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KERATOCONUS CONTACT

Are Hard Contact Lenses Still Useful?

Are hard contact lenses still useful?

With the invention of scleral lenses, corneal gas permeable lenses may seem like a thing of the past. However, corneal gas permeable lenses still remain a very effective option for many patients.

We have the pleasure of seeing a patient with keratoconus. He was used to wearing a corneal GP lens for keratoconus, and wanted to remain in the same lens modality. His lens was 5 years old, however the fit still looked ok. There were some scratches and deposits on the lens surface, and there was some excessive touch on the apex of the cone.


Patient’s habitual contact lens (unknown parameters)

Based on the topography, we decided to try the Rose K 2 lens. This corneal gas permeable lens is great for patients with nipple cones and oval cones. He falls into the mild/moderate category of keratoconus, so we thought this was a good lens to try first.

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The topography shows a mild/moderate keratoconus with a nipple/central cone

Based on the fitting guide, we chose the base curve that we equal to his average K. The average K was 6.96mm so we selected the 6.9mm lens in the Rose K 2 fitting set.

When we placed the lens on the eye, it looked great! We were super happy with the fit and he was able to see 20/20 in this lens. Usually, we need to try several lenses on to get the perfect fit, but we really lucked out today! The lens was very well centered with good edge alignment. There is a very light feather touch on the apex of the cone, which is visible with the wratten filter.


The Rose K 2 lens was very well centered.

Stay tuned for his dispense!

NEXT: WHAT IS KERATOCONUS?

Can you use scleral lenses for sports vision?

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Topography of keratoconus patient’s right eye

Thank you Dr. Jen Burke for your kind referral!

Dr. Burke sent a 17 year old patient to use for a corneal consultation. Even though the patient can see 20/20 with glasses, he reports seeing “lines” in his vision when he looks at a light source, especially at night.

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Topography of keratoconus patient’s left eye

A topography was taken of each eye, and you can see that both eyes exhibit irregular astigmatism. The left eye has more irregularity than the right eye. The steeper area on the left eye is also displaced nasally, so as the pupil gets bigger at night, it gets into the steeper shape, which can cause even more distortion.

As a hobby, he races formula drift, so his visual quality is very important.

With glasses, he can achieve 20/20 in the right eye and 20/30+2 in the left eye. He reports that the letters on the left eye appear more blurry and distorted.

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Photo of patient’s right eye

His pachymetry readings do not show a super thin cornea, which is great news.

We trialed the Europa scleral lens today, to see if it improved his visual quality. With an over-refraction, he could see 20/15 in the right eye and 20/15 in the left eye. He noticed the distortion was gone in the left eye, too.

We decided that the Latitude custom scleral lens would offer him the best vision and comfort, so we took 3D images of both eyes today. That information was sent to the lab and will be used to design custom fit lenses for each eye.

We are hoping that scleral lenses will help him see better and help with some of the visual disturbances. Looking forward to seeing him at his dispense appointment next week!

Thanks again Dr. Burke for thinking of us!

Keratoconus patient sees clearly for the first time in years!

Keratoconus patients are so rewarding!

A 22 year old female was referred to us from Dr. Wellish. She has keratoconus in both eyes. She had corneal crosslinking in the left eye 3 months ago. She will be getting corneal crosslinking in the right eye next month.

She complains of blurry vision, distorted vision, and fluctuating vision. She states her left eye has been a lazy eye for quite some time and she remembers that her vision in that eye was able to achieve 20/40 at one point.

With glasses, she could achieve 20/80 vision in the right eye and 20/200 in the left eye.

After reviewing all of the options, she decided to proceed with the Latitude custom scleral lens. We took 3D images of the left eye and used a diagnostic scleral lens to determine her vision. To our surprise, she was able to achieve 20/20 vision!

We built a trial frame for her and let her roam around the office so she could get a sense of what her new vision would be! She was thrilled and her mom was thrilled too!

Such a fun case, we can’t wait to see her back for her dispense.

