Reducing Visual Disturbance In Keratoconus

To highlight an alternative approach for visual rehabilitation in keratoconus patients with persistent visual disturbance despite acceptable visual acuity. The aim is to emphasize the role of pupil modulation in improving visual quality and reducing photic phenomena when conventional optical or corneal interventions are insufficient.

A tertiary referral anterior segment and cataract surgery practice managing complex keratoconus patients with persistent visual disturbance and reduced quality of vision despite optimized conventional optical and corneal management.

A patient with stable keratoconus presented with significant visual disturbance including glare and photic phenomena despite acceptable best-corrected visual acuity. Conventional management options, including optical correction, were insufficient to improve subjective visual quality. Given the predominance of symptoms related to pupil-dependent aberrations, a pupil-modulating capsular ring was implanted to reduce effective pupil size and limit peripheral light entry. Postoperatively, the patient reported marked improvement in visual quality with significant reduction of glare and photic symptoms, while maintaining stable visual acuity. No intraoperative or postoperative complications were observed.

Visual rehabilitation in keratoconus should address quality of vision in addition to visual acuity. Pupil modulation using a capsular ring may represent a valuable adjunctive option for selected patients with persistent glare and photic phenomena when conventional management is insufficient. Careful patient selection and surgical technique are essential to achieve stable centration and optimal visual outcomes.