This poster presents a longitudinal case demonstrating the clinical impact of wavefront-guided scleral lenses for the correction of visually significant higher-order aberrations (HOAs) in a highly irregular cornea. A patient with advanced corneal ectasia reported the paradoxical outcome that the eye traditionally considered the “bad eye” achieved superior functional vision compared to the fellow eye following HOA-corrected scleral lens wear. Baseline imaging included corneal tomography, aberrometry, and point spread function analysis, revealing elevated HOAs and poor optical quality with conventional scleral lens correction. A wavefront-guided scleral lens was designed to neutralize higher-order aberrations beyond lower-order refractive error. Post-dispensing outcomes demonstrated a meaningful reduction in total HOA root mean square (RMS), improvement in point spread function, and a corresponding improvement in subjective and objective visual performance. Importantly, the case was replicated one year later, confirming the stability, repeatability, and durability of wavefront-guided scleral lens correction in the same eye. Comparative analysis between conventional and wavefront-guided designs highlights the limitations of standard scleral optics in select patients and underscores the role of individualized HOA correction in maximizing visual outcomes. This case supports the clinical value of wavefront-guided scleral lenses in appropriately selected patients with complex aberration profiles and demonstrates that, with adequate lens stability and alignment, advanced optical correction can be consistently reproduced over time.
Nathan H. Schramm (Sat,) studied this question.