Transforming Irregular Corneas: Real‑World Outcomes Of Customeyes‑Guided Regularisation - A Two‑Stage Regularisation And Refractive Pathway

To evaluate the visual and tomographic outcomes of a structured, two‑stage management pathway for irregular corneas—CustomEyes (topography‑ and wavefront‑guided transepithelial PRK using SCHWIND technology) with or without adjunctive corneal crosslinking (CXL)—and to assess its role in visual rehabilitation and refractive optimisation, including subsequent refractive procedures where indicated.

Single surgeon - UK clinic

A retrospective analysis was performed on 96 eyes (74 patients) treated in a single-centre keratoconus and ectasia service. All eyes underwent a regularisation stage using CustomEyes, with 66 eyes receiving simultaneous or sequential CXL. A subset of 27 eyes proceeded to a refractive stage (ICL implantation or lens replacement). Outcomes included corrected (CDVA) and uncorrected (UDVA) distance visual acuity, higher‑order aberration (HOA) reduction, and keratometric stability over 18–24 months. Real‑world treatment parameters and Foresight‑based planning data were analysed.

CustomEyes produced consistent improvements in corneal regularity and visual function. 100% of eyes showed HOA reduction, with 73% achieving >50% reduction and ~17% achieving >75% reduction. CDVA improved in 75% of eyes, with ~20% gaining ≥4 lines, and 97.7% maintained or improved safety. UDVA improved in 54–76% of eyes depending on subgroup. Keratometry (K1, K2, Kmax) remained stable across 18 months in CXL-only, CustomEyes-only, and combined groups. In the refractive‑stage cohort (n=27), >89% achieved unaided driving vision, 48% reached 6/6, and 15% exceeded 6/6, with 59.3% gaining ≥3 lines relative to preoperative CDVA.

CustomEyes provides effective corneal regularisation and substantial reduction of higher‑order aberrations in irregular corneas, with a strong safety profile and stable keratometry. When followed by a tailored refractive procedure, the two‑stage pathway delivers high rates of functional unaided vision, offering a powerful alternative to traditional keratoconus rehabilitation strategies. This integrated approach supports improved quality of vision and quality of life in a predominantly young patient population.