Tomographic Predictors Of Visual Success With Custom Soft Contact Lenses In Corneal Ectasia

To evaluate whether pre-fitting corneal tomographic characteristics influence visual success with custom soft contact lenses in eyes with corneal ectasia.

Single-center retrospective study performed at a tertiary referral ophthalmology clinic.

The study included 40 patients (57 eyes; 16 females and 24 males; mean age 30.4 ± 9.3 years) with corneal ectasia fitted with a commercially available custom soft contact lens (KeraSoft® IC). Successful fitting was defined as a ≥3-line gain in BCLCVA compared to pre-fitting BSCVA, or a final BCLCVA ≤0.15 logMAR. Eyes were categorized as successful or limited visual gain. Pre-fitting corneal tomographic parameters, including keratometry, elevation, symmetry indices, and higher-order aberrations, were compared. ROC analysis was performed to evaluate predictive performance.

Successful fitting was achieved in 56.1% of eyes. Eyes with limited visual gain demonstrated significantly greater posterior corneal steepening (K back max, p=0.023), higher anterior and posterior asymmetry indices (SI front p=0.027; SI back p=0.017), and increased posterior elevation (p=0.031). ROC analysis showed moderate discriminatory ability for K back max (AUC=0.65). A cut-off value of K back max ≤ −11.23 D yielded 40% sensitivity and 93.8% specificity for predicting limited visual gain.

Posterior corneal morphology appears to influence visual rehabilitation outcomes with custom soft contact lenses in corneal ectasia. Increased posterior steepening may reduce the likelihood of achieving substantial visual improvement. Pre-fitting posterior corneal assessment may assist in patient selection and clinical decision-making.