Keratoconus patient sees clearly

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Keratoconus patient sees clearly 3

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Keratoconus Patient fit into custom scleral lens

Thank you Dr. Dadej for your kind referral of your keratoconus patient to our office!

This young man was diagnosed with keratoconus about 5 years ago and was fit into hybrid lenses. The hybrid lenses were not comfortable, so he was switched into scleral lenses a few years ago. Hybrid contact lenses are a lens type that combines a gas permeable contact lens with a soft contact lens. The middle of a hybrid lens is made with a gas permeable lens which is then surrounded by a soft contact lens skirt. Hybrid lenses are used for a lot of different patients. The Ultrahealth hybrid lens is intended for Keratoconus patients. Many patients do well with hybrid lenses.

This patient wore scleral lenses successfully for years.

Dr. Dadej did a great job fitting him into new scleral lenses this year, but because of the severity of his keratoconus, the lenses were still not fitting just right. He developed a corneal scar on the right eye and the left eye, and Dr. Dadej referred him to me right away to help prevent a central cornea scar. Central corneal scars can cause significant vision impairment, and may require a corneal transplant if severe enough.

After discussing the different contact lens options, we decided on the Latitude custom scleral lens. We took 3 D images of both eyes and sent the images to Visionary Optics to help design and fabricate Latitude custom scleral lenses for him. With a diagnostic Europa lens and over-refraction, he achieved 20/20 vision in each eye and he was very happy. I am excited for his dispense!

Thank you again Dr. Dadej for thinking of us to help this special patient!

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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!

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Topography right eye

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left eye

Corneal Transplant Patient Fit With Custom Scleral Lens

We had the pleasure of seeing one of our keratoconus patients today for a specialty contact lens fitting for his right eye.

This patient has advanced keratoconus in both eyes. Last year, Dr. Stafeeva performed a corneal transplant on the right eye due to the advanced keratoconus disease. Many patients who have scarring on the front of their eye from keratoconus require a corneal transplant. She was waiting for the transplant to heal up on the right eye so she could perform cataract surgery (he had a visually significant cataract on the right eye as well).

In the meantime, we were focusing our efforts on his left eye to help improve the vision and the fit of the scleral lens. He has advanced keratoconus in the left eye with central scarring. He was fit with a scleral lens from another clinic, but when he saw us, the cornea had changed shape, and he advanced to the point where the cornea was touching the inside of the scleral lens. It is not safe for the scleral lens to touch the cornea, so it was important that we re fit him into a safer scleral lens design. He had a standard intraocular lens from cataract surgery in the left eye, as well as a scleral buckle from a prior retinal surgery. Since his eye was a very complicated case, we recommended a more custom scleral lens. A more custom fit scleral lens helps with lens comfort and can decrease redness.

We saw him in the summer of 2020 and ended up fitting his left eye into an EyePrint Prosthetic. With that lens, he was able to achieve 20/60 vision.

Today, we decided to fit his right eye into the Latitude scleral lens. We felt that because of his corneal transplant, along with the toric IOL in the right eye, a custom scleral lens would be the best option for him. With an over refraction of +2.00-3.50×116, he ended up achieving 20/15 vision! The Latitude scleral lens is a great choice for him because the custom fit of the lens will help to center and stabilize the optics of the scleral lens. This will allow for the best possible vision.

We are very excited for his Latitude scleral lens to arrive! With the amount of astigmatism, we did educate him that it could take 1 or 2 additional lenses to center the optics, but we do feel very good about the fact that he will be able to achieve such great vision.

Thanks for Dr. Stafeeva for thinking of us for this fun case!

Keratoconus patient fit with Ampleye Scleral Lens

18 year old male was referred to our clinic for a scleral lens fit to improve his vision. He was diagnosed with Keratoconus in both eyes two years ago. The first symptoms he noticed was blurry vision that did not improve with glasses. He wore Corneal Gas Permeable lenses which improved his vision but was unable to adapt to the comfort and discontinued wear. He had corneal crosslinking surgery in the right eye about a year ago and in the left eye about 6 months ago. Corneal cross linking is a surgery that is FDA approved to slow down the progression of keratoconus. This patient is very young, so cross linking is necessary to prevent his cornea from worsening over time. Since the surgery, he has not worn any contact lenses and still notices blurry vision and poor night vision.

