Efficacy of Rose-K lens in enhancing visual acuity and contrast sensitivity in keratoconus
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 2 (2025),
31 July 2025
,
Page 50-56
https://doi.org/10.51329/mehdioptometry222
Abstract
Background: Keratoconus is a progressive, noninflammatory corneal ectasia that is characterized by corneal thinning and conical deformation, which leads to irregular astigmatism, myopia, and reduced visual quality. As the disease progresses, spectacles often become inadequate, necessitating the use of rigid gas-permeable or specialty contact lenses to restore vision. Traditional evaluations rely on high-contrast visual acuity tests, which alone do not capture functional vision impairments. A more comprehensive assessment includes contrast sensitivity (CS), a key predictor of real-world visual performance. The ROSE K2 XL semi-scleral lens offers tailored optical correction for irregular corneas. We investigated its efficacy in enhancing best-corrected distance visual acuity (BCDVA) and CS in patients with keratoconus.Methods: In this prospective study, we recruited adults with varying keratoconus severities from the Armed Forces Hospital in Oman, between February and December 2024. The patients were fitted with ROSE K2 XL semi-scleral lenses to assess changes in BCDVA and CS. Participants who had undergone prior ocular surgery (except for corneal crosslinking) or who had other corneal pathologies were excluded. Baseline and post-fitting BCDVA were measured using a crowded Keeler logarithm of the minimum angle of resolution (logMAR) chart. CS was assessed using the Pelli–Robson chart under standardized photopic conditions. Keratoconus severity was graded using the Amsler–Krumeich classification system. All examinations were performed by the same experienced optometrist to ensure consistency and to reduce measurement variability.
Results: We enrolled 180 eyes from 90 participants with keratoconus (mean [standard deviation, SD] age: 29.2 [5.4] years; 65.6% [n = 59] female). Disease severity was classified as follows: stage I (n = 16, 8.9%), stage II (n = 52, 28.9%), stage III (n = 70, 38.9%), and stage IV (n = 42, 23.3%). After ROSE K2 XL lens fitting, the mean (SD) BCDVA improved significantly, from 0.90 (0.48) logMAR to 0.10 (0.11) logMAR (P < 0.001). The mean (SD) CS also increased significantly, from 0.96 (0.47) log CS to 1.90 (0.16) log CS (P < 0.001). Significant improvements in BCDVA and CS were observed across all disease stages (all P < 0.001), with the most pronounced gains found in cases of advanced keratoconus (stage IV).
Conclusions: Fitting ROSE K2 XL semi-scleral contact lenses in patients with keratoconus resulted in significant improvements in both BCDVA and CS across all disease severity levels. These findings show the clinical value of semi-scleral lenses for visual rehabilitation of keratoconus, particularly in the advanced stages, where conventional spectacles or lenses may offer limited benefits. Incorporating CS assessment with visual acuity evaluations provides a more comprehensive investigation of real-world visual function, supporting evidence-based lens selection to optimize patient outcomes. Future studies should explore the long-term effects of these lenses on corneal physiology and patient-reported quality of life.
Keywords:
- corneas
- keratoconus
- visual contrast sensitivity
- visual acuities
- contact lens
- habilitation
References
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2. Lucas SEM, Burdon KP. Genetic and Environmental Risk Factors for Keratoconus. Annu Rev Vis Sci. 2020 Sep 15;6:25-46. doi: 10.1146/annurev-vision-121219-081723. Epub 2020 Apr 22. PMID: 32320633.
3. Patel D, McGhee C. Understanding keratoconus: what have we learned from the New Zealand perspective? Clin Exp Optom. 2013 Mar;96(2):183-7. doi: 10.1111/cxo.12006. Epub 2012 Dec 25. PMID: 23278718.
4. Alqudah N. Keratoconus: imaging modalities and management. Med Hypothesis Discov Innov Ophthalmol. 2024 Jul 1;13(1):44-54. doi: 10.51329/mehdiophthal1493. PMID: 38978828; PMCID: PMC11227666.
