros* 1 , Farhad Hafezi 2 , Emilio A. Torres-Netto 2 , Mark Hillen 2 , M. Enes Aydemir 2 , Lorella Dado 3 , Padraig Mulholland 4
1ELZA Institute,Zurich,Switzerland;Institute of Optometry,University of Applied Sciences and Arts Northwestern Switzerland (FHNW),Olten,Switzerland;Lorella & Léonard OPTIC,Biel/Bienne,Switzerland;School of Optometry & Vision Sciences,Cardiff University,Cardiff,United Kingdom, 2ELZA Institute,Zurich,Switzerland, 3Lorella & Léonard OPTIC,Biel/Bienne,Switzerland, 4Centre for Optometry and Vision Science,Ulster University,Coleraine,United Kingdom
Purpose
To evaluate the effect of mini-scleral contact lenses (mSCLs) on anterior corneal surface higher-order aberrations (HOAs), visual acuity, and vision-related quality of life in patients with keratoconus, and to assess associations between optical quality, visual function, and disease severity using the ABCD classification system.
Setting
Prospective interventional study conducted at the ELZA Institute, Zurich, Switzerland. Ethical approval was obtained from the Cantonal Ethics Committee of Zurich (KEK 2021-00008).
Methods
Twenty-two eyes from 12 adults with stable keratoconus (mean age 31.4±8.8 years) were evaluated with and without habitual mSCL wear. Seventeen eyes had undergone prior corneal cross-linking. After ≥10 days without lens wear, anterior corneal and total ocular HOAs were measured using a Placido-disc aberrometer (5-mm pupil). High-contrast (100%) and low-contrast (6%) logMAR visual acuity were assessed monocularly. Measurements were repeated after ≥2 hours of mSCL wear. Vision-related quality of life was assessed using the NEI VFQ-25 questionnaire. Paired statistical testing and Spearman correlation analyses were performed.
Results
Median ocular root mean square (RMS) HOAs decreased from 1.08 µm (IQR 0.98) without mSCL to 0.51 µm (IQR 0.25) with mSCL (P<0.001). Vertical coma was reduced from −1.23 µm to −0.03 µm (P<0.001), corresponding to a mean correction of 97.3%. Spherical aberration was also significantly reduced (P=0.002). High-contrast visual acuity improved from 0.21 logMAR (IQR 0.27) to −0.06 logMAR (IQR 0.12) (P<0.001). HOAs correlated with high-contrast (rs=+0.49, P=0.02) and low-contrast visual acuity (rs=+0.62, P<0.001). High-contrast visual acuity with mSCL correlated strongly with the posterior radius (B-value) of the ABCD classification (rs=+0.71, P<0.001). VFQ-25 scores improved significantly with mSCL wear (median 62.4 vs 83.8, P<0.001).
Conclusions
Mini-scleral contact lenses significantly reduce anterior corneal higher-order aberrations in keratoconus, particularly vertical coma and spherical aberration, resulting in improved high- and low-contrast visual acuity. Optical improvements correlate with disease severity and translate into meaningful gains in vision-related quality of life. These findings support mSCL as an effective modality for optical rehabilitation across keratoconus stages.