AOA 2025: Keratoconus contact lens fitting before and after surgery

Clark Chang, OD, MSA, MSc, FAAO, delivered a lecture on keratoconus contact lens fitting, focusing on management before and after surgical interventions. The presentation, copresented with Susan Gromacki, OD, MS, FAAO, FSLS, highlighted the significant advancements in treating this complex corneal condition. Chang emphasized that recent developments in corneal collagen cross-linking and contact lens technologies have dramatically improved keratoconus management. However, he stressed that early detection and treatment remain critical. When early intervention fails, multiple treatment options exist to enhance patient outcomes. These options include:

• Intrastromal ring segments
• Allogeneic donor tissue procedures
• Lamellar keratoplasty
• Penetrating keratoplasty

The lecture featured a compelling case study of a patient who underwent penetrating corneal keratoplasty within the past 12 months. The patient mistakenly believed the surgery would eliminate the need for corrective lenses. In reality, optimizing vision post surgery requires specialized contact lens management. Initially fitted with a profilometry-guided scleral lens, the patient reported persistent visual disturbances, including halos and glare. A detailed examination revealed significant higher-order aberrations, specifically vertical coma and secondary astigmatism. The innovative solution involved applying a high-order aberration (HOA) guided optical patch to the lens surface. This intervention yielded remarkable results:

• Vision improved from 20/40 to 20/25
• Eliminated patient's halo and glare complaints
• Significantly enhanced visual comfort

Chang's key takeaways included:

• Combination management is crucial in complex cases
• Early intervention with corneal cross-linking can prevent more invasive surgeries
• Advanced lens fitting techniques can dramatically improve patient outcomes

The presentation concluded by highlighting the importance of comprehensive, personalized approaches to keratoconus management, emphasizing that surgical intervention is not the end of the treatment journey, but often just one step in ongoing vision care.