Soft customized lenses represent an advanced and patient-centered option in the management of keratoconus, especially for patients who require improved visual quality with better comfort and easier adaptation compared with rigid lens designs. By using individualized parameters and advanced fitting technology, these lenses can help enhance visual performance, improve lens stability, and support daily wear comfort in selected keratoconus cases.
Case Description
A 55-year-old patient who had a long-standing history of bilateral keratoconus presented with reduced visual acuity and intolerance to rigid GP (RGP) lenses.
Uncorrected visual acuity (UCVA) OD was 0.1 and best-corrected visual acuity (BCVA) with RGP lenses 0.9. UCVA OS was 0.2 with a BCVA with RGP lenses of 1.0. Although the patient achieved good visual acuity with RGP lenses, he reported poor comfort, significant lens awareness, and excessive lens movement in both eyes, leading to reduced wearing time and dissatisfaction.
Due to RGP intolerance, a 2-week washout period was advised to eliminate corneal molding effects. Following this, the patient was refitted with customized ARC (X-Cel Specialty Contacts) soft contact lenses designed for keratoconus.
The lens fitting and clinical outcomes were OD: base curve 8.30 mm, thickness 0.50 mm, initial power –6.00 D, manufactured in Definitive silicone hydrogel (SiHy) material. Over-refraction was 1.75 D resulting final lens power of –7.75 D. The achieved visual acuity was 0.9.
The (OS) base curve was 8.60 mm, thickness was 0.50 mm, initial power of –6.00 D also in Definitive SiHy material. Over-refraction was –1.50 / –0.75 × 020. Final lens power was adjusted accordingly to –7.50 –0.75 x 20, resulting in achieved visual acuity of 0.9+.
Discussion
The customized soft lenses demonstrated excellent lens stability with minimal movement, significantly improving patient comfort compared to the RGP lenses. There was a shorter and more efficient fitting process compared to specialty rigid lenses, resulting in easy patient adaptation with rapid acceptance. The customized lenses exceeded the patient’s expectations in terms of comfort and vision. The fit managed to change the irregularity to regular surface, with the soft gentle edge landing enhancing comfort (Figure 1).
The patient reported high satisfaction, achieving a balance between visual quality and comfort.
Conclusion
This case demonstrates that customized soft contact lenses can successfully exceed patient expectations by delivering both high-quality vision and comfort in keratoconus management. In this case, the lenses provided visual acuity comparable to RGP lenses, improved comfort and wearability while reducing the fitting time compared to other specialty lens modalities.
Customized soft lenses represent a practical, patient-friendly alternative for individuals who are intolerant to rigid lenses, without significantly compromising visual outcomes. Combining the comfort of a soft lens material with a customized design tailored to the irregular corneal shape makes customized soft lenses a valuable option for early to moderate keratoconus, post-cross-linking patients, or cases where conventional lenses are not well tolerated.
To watch Dr. Damati discuss this case, click here.