AOA enhances scleral lens success

Karen R. Hoffman, OD, used three AOA 2025 cases to show how a scleral lens can succeed when the peripheral landing zone is customized instead of left in a standard shape. Optometry Times reported on June 26, 2025 that Hoffman’s poster focused on customizable toric peripheral curves in Zenlens, a Bausch + Lomb scleral lens, for patients with irregular astigmatism and complex corneal anatomy. The cases centered on a practical fitting problem: a lens can vault the cornea well but still decenter, impinge or feel unstable if the scleral landing zone does not match the eye’s asymmetry. In Hoffman’s account, changing that peripheral geometry improved fit, vision and wear time in difficult eyes. ### What exactly was being customized in these lenses? Optometry Times said Hoffman framed scleral lens design in three zones: the optical zone, the vaulting chamber and the peripheral haptic. The toric peripheral curve adjustment was applied to that outer landing area, where the lens meets the sclera rather than the cornea. Hoffman said that approach lets clinicians align the lens more precisely in eyes with asymmetric scleral shape. (optometrytimes.com) Bausch + Lomb’s meeting preview listed Hoffman’s poster as “Utilization of Customizable Toric Peripheral Curves to Optimize Scleral Lens Fit and Vision Outcomes in Patients with Irregular Astigmatism and Corneal Complexities.” The company listed the presentation among its posters for Optometry’s Meeting in Minneapolis, held June 25-28, 2025. (optometrytimes.com) ### Which patients were these adjustments meant to help? The AOA 2025 coverage described the target group as patients with complex corneal conditions and irregular astigmatism. The upstream reporting on the case series identified post-keratoplasty and ectatic corneas as examples where standard geometry can struggle to center and align properly. In those patients, the fitting issue is often not whether a scleral lens can vault the cornea, but whether the edge and landing zone can remain stable on an uneven ocular surface. (ir.bausch.com) Optometry Advisor, summarizing related AOA 2025 material, reported that Karen Hoffman, OD, and Cian Gildea, BScOptom, presented three case studies from experienced scleral lens fitters using Zenlens in Minneapolis. That report said the work involved irregular astigmatism and complex corneal conditions, matching the patient group described in the Optometry Times item. (optometrytimes.com) ### What changed in the cases after the peripheral curves were adjusted? Optometry Times reported that customizable toric peripheral curves “significantly improve fit, vision, and wearability” in patients with challenging ocular anatomy. The article described improved alignment as the mechanism that allowed better centration and more stable lens performance. In practical terms, that means the lens was not only clearing the cornea but also sitting more appropriately on the sclera. (optometryadvisor.com) A separate Optometry Times article published June 28, 2025 on Hoffman’s AOA presentation about microvaults reported that three patients with complex corneas achieved 20/20 vision and comfortable extended wear with customized scleral lenses. That was a separate customization feature, not the toric peripheral curve report itself, but it came from the same presenter and meeting and showed the same emphasis on tailoring lens design to anatomy. (optometrytimes.com) ### Why does this matter before another surgery is considered? The June 26, 2025 report positioned customized scleral fitting as a rehabilitation option for patients whose optics remain poor because of irregular corneal shape. In those cases, the article suggested that a fitting failure may reflect lens geometry rather than a dead end for scleral therapy. That matters in post-graft and ectatic eyes, where another procedure carries its own risk and cost, and clinicians may first try to improve vision through specialty lens design. (optometrytimes.com) This is an inference from the case-series framing and the patient types described in the coverage. Optometry Times’ author page shows Hoffman had two AOA 2025 reports on scleral customization published on June 26 and June 28, 2025. Those reports remain the clearest public descriptions of the cases and the fitting approach presented at the Minneapolis meeting. (optometrytimes.com 1) (optometrytimes.com 2)