A 35-year-old with advanced keratoconus cannot tolerate rigid gas-permeable lenses due to constant discomfort despite several fittings, and central corneal scarring is minimal. The MOST appropriate next step in visual rehabilitation is:

• A Scleral contact lens fitting ✓
• B Repeat fitting with larger standard soft lenses
• C Corneal collagen cross-linking
• D Immediate penetrating keratoplasty

Explanation

Scleral lenses rest entirely on the sclera and vault over the irregular cone without touching the apex, eliminating the bearing discomfort of RGP lenses while the fluid reservoir behind the lens neutralises irregular astigmatism and also protects the cornea. They are the standard option for RGP-intolerant keratoconus before considering keratoplasty. Cross-linking halts progression but does not improve vision, and penetrating keratoplasty is reserved for failure of all lens options or significant scarring.

Reference: Khurana, Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.