5. Barnwal NK, Sah SK, Chaudhary B, Adhikari PR, Karn RR. Visual and keratometric outcomes following corneal collagen cross-linking in keratoconus: an experience from Nepal. Med Hypothesis Discov Innov Optom. 2025 Spring; 6(1): 15-21. doi: 10.51329/mehdioptometry217.
6. Mandathara PS, Stapleton FJ, Willcox MDP. Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities. Eye Contact Lens. 2017 May;43(3):141-154. doi: 10.1097/ICL.0000000000000270. PMID: 27171132.
7. Owsley C. Contrast sensitivity. Ophthalmol Clin North Am. 2003 Jun;16(2):171-7. doi: 10.1016/s0896-1549(03)00003-8. PMID: 12809156.
8. McAlinden C, Pesudovs K, Moore JE. The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5537-45. doi: 10.1167/iovs.10-5341. Epub 2010 May 26. PMID: 20505205.
9. Marta A, Marques JH, Almeida D, José D, Barbosa I. Keratoconus and Visual Performance with Different Contact Lenses. Clin Ophthalmol. 2021 Dec 16;15:4697-4705. doi: 10.2147/OPTH.S345154. PMID: 34949911; PMCID: PMC8689658.
10. Owsley C, McGwin G Jr. Vision and driving. Vision Res. 2010 Nov 23;50(23):2348-61. doi: 10.1016/j.visres.2010.05.021. Epub 2010 May 23. PMID: 20580907; PMCID: PMC2975746.
11. Vincent SJ, Alonso-Caneiro D, Kricancic H, Collins MJ. Scleral contact lens thickness profiles: The relationship between average and centre lens thickness. Cont Lens Anterior Eye. 2019 Feb;42(1):55-62. doi: 10.1016/j.clae.2018.03.002. Epub 2018 Mar 16. PMID: 29555408.
12. Naderan M, Shoar S, Kamaleddin MA, Rajabi MT, Naderan M, Khodadadi M. Keratoconus Clinical Findings According to Different Classifications. Cornea. 2015 Sep;34(9):1005-11. doi: 10.1097/ICO.0000000000000537. PMID: 26203749.
13. Fernandez-Velazquez FJ. Kerasoft IC compared to Rose-K in the management of corneal ectasias. Cont Lens Anterior Eye. 2012 Aug;35(4):175-9. doi: 10.1016/j.clae.2012.02.005. Epub 2012 Mar 10. PMID: 22409949.
14. Asimellis G, Kaufman EJ. Keratoconus. 2024 Apr 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29262160.
15. Ozkurt Y, Atakan M, Gencaga T, Akkaya S. Contact lens visual rehabilitation in keratoconus and corneal keratoplasty. J Ophthalmol. 2012;2012:832070. doi: 10.1155/2012/832070. Epub 2012 Jan 15. PMID: 22292112; PMCID: PMC3265106.
16. Saraç Ö, Kars ME, Temel B, Ça??l N. Clinical evaluation of different types of contact lenses in keratoconus management. Cont Lens Anterior Eye. 2019 Oct;42(5):482-486. doi: 10.1016/j.clae.2019.02.013. Epub 2019 Feb 23. PMID: 30808595.
17. Romero-Jiménez M, Flores-Rodríguez P. Utility of a semi-scleral contact lens design in the management of the irregular cornea. Cont Lens Anterior Eye. 2013 Jun;36(3):146-50. doi: 10.1016/j.clae.2012.12.006. Epub 2013 Jan 3. PMID: 23291263.
18. Kumar P, Bandela PK, Bharadwaj SR. Do visual performance and optical quality vary across different contact lens correction modalities in keratoconus? Cont Lens Anterior Eye. 2020 Dec;43(6):568-576. doi: 10.1016/j.clae.2020.03.009. Epub 2020 Mar 29. PMID: 32238301.
19. Betts AM, Mitchell GL, Zadnik K. Visual performance and comfort with the Rose K lens for keratoconus. Optom Vis Sci. 2002 Aug;79(8):493-501. doi: 10.1097/00006324-200208000-00011. PMID: 12199541.
