How do visual outcomes differ among scleral lenses, refractive surgery, and phakic IOLs in keratoconus patients with irregular astigmatism following cross-linking?  

These are three distinct avenues of treatment for KC. The visual disability in keratoconus is secondary to perturbation of the corneal optics. This manifests itself in changes in sphere, cylinder, and optical aberrations. Scleral contact lenses, for the most part, correct all three and often give ex...