These days, more of our keratoconic patients are demanding improved levels of vision so that they may go about their days unhindered by blur and distortion. This is especially true in someone with monocular corneal disease, as these patients typically have a fellow eye with excellent vision, enabling sometimes unfair comparison. Fortunately with technological updates to contact lens technology, excellent vision is obtainable especially in patients with only mild to moderate levels of corneal ectasia and clear ocular media. This case describes how troublesome residual astigmatism in a non-rotationally symmetrical scleral lens can be alleviated with the use of a toric front optic-zone in a patient with moderate monocular keratoconus.
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