GSLS 2026: Enhancing visual quality in keratoconus

Jamie Kuzniar, OD, FAAO, FSLS, discusses her GSLS 2026 poster presentation, "Enhancing visual quality in keratoconus: Outcomes with wavefront-guided scleral lenses," which focuses on wavefront-guided scleral lenses for keratoconus patients, specifically using the Zenlens Chroma HOA lens (Bausch + Lomb). She explains that last year she presented initial results from her first group of patients, which already showed very good outcomes. This year’s work is essentially a follow‑up case series, reflecting refinements in both lens manufacturing and her own skills in candidacy selection and fitting, resulting in even better visual outcomes.

Across her patient series, Kuzniar reports an average 73.5% reduction in higher-order aberrations (HOAs), which she describes as phenomenal. She emphasizes that in keratoconus, the most impactful HOAs are coma and spherical aberration, so she systematically screens her scleral lens wearers for significant levels of these aberrations. Patients with substantial coma or spherical aberration are considered for HOA-correcting (wavefront‑guided) lenses such as Chroma, and these patients experience dramatic improvements both subjectively (real‑world vision, especially at night) and objectively (measured visual acuity).

A central theme is lens stability and centration. Kuzniar explains that wavefront-guided optics are highly sensitive to rotation; even small rotational shifts can cause visual fluctuations. She highlights the excellent rotational stability of the Zenlens, particularly when using back-surface elevation features that “lock in” the lens position. Improved centration further reduces HOAs and enhances visual quality. She also values the design’s customizability for a wide range of corneal conditions beyond keratoconus, and notes that the generous landing zone tends to provide better comfort and longer wearing times.

Kuzniar strongly encourages practitioners to adopt HOA scleral lenses, stressing that there is genuine patient demand but still limited access. Some of her case‑study patients traveled long distances and even found her online because they were specifically searching for this technology—sometimes knowing about it before their own doctors did. She underlines that many scleral lens patients are grateful yet still desire better vision, and that clinicians should at least educate patients about these options, even if they refer to a colleague. As patients become increasingly informed through the internet, articles, and webinars, Kuzniar argues that eye care providers must “rise to the occasion” and meet these evolving expectations with advanced technologies like wavefront‑guided scleral lenses.