20. Iqbal M, Hammour A, Elsayed A, Gad A. Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study. Med Hypothesis Discov Innov Ophthalmol. 2023 Dec 31;12(2):78-89. doi: 10.51329/mehdiophthal1473. PMID: 38357612; PMCID: PMC10862023.
21. Wagner H, Barr JT, Zadnik K. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: methods and findings to date. Cont Lens Anterior Eye. 2007 Sep;30(4):223-32. doi: 10.1016/j.clae.2007.03.001. Epub 2007 May 3. PMID: 17481941; PMCID: PMC3966142.
22. O'Boyle C, Chen SI, Little JA. Crowded letter and crowded picture logMAR acuity in children with amblyopia: a quantitative comparison. Br J Ophthalmol. 2017 Apr;101(4):457-461. doi: 10.1136/bjophthalmol-2015-307677. Epub 2016 Jul 7. PMID: 27388249; PMCID: PMC5583677.
23. Mäntyjärvi M, Laitinen T. Normal values for the Pelli-Robson contrast sensitivity test. J Cataract Refract Surg. 2001 Feb;27(2):261-6. doi: 10.1016/s0886-3350(00)00562-9. PMID: 11226793.
24. Kaur K, Gurnani B. Contrast Sensitivity. 2023 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35593849.
25. de Luis Eguileor B, Etxebarria Ecenarro J, Santamaria Carro A, Feijoo Lera R. Irregular Corneas: Improve Visual Function With Scleral Contact Lenses. Eye Contact Lens. 2018 May;44(3):159-163. doi: 10.1097/ICL.0000000000000340. PMID: 27768614.
26. Abou Samra WA, Badawi AE, Kishk H, Abd El Ghafar A, Elwan MM, Abouelkheir HY. Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation. J Ophthalmol. 2018 Feb 1;2018:3923170. doi: 10.1155/2018/3923170. PMID: 29484205; PMCID: PMC5816849.
27. Kumar M, Shetty R, Dutta D, Rao HL, Jayadev C, Atchison DA. Effects of a semi-scleral contact lens on refraction and higher order aberrations. Cont Lens Anterior Eye. 2019 Dec;42(6):670-674. doi: 10.1016/j.clae.2019.06.002. Epub 2019 Jun 21. PMID: 31230973.
28. Devi P, Kumar P, Bharadwaj SR. Computational analysis of retinal image quality with different contact lens designs in keratoconus. Cont Lens Anterior Eye. 2023 Apr;46(2):101794. doi: 10.1016/j.clae.2022.101794. Epub 2022 Dec 10. PMID: 36513565.
29. de Luis Eguileor B, Acera A, Santamaría Carro A, Feijoo Lera R, Escudero Argaluza J, Etxebarria Ecenarro J. Changes in the corneal thickness and limbus after 1 year of scleral contact lens use. Eye (Lond). 2020 Sep;34(9):1654-1661. doi: 10.1038/s41433-019-0729-z. Epub 2019 Dec 10. PMID: 31822857; PMCID: PMC7608222.
30. Elagamy A, AlOmair N. Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients. Cont Lens Anterior Eye. 2022 Feb;45(1):101520. doi: 10.1016/j.clae.2021.101520. Epub 2021 Oct 20. PMID: 34686431.
31. Romero-Jiménez M, Santodomingo-Rubido J, González-Méijome JM. An assessment of the optimal lens fit rate in keratoconus subjects using three-point-touch and apical touch fitting approaches with the rose K2 lens. Eye Contact Lens. 2013 Jul;39(4):269-72. doi: 10.1097/ICL.0b013e318295b4f4. PMID: 23771007.
32. Elbendary AM, Abou Samra W. Evaluation of rigid gas permeable lens fitting in keratoconic patients with optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2013 Jun;251(6):1565-70. doi: 10.1007/s00417-013-2271-1. Epub 2013 Feb 8. PMID: 23392819.
