AAOpt 2025: Fitting irregular corneas

Note: Video captions are auto-generated with the assistance of AI and may contain errors.

Clark Chang, OD, MSA, MSc, FAAO, a cornea specialist from Wills Eye Hospital and senior director at EssilorLuxottica, presented a lecture on fitting irregular corneas at the Academy of Optometry in Boston. Alongside co-presenters, he discussed a comprehensive approach to examining patients with corneal irregularities. The presentation emphasized a systematic examination process, including topography, OCT imaging, baseline refraction, and understanding patient-specific visual goals and lens tolerance.

Chang illustrated his approach through a detailed case study of a keratoconus patient with corneal scarring. The patient experienced significant visual challenges, particularly night-time starbursting and ghosting. Initially using corneal GP lenses, she was becoming intolerant due to lens instability. Chang transitioned her to scleral lenses, which immediately improved her vision from 20/60 to 20/30 in her right eye and maintained 20/20 in her left eye. To address persistent visual symptoms, Chang implemented a multi-step intervention:

1. First, he tried pupil-constricting drops during night-time use
2. Then, he utilized aberrometry to capture and correct residual visual aberrations
3. Finally, he incorporated wavefront-guided, high-order aberration (HOA) correcting optics in both lenses

The innovative approach yielded remarkable results. The patient's right eye improved to 20/20, and her left eye achieved 20/15 vision. Interestingly, the patient reported feeling most comfortable when both eyes used the same HOA lens design. Key takeaways from the presentation include:

• The importance of personalized lens fitting for irregular corneas
• Potential benefits of wavefront-guided optics
• Innovative strategies like pupil-constricting drops to manage night-time visual symptoms
• The value of comprehensive patient assessment and goal-oriented treatment

Chang concluded by highlighting the potential for future research and improved patient care in managing complex corneal conditions.