Visual Outcomes And Comfort With Scleral Versus Rigid Gas Permeable Lenses In Advanced Keratoconus: A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: PP05.017 | Type: Free paper | DOI: 10.82333/s5v5-3a03
Authors: Dr Erum Habib 1 , Dr Ariba Asif 2 , Dr Sana Iftikhar 3 , Dr Akif Shahid Khan 4 , Dr Jawad Jihad 5 , Dr Ihda Bani Khalaf 6 , Dr Sawaira Murad 7 , Dr Ayah Abdulgadir 8 , Dr Maria Qadri 9 , Dr Omar Abdullah Gill 2 , Dr Muhammad Nabeel Saddique 2 , Dr Saad Ashraf 1 , Dr Hashem Abu Serhan* 10
1Faculty of Medicine,Dow University of Health Sciences,Karachi,Pakistan, 2Faculty of Medicine,King Edward Medical University,Lahore,Pakistan, 3Faculty of Medicine,Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College,Lahore,Pakistan, 4Faculty of Medicine,Northwest School of Medicine,Lahore,Pakistan, 5Faculty of Medicine,Cairo University,Cairo,Egypt, 6Faculty of Medicine,Jordan University of Science and Technology,Irbid,Jordan, 7Faculty of Medicine,Khyber Girls Medical College,Pashawer,Pakistan, 8Faculty of Medicine,University of Khartoum,Khartoum,Sudan, 9Faculty of Medicine,Jinnah Sindh Medical University,Karachi,Pakistan, 10Department of Ophthalmology,Hamad Medical Corporation,Doha,Qatar
Purpose
To evaluate the efficacy and safety of rigid gas permeable (RGP) versus scleral lenses in patients with advanced keratoconus.
Setting
A systematic review and meta-analysis.
Methods
PubMed, Embase, Cochrane, and ClinicalTrials.gov were searched from inception to April 2025. The primary outcomes included progression of keratoconus measured by changes in Kmax, corneal thickness, and visual acuity. Secondary outcomes included treatment-related adverse events, corneal biomechanics, and quality-of-life measures. Pooled estimates were calculated using random-effects models, reporting mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was evaluated using I² and X² statistics. The methodological quality was assessed using the Cochrane Risk of Bias (ROB) and the Newcastle–Ottawa Scale (NOS). All calculations were performed using RevMan 5.4.
Results
Three studies with 209 patients (RGP=102; scleral=107) with advanced keratoconus were included. No significant differences were observed in BCVA (MD 0.01, 95% CI: –0.03 to 0.05; P=0.68; I²=0%), contrast sensitivity (MD –0.08, 95% CI: –0.18 to 0.02; P=0.12; I²=0%) and across all spatial frequencies (MD –0.08, 95% CI: –0.24 to 0.08; P=0.31; I²=0%), ease of use (MD –0.44, 95% CI: –1.32 to 0.45; P=0.33; I²=34%), ocular pain (MD 0.46, 95% CI: –3.60 to 4.51; P=0.83; I²=6%), and vision satisfaction (MD –0.48, 95% CI: –1.05 to 0.08; P=0.09; I²=78%). Scleral lenses showed significantly better comfort satisfaction (MD –1.15, 95% CI: –1.48 to –0.82; P<0.001; I²=0%) and subjective comfort (MD –1.29, 95% CI: –2.30 to –0.28; P=0.01; I²=76%).
Conclusions
RGP and scleral lenses offer comparable visual acuity and contrast sensitivity in advanced keratoconus. However, scleral lenses are associated with superior comfort and user satisfaction, supporting their preferential use when patient tolerance is a key consideration.