33. Risser G, Mechleb N, Muselier A, Gatinel D, Zéboulon P. Novel deep learning approach to estimate rigid gas permeable contact lens base curve for keratoconus fitting. Cont Lens Anterior Eye. 2023 Dec;46(6):102063. doi: 10.1016/j.clae.2023.102063. Epub 2023 Sep 28. PMID: 37777429.
34. Abadou J, Dahan S, Knoeri J, Leveziel L, Bouheraoua N, Borderie VM. Artificial intelligence versus conventional methods for RGP lens fitting in keratoconus. Cont Lens Anterior Eye. 2025 Feb;48(1):102321. doi: 10.1016/j.clae.2024.102321. Epub 2024 Nov 4. PMID: 39500688.
35. Kumar P, Ali MH, Reddy JC, Vaddavalli PK. Short-term changes in topometric indices after discontinuation of rigid gas permeable lens wear in keratoconic eyes. Indian J Ophthalmol. 2020 Dec;68(12):2911-2917. doi: 10.4103/ijo.IJO_1522_20. PMID: 33229669; PMCID: PMC7856990.
36. Romero-Jiménez M, Santodomingo-Rubido J, González-Meijóme JM, Flores-Rodriguez P, Villa-Collar C. Which soft lens power is better for piggyback in keratoconus? Part II. Cont Lens Anterior Eye. 2015 Feb;38(1):48-53. doi: 10.1016/j.clae.2014.09.012. Epub 2014 Oct 23. PMID: 25458076.
37. Uzunel UD, Kusbeci T, Yuce B, Yüksel B. Effects of rigid contact lenses on optical coherence tomographic parameters in eyes with keratoconus. Clin Exp Optom. 2015 Jul;98(4):319-22. doi: 10.1111/cxo.12287. PMID: 26104591.
38. Shneor E, Piñero DP, Doron R. Contrast sensitivity and higher-order aberrations in Keratoconus subjects. Sci Rep. 2021 Jun 21;11(1):12971. doi: 10.1038/s41598-021-92396-5. PMID: 34155283; PMCID: PMC8217180.
39. Erdinest N, London N, Landau D, Barbara R, Barbara A, Naroo SA. Higher order aberrations in keratoconus?. Int Ophthalmol. 2024 Apr 10;44(1):172. doi: 10.1007/s10792-024-03118-5. PMID: 38594548.
40. Moschos MM, Nitoda E, Georgoudis P, Balidis M, Karageorgiadis E, Kozeis N. Contact Lenses for Keratoconus- Current Practice. Open Ophthalmol J. 2017 Jul 31;11:241-251. doi: 10.2174/1874364101711010241. PMID: 28932340; PMCID: PMC5585463.
41. Wei RH, Khor WB, Lim L, Tan DT. Contact lens characteristics and contrast sensitivity of patients with keratoconus. Eye Contact Lens. 2011 Sep;37(5):307-11. doi: 10.1097/ICL.0b013e3182254e7d. PMID: 21792058.
42. Badrinarayanan A, Balakrishnan AC, Dutta R, Kumar RM, Iqbal A. Impact of Scleral Lens Front Surface Eccentricity on Visual Acuity, Contrast Sensitivity, and Higher-Order Aberrations in Eyes With Keratoconus. Eye Contact Lens. 2023 Sep 1;49(9):374-378. doi: 10.1097/ICL.0000000000001007. Epub 2023 Jun 2. PMID: 37272679.
43. Rathi VM, Mandathara PS, Taneja M, Dumpati S, Sangwan VS. Scleral lens for keratoconus: technology update. Clin Ophthalmol. 2015 Oct 28;9:2013-8. doi: 10.2147/OPTH.S52483. PMID: 26604671; PMCID: PMC4630203.
2. Lucas SEM, Burdon KP. Genetic and Environmental Risk Factors for Keratoconus. Annu Rev Vis Sci. 2020 Sep 15;6:25-46. doi: 10.1146/annurev-vision-121219-081723. Epub 2020 Apr 22. PMID: 32320633.
