Keratoconus is a progressive, non-infl ammatory corneal ectasia characterized by thinning and weakening of the corneal stroma which results in its’ protrusion. The onset is during puberty and progresses until the fourth decade of life. In earlier stages, good visual acuity can be provided with spectacles. With progression, contact lenses are considered to be a better therapy. Aim of this study was to determine if there is statistically signifi cant difference between best corrected visual acuity (BCVA) obtained by spectacles and contact lenses in newly diagnosed keratoconus patients, as well as to determine which type of contact lenses provide better BCVA in keratoconus patients. We conducted a 5-year retrospective study of all 2891 patients attending our Contact Lens Department for the fi rst time, searching for patients newly diagnosed with keratoconus. Data were obtained on gender, age, education level, treated eyes, corneal changes, keratoconus severity, BCVA with spectacles, contact lenses and best fi tted contact lens type. All patients underwent standard ophthalmic exam, refractometry and keratometry have been done, followed by a spectacles correction and lens fi tting. Wilcoxon signed rank test was used for statistical analysis. Results showed that of all 2891 patients examined for the fi rst time, 137 patients (4.74%) have been newly diagnosed with keratoconus, there was male bias (72.26%), mean age 27.7±9.9 years. Most patients had high school education (51.11%), 3.70% had present corneal changes, 50.37% had mild keratoconus. Majority had keratoconus on both eyes (36.3%) or keratoconus of right eye (26.67%). There was a statistically signifi cant difference (p<0.001) between the BCVA obtained with contact lenses (0.82±0.21 Snellen chart) rather than spectacles (0.37±0.27 Snellen chart). The best corrected visual acuity was achieved with rigid gas permeable (RGP) lenses in majority of keratoconus eyes (51.85%), with semi-gas permeable (SGP) lenses in 43.39%, in 4.23% with polymethyl methacrylate (PMMA) lenses and with hard-soft gas permeable (GP) contact lenses in 0.53% of keratoconus eyes. We have showed that there is a statistically signifi cant difference in BCVA achieved better with contact lenses than with spectacles. RGP lenses are most frequently used in conservative treatment of keratoconus, but SGP lenses were also shown to be a good option that gives equally satisfying fi nal visual acuity with subjective comfortable feeling of contact lens wear.