On-eye performance of custom wavefront-guided soft contact lenses in a habitual soft lens-wearing keratoconic patient.

PURPOSE To assess visual, optical, and fitting characteristics for wavefront-guided soft contact lenses produced for one habitual soft lens-wearing moderate keratoconic eye. METHODS A process for production and evaluation of custom wavefront-guided soft contact lenses was developed. Wavefront aberrations were quantified with the COAS-HD wavefront sensor (Wavefront Sciences); soft contact lenses containing both high and low order aberrations were designed with custom software and produced using an ophthalmic lens lathe. Photopic high and low contrast logMAR visual acuity were recorded with the lens in place over an artificial 5-mm pupil and residual 2nd to 10th order root-mean-square (RMS) aberrations were analyzed over a 5-mm pupil. Comparisons were made to the eye's habitual toric soft contact lens using t tests. RESULTS Photopic high contrast values for habitual and final custom contact lenses for a 5-mm pupil were 0.07+/-0.06 and -0.08+/-0.05, respectively. Photopic low contrast values were 0.73+/-0.06 and 0.62+/-0.07, respectively. Habitual and final custom correction low order RMS over a 5-mm pupil were 2.08 and 0.34 microm, and high order RMS levels were 0.77 and 0.39 microm, respectively. CONCLUSIONS The final custom contact lens showed 1.5 lines of improvement for photopic high contrast (P=.03) and 1 line for photopic low contrast (P=.11) over a 5-mm pupil compared to habitual correction. Low and high order aberrations were reduced by 84% and 50% over a 5-mm pupil, respectively. Further improvements in performance of custom lenses may be achieved with further wavefront iterations.