3. Patel D, McGhee C. Understanding keratoconus: what have we learned from the New Zealand perspective? Clin Exp Optom. 2013 Mar;96(2):183-7. doi: 10.1111/cxo.12006. Epub 2012 Dec 25. PMID: 23278718.
4. Alqudah N. Keratoconus: imaging modalities and management. Med Hypothesis Discov Innov Ophthalmol. 2024 Jul 1;13(1):44-54. doi: 10.51329/mehdiophthal1493. PMID: 38978828; PMCID: PMC11227666.
5. Barnwal NK, Sah SK, Chaudhary B, Adhikari PR, Karn RR. Visual and keratometric outcomes following corneal collagen cross-linking in keratoconus: an experience from Nepal. Med Hypothesis Discov Innov Optom. 2025 Spring; 6(1): 15-21. doi: 10.51329/mehdioptometry217.
6. Mandathara PS, Stapleton FJ, Willcox MDP. Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities. Eye Contact Lens. 2017 May;43(3):141-154. doi: 10.1097/ICL.0000000000000270. PMID: 27171132.
7. Owsley C. Contrast sensitivity. Ophthalmol Clin North Am. 2003 Jun;16(2):171-7. doi: 10.1016/s0896-1549(03)00003-8. PMID: 12809156.
8. McAlinden C, Pesudovs K, Moore JE. The development of an instrument to measure quality of vision: the Quality of Vision (QoV) questionnaire. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5537-45. doi: 10.1167/iovs.10-5341. Epub 2010 May 26. PMID: 20505205.
9. Marta A, Marques JH, Almeida D, José D, Barbosa I. Keratoconus and Visual Performance with Different Contact Lenses. Clin Ophthalmol. 2021 Dec 16;15:4697-4705. doi: 10.2147/OPTH.S345154. PMID: 34949911; PMCID: PMC8689658.
10. Owsley C, McGwin G Jr. Vision and driving. Vision Res. 2010 Nov 23;50(23):2348-61. doi: 10.1016/j.visres.2010.05.021. Epub 2010 May 23. PMID: 20580907; PMCID: PMC2975746.
11. Vincent SJ, Alonso-Caneiro D, Kricancic H, Collins MJ. Scleral contact lens thickness profiles: The relationship between average and centre lens thickness. Cont Lens Anterior Eye. 2019 Feb;42(1):55-62. doi: 10.1016/j.clae.2018.03.002. Epub 2018 Mar 16. PMID: 29555408.
12. Naderan M, Shoar S, Kamaleddin MA, Rajabi MT, Naderan M, Khodadadi M. Keratoconus Clinical Findings According to Different Classifications. Cornea. 2015 Sep;34(9):1005-11. doi: 10.1097/ICO.0000000000000537. PMID: 26203749.
13. Fernandez-Velazquez FJ. Kerasoft IC compared to Rose-K in the management of corneal ectasias. Cont Lens Anterior Eye. 2012 Aug;35(4):175-9. doi: 10.1016/j.clae.2012.02.005. Epub 2012 Mar 10. PMID: 22409949.
14. Asimellis G, Kaufman EJ. Keratoconus. 2024 Apr 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29262160.
15. Ozkurt Y, Atakan M, Gencaga T, Akkaya S. Contact lens visual rehabilitation in keratoconus and corneal keratoplasty. J Ophthalmol. 2012;2012:832070. doi: 10.1155/2012/832070. Epub 2012 Jan 15. PMID: 22292112; PMCID: PMC3265106.
16. Saraç Ö, Kars ME, Temel B, Ça??l N. Clinical evaluation of different types of contact lenses in keratoconus management. Cont Lens Anterior Eye. 2019 Oct;42(5):482-486. doi: 10.1016/j.clae.2019.02.013. Epub 2019 Feb 23. PMID: 30808595.
17. Romero-Jiménez M, Flores-Rodríguez P. Utility of a semi-scleral contact lens design in the management of the irregular cornea. Cont Lens Anterior Eye. 2013 Jun;36(3):146-50. doi: 10.1016/j.clae.2012.12.006. Epub 2013 Jan 3. PMID: 23291263.
