Soft contact lenses for irregular astigmatism after laser in situ keratomileusis

PURPOSE: To investigate soft contact lenses for managing irregular astigmat ism after laser in situ keratomileusis (LASIK). The prevailing notion has b een that soft contacts conform to corneal surface irregularities and have a limited role for managing LASIK-induced irregular astigmatism. METHODS: A 41-year-old man with bilateral central steep islands following L ASIK had best spectacle-corrected visual acuity of 20/40(+1) in the right e ye and 20/70(+2) in the left eye, despite 20/20 acuity in each eye with rig id contact lenses. Three soft lenses made of etafilcon A (58% H(2)0) in dif ferent center thicknesses were placed sequentially on each eye. All lenses were -2.00 D sphere, in the flatter of the two available base curves. With each lens, corneal topography, spherical over-refraction, and the resulting visual acuity were recorded. RESULTS: In all instances, corneal topography showed reduced surface irregu larity although at least some irregularity still transmitted through the le nses. Each spherical over-refraction gave better visual acuity than the cor responding best spectacle-corrected visual acuity. The right eye achieved 2 0/20 with the thickest lens and spherical over-refraction. The left eye ach ieved 20/25 with the lens of intermediate thickness and spherical over-refr action. The patient reported functional vision and good comfort with these lenses. CONCLUSIONS: Disposable soft contact lenses can modestly mask irregular ast igmatism caused by excimer laser ablation.