Why do patients with improved visual acuity drop out of RGP contact lens use? Ten-year follow-up results in patients with scarred corneas BERNA ÖZKAN, ORHAN EL  BOL, NURŞEN YÜKSEL, ÖZGÜL ALTINTAŞ, V. LEVENT KARABAŞ, YUSUF ÇAĞLAR Ophthalmology Department, Faculty of Medicine, Kocaeli University, Kocaeli - Turkey INTRODUCTION Corneal penetrating injuries and infections may lead to corneal scars. Corneal scars cause significant vi- sual reduction, mainly because of direct obstruction of rays by the opacity and also because of the irreg- ular corneal astigmatism. Eyeglasses cannot fully com- pensate for an irregular corneal surface (1, 2). Treat- ment options for this high degree of astigmatism have been expanded during recent years, with the advent European Journal of Ophthalmology / Vol. 19 no. 3, 2009 / pp. 343-347 1120-6721/343-05$25.00/0 © Wichtig Editore, 2009 PURPOSE. To evaluate the long-term results of rigid gas permeable (RGP) contact lenses and to investigate the reasons for patient dissatisfaction with this therapy. METHODS. Records of 17 patients (20 eyes) who started using RGP contact lenses for correc- tion of irregular astigmatism due to scarred corneas between 1995 and 1996 were evaluated retrospectively. Best-corrected visual acuities with or without RGP contact lenses were not- ed. The mean duration of contact lens use, reasons for discontinuation of therapy, and treat- ment methods preferred over contact lens use were evaluated. RESULTS. The irregular astigmatisms were induced by herpetic keratitis (3 eyes), corneal trau- ma (5 eyes), and previous corneal infections (12 eyes). All of the patients had increase in vi- sual acuity with RGP contact lenses (p=0.000). At the end of the follow-up it was found that only one patient was still using RGP contact lenses (5%). The mean duration for contact lens use was 21.42±4.53 SE months (2–72 months). The reasons for dropping out contact lenses were intervening surgical procedures (57.8%), loss of patient motivation (26.3%), recurrent punctate epitheliopathy (10.5%), and herpes simplex keratitis reactivation (5.2%). CONCLUSIONS. RGP contact lens use is a successful method of increasing visual acuity in scarred corneas. However, patients with good visual acuity in the fellow eye find it hard to remain mo- tivated for RGP contact lens use in the unhealthy eye. Furthermore, patients prefer permanent treatment methods even though these methods would result in decreased visual acuity. (Eur J Ophthalmol 2009; 19: 343-7) KEY WORDS. Rigid gas permeable contact lens, Scarred corneas Accepted: September 25, 2008 of finely controlled corneal ablation using excimer laser (3, 4). Before that, limited correction of astigmatism was possible with selective incision placement, placement and removal of sutures, and penetrating and lamellar keratoplasty. However, these procedures are of limited value due to limited availability of donor tissues, technical difficulties in traumatized eyes, and postoperative complications. Another treatment op- tion for irregular corneal astigmatism is optical cor- rection with rigid gas permeable (RGP) contact lens-