18. Kumar P, Bandela PK, Bharadwaj SR. Do visual performance and optical quality vary across different contact lens correction modalities in keratoconus? Cont Lens Anterior Eye. 2020 Dec;43(6):568-576. doi: 10.1016/j.clae.2020.03.009. Epub 2020 Mar 29. PMID: 32238301.
19. Betts AM, Mitchell GL, Zadnik K. Visual performance and comfort with the Rose K lens for keratoconus. Optom Vis Sci. 2002 Aug;79(8):493-501. doi: 10.1097/00006324-200208000-00011. PMID: 12199541.
20. Iqbal M, Hammour A, Elsayed A, Gad A. Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study. Med Hypothesis Discov Innov Ophthalmol. 2023 Dec 31;12(2):78-89. doi: 10.51329/mehdiophthal1473. PMID: 38357612; PMCID: PMC10862023.
21. Wagner H, Barr JT, Zadnik K. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: methods and findings to date. Cont Lens Anterior Eye. 2007 Sep;30(4):223-32. doi: 10.1016/j.clae.2007.03.001. Epub 2007 May 3. PMID: 17481941; PMCID: PMC3966142.
22. O'Boyle C, Chen SI, Little JA. Crowded letter and crowded picture logMAR acuity in children with amblyopia: a quantitative comparison. Br J Ophthalmol. 2017 Apr;101(4):457-461. doi: 10.1136/bjophthalmol-2015-307677. Epub 2016 Jul 7. PMID: 27388249; PMCID: PMC5583677.
23. Mäntyjärvi M, Laitinen T. Normal values for the Pelli-Robson contrast sensitivity test. J Cataract Refract Surg. 2001 Feb;27(2):261-6. doi: 10.1016/s0886-3350(00)00562-9. PMID: 11226793.
24. Kaur K, Gurnani B. Contrast Sensitivity. 2023 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35593849.
25. de Luis Eguileor B, Etxebarria Ecenarro J, Santamaria Carro A, Feijoo Lera R. Irregular Corneas: Improve Visual Function With Scleral Contact Lenses. Eye Contact Lens. 2018 May;44(3):159-163. doi: 10.1097/ICL.0000000000000340. PMID: 27768614.
26. Abou Samra WA, Badawi AE, Kishk H, Abd El Ghafar A, Elwan MM, Abouelkheir HY. Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation. J Ophthalmol. 2018 Feb 1;2018:3923170. doi: 10.1155/2018/3923170. PMID: 29484205; PMCID: PMC5816849.
27. Kumar M, Shetty R, Dutta D, Rao HL, Jayadev C, Atchison DA. Effects of a semi-scleral contact lens on refraction and higher order aberrations. Cont Lens Anterior Eye. 2019 Dec;42(6):670-674. doi: 10.1016/j.clae.2019.06.002. Epub 2019 Jun 21. PMID: 31230973.
28. Devi P, Kumar P, Bharadwaj SR. Computational analysis of retinal image quality with different contact lens designs in keratoconus. Cont Lens Anterior Eye. 2023 Apr;46(2):101794. doi: 10.1016/j.clae.2022.101794. Epub 2022 Dec 10. PMID: 36513565.
29. de Luis Eguileor B, Acera A, Santamaría Carro A, Feijoo Lera R, Escudero Argaluza J, Etxebarria Ecenarro J. Changes in the corneal thickness and limbus after 1 year of scleral contact lens use. Eye (Lond). 2020 Sep;34(9):1654-1661. doi: 10.1038/s41433-019-0729-z. Epub 2019 Dec 10. PMID: 31822857; PMCID: PMC7608222.
30. Elagamy A, AlOmair N. Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients. Cont Lens Anterior Eye. 2022 Feb;45(1):101520. doi: 10.1016/j.clae.2021.101520. Epub 2021 Oct 20. PMID: 34686431.
