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Keratoconus patient fit into custom scleral lens

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A nice patient was seen today for a specialty contact lens consultation. He was diagnosed with keratoconus 2 years ago at the age of 34 years old. He wore focus daily soft lenses for years, but 2 years ago, he noticed some changes in his vision, which led his optometrist to perform a topography. The topography revealed keratoconus OD>OS.

He gets Pentacam images every 3 months, and his corneas are both very stable, which is why he has not had corneal cross linking.

He was then fit into different scleral lenses which didn't feel right (comfort wise) and the most recent lenses made him feel "wonky." His main complaint was that his eyes suffer from ghosting, especially at night. With the current scleral lens, the ghosting is still apparent sometimes when the lens decenters.

We decided to perform a few tests and see for ourselves.

His scleral topography is interesting because the more elevated areas are at more of an oblique axis, which might explain why the traditional scleral lenses did not fit perfectly. With a diagnostic Europa lens, he still noticed some ghosting and accepted cylinder in his over-refraction. I performed an over topography to check for flexure, and it appears that it is possible that the lens shape could be contributing to the residual cylinder.

After analyzing all of the image, Sabrina from Visionary Optics helped me design a new lens for him. We decided to keep any cylinder out of the first pair, because that will make things more challenging if we need to alter the fit or Rx later. We are going to increase the optic zone to 9.0 mm to help with the ghosting as well. I am hoping that by order the custom Latitude scleral lens, the lens will center much better and will help to decrease or eliminate the ghosting.

Looking forward to his dispense. Thanks to the sMap team for their help with this fun case!

corneal map keratoconus
Topography right eye

right eye
over ks 1
over ks 2
over ks 3
left eye

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