The effect of landing zone toricity on scleral lens fitting characteristics and optics

Abstract Purpose The fit and optical performance of a scleral lens is affected by the alignment of the landing zone with the underlying ocular surface. The aim of this research was to quantify the effect of landing zone toricity upon scleral lens fitting characteristics (rotation and decentration) and optics (lens flexure) during short‐term wear. Methods Scleral lenses with nominal landing zone toricities of 0, 100, 150 and 200 μm were worn in a randomised order by 10 young healthy participants (mean [SD] 24 [7] years) for 30 min, with other lens parameters held constant. Scleral toricity was quantified using a corneo‐scleral profilometer, and lens flexure, rotation, and decentration were quantified using over‐topography during lens wear. Repeated measures analyses were conducted as a function of landing zone toricity and residual scleral toricity (the difference between scleral and lens toricity) for eyes with ‘low’ magnitude scleral toricity (mean: 96 μm) and ‘high’ magnitude scleral toricity (mean: 319 μm). Results Toric landing zones significantly reduced lens flexure (by 0.37 [0.21] D, p < 0.05) and lens rotation (by 20 [24]°, p < 0.05) compared with a spherical landing zone. Horizontal and vertical lens decentration did not vary significantly with landing zone toricity. These trends for flexure, rotation, and decentration were also observed for eyes with ‘low’ and ‘high’ magnitude scleral toricity as a function of residual scleral toricity. Conclusion Landing zones with 100–200 μm toricity significantly reduced lens flexure (by ~62%) and rotation (by ~77%) but not horizontal or vertical lens decentration, compared with a spherical landing zone, when controlling for other confounding variables. The incorporation of a toric landing zone, even for eyes with lower magnitude scleral toricity (~100 μm), may be beneficial, particularly for front surface optical designs.