31. Romero-Jiménez M, Santodomingo-Rubido J, González-Méijome JM. An assessment of the optimal lens fit rate in keratoconus subjects using three-point-touch and apical touch fitting approaches with the rose K2 lens. Eye Contact Lens. 2013 Jul;39(4):269-72. doi: 10.1097/ICL.0b013e318295b4f4. PMID: 23771007.
32. Elbendary AM, Abou Samra W. Evaluation of rigid gas permeable lens fitting in keratoconic patients with optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2013 Jun;251(6):1565-70. doi: 10.1007/s00417-013-2271-1. Epub 2013 Feb 8. PMID: 23392819.
33. Risser G, Mechleb N, Muselier A, Gatinel D, Zéboulon P. Novel deep learning approach to estimate rigid gas permeable contact lens base curve for keratoconus fitting. Cont Lens Anterior Eye. 2023 Dec;46(6):102063. doi: 10.1016/j.clae.2023.102063. Epub 2023 Sep 28. PMID: 37777429.
34. Abadou J, Dahan S, Knoeri J, Leveziel L, Bouheraoua N, Borderie VM. Artificial intelligence versus conventional methods for RGP lens fitting in keratoconus. Cont Lens Anterior Eye. 2025 Feb;48(1):102321. doi: 10.1016/j.clae.2024.102321. Epub 2024 Nov 4. PMID: 39500688.
35. Kumar P, Ali MH, Reddy JC, Vaddavalli PK. Short-term changes in topometric indices after discontinuation of rigid gas permeable lens wear in keratoconic eyes. Indian J Ophthalmol. 2020 Dec;68(12):2911-2917. doi: 10.4103/ijo.IJO_1522_20. PMID: 33229669; PMCID: PMC7856990.
36. Romero-Jiménez M, Santodomingo-Rubido J, González-Meijóme JM, Flores-Rodriguez P, Villa-Collar C. Which soft lens power is better for piggyback in keratoconus? Part II. Cont Lens Anterior Eye. 2015 Feb;38(1):48-53. doi: 10.1016/j.clae.2014.09.012. Epub 2014 Oct 23. PMID: 25458076.
37. Uzunel UD, Kusbeci T, Yuce B, Yüksel B. Effects of rigid contact lenses on optical coherence tomographic parameters in eyes with keratoconus. Clin Exp Optom. 2015 Jul;98(4):319-22. doi: 10.1111/cxo.12287. PMID: 26104591.
38. Shneor E, Piñero DP, Doron R. Contrast sensitivity and higher-order aberrations in Keratoconus subjects. Sci Rep. 2021 Jun 21;11(1):12971. doi: 10.1038/s41598-021-92396-5. PMID: 34155283; PMCID: PMC8217180.
39. Erdinest N, London N, Landau D, Barbara R, Barbara A, Naroo SA. Higher order aberrations in keratoconus?. Int Ophthalmol. 2024 Apr 10;44(1):172. doi: 10.1007/s10792-024-03118-5. PMID: 38594548.
40. Moschos MM, Nitoda E, Georgoudis P, Balidis M, Karageorgiadis E, Kozeis N. Contact Lenses for Keratoconus- Current Practice. Open Ophthalmol J. 2017 Jul 31;11:241-251. doi: 10.2174/1874364101711010241. PMID: 28932340; PMCID: PMC5585463.
41. Wei RH, Khor WB, Lim L, Tan DT. Contact lens characteristics and contrast sensitivity of patients with keratoconus. Eye Contact Lens. 2011 Sep;37(5):307-11. doi: 10.1097/ICL.0b013e3182254e7d. PMID: 21792058.
42. Badrinarayanan A, Balakrishnan AC, Dutta R, Kumar RM, Iqbal A. Impact of Scleral Lens Front Surface Eccentricity on Visual Acuity, Contrast Sensitivity, and Higher-Order Aberrations in Eyes With Keratoconus. Eye Contact Lens. 2023 Sep 1;49(9):374-378. doi: 10.1097/ICL.0000000000001007. Epub 2023 Jun 2. PMID: 37272679.
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