During our initial evaluation, his vision was 20/60 in the right eye and left eye. His right eye had central corneal scarring and haze while his left eye had some striae. With a diagnostic lens he was able to see 20/30 in the right eye and 20/20 in the left eye. After experiencing the better comfort of the scleral lens on his eyes, he decided to proceed with the fitting! We fit him into the Ampleye scleral lens with optimum extra material.

We recently saw him for his first follow up after dispensing his lenses and found that he was able to achieve 20/20 right eye and left eye even with the central scarring! He shared that he felt much more comfortable with these lenses over his previous lenses.

We love helping keratoconus patients see again!

Keratoconus patient goes from 20/100 to 20/40 to 20/25+ in just a few weeks!

39 year old hispanic male was referred for dry eye in his right eye. He has a history of keratoconus in both eyes. He had corneal crosslinking performed in the right eye only. He has punctal plugs and uses preservative free artificial tears every hour with mild improvement. His current glasses are about 4 years old and his vision is 20/100 right eye and 20/200 left eye. His slit lamp findings showed thin tear meniscus and meibomian gland dysfunction in both eyes. His right eye had a central corneal scar with adjacent thinning inferior central and a nasal pterygium with about 2mm encroachment. The left eye had corneal striae and a temporal corneal scar. Due to his irregular corneal shape and large pterygium, we recommended an EyePrint Prosthetic.

At his dispense, he was able to achieve 20/40 vision in the right eye. The lens was fitting great with no compression over the pterygium. After about a month of wear with some time to adapt to the lens, his vision improved to 20/25+ in the right eye, even with the central corneal scar! In addition to the improvement of his vision, he was comfortable wearing the lens for 16 hours a day.

Corneal scarring can limit the vision potential in keratoconus patients, but we are very excited that he was able to improve to 20/25 in just a few weeks after wearing his new lens! He is thrilled, and we are so happy for him!

Intacs patient helped with scleral lens

This patient had LASIK years ago and then developed something called Keratoconus. Keratoconus is an eye diseases in which the shape of your eye steepens and thins over time. The result is highly distorted and blurred vision.

She then had small plastic rings called Intacs inserted into her eye to help stabilize the vision and the keratoconus. Unfortunately, one of the Intacs rejected and had to be removed, leaving her with a hazy cornea.

She can see count fingers out of this eye ( that is MUCH worse than the big E on the vision chart at the eye doctor’s office).

We fit her with a medical device called the EyePrint Prosthetic. This device is custom molded to fit your eye perfectly. With this device, she could see 20/30 right away! What a huge improvement in her vision and quality of life.

Keratoconus patient fit into EyePrint Prosthetic

Thank you Dr. Malik for your kind referral!

A 23 year old white male with Keratoconus was kindly referred to us for a specialty contact lens consultation.

With his glasses, he could achieve 20/400 in the right eye and 20/40 with ghosting and double vision in the left eye.

His topographies showed irregular astigmatism in each eye (right eye worse than the left eye). He does have striae and thinning on the right eye and thinning on the left eye. The rest of his ocular structures appeared normal.

After discussing the different options, he and his family decided on the EyePrint Prosthetic for each eye. We performed the impression on each eye in office, and the proceeded to a diagnostic scleral lens fitting to determine the vision potential.

The right eye went from 20/400 to 20/25-2 and the left eye went from 20/40 (ghosted and double) to 20/15-2 and no ghosting or double vision!

We sent the impressions out this evening, so the lab will start working on designing his devices early next week. We are thrilled for him! We cannot wait for his lenses to arrive!

Thanks again to Dr. Malik and his staff at Eyes and Optics for trusting us with his care! It’s always such a pleasure to be a part of a patient’s journey to better vision!