Management of Binocular Diplopia With Prism Incorporated Ocular Impression-Based Scleral Lenses With and Without Wavefront-Guided Optics

OBJECTIVE: The purpose of this study was to report the efficacy of prism-incorporated impression-based scleral lenses (pibSL) in the management of binocular diplopia. METHODS: This case series includes seven patients with various etiologies of binocular diplopia, including congenital and acquired conditions, that were managed with pibSLs. Of the seven patients, two had corneal irregularity. Visual acuity (VA), diplopia resolution, and subjective patient reports on comfort and cosmetics were assessed. Wavefront-guided (wfg) optics were incorporated in select cases where poor visual quality was reported. RESULTS: All patients experienced resolution of diplopia with VA improving to 20/20 or better with pibSLs. Wfg optics reduced residual higher-order aberrations, resulting in subjective improvement in vision quality and balanced VA. Patients reported high levels of satisfaction with pibSL. CONCLUSIONS: PibSLs are an effective, well-tolerated alternative to traditional prism spectacles for managing binocular diplopia and can address multiple comorbidities. The addition of wfg optics further improved visual quality in patients with complex visual needs.