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KERATOCONUS CONTACTS

Corneal Transplant Patient Looking To Improve Vision

Thank you for the kind referral from Dr. Tami Le!

49 year old African American male came to us looking for a way to improve his vision. The patient has had corneal transplants in both eyes due to severe keratoconus diagnosed in 2013. His entering visual acuity was 20/200 right eye, and 20/200-1 left eye.

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After 3D sMap images were taken, it was discovered that the patient had almost 507 microns of scleral toricity in the right eye! The sMap is a special instrument in our office that takes a 3D scan of the patient's eye to determine the shape of the eye. For comparison, a normal scleral toricity is about 125 microns and he has over 500 microns! When someone has a very unique shape, such as this patient, we usually recommend a custom scleral lens right off the bat to minimize the amount of remakes and improve overall success of lens fitting.

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The patient was fit into Custom Latitude Scleral Lenses in both eyes.

OCT Od Latitude central clearance 353um

OCT OS Latitude central clearance 300um

The lab designed the lenses and shipped them to our office.

The patient came in for his dispense and with the lenses on and an adjusted over refraction, the patient was able to obtain 20/20-2 right eye and 20/25+1 left eye! What a huge improvement in his vision in both eyes! This patient will not only achieve better vision but now he is legal to drive! The functionality of his vision is going to be spectacular!

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OS scleral elevation

When we inserted his scleral lenses, he was so excited to be able to see clearly for the first time in years! This is always such a joy to experience in the office.

We are so excited that his vision improved so much and we cannot wait to report his findings from his follow up visits! Keratoconus patients are so rewarding, and it is such a pleasure to help them see better!

Keratoconus Patient Wore Gas Permeable Contacts For Many Years

Thank you Dr. Ochiltree for this kind referral!

73 yo female has worn gas permeable lenses for many years due to keratoconus.

Keratoconus patients are not able to wear traditional contact lenses or glasses due to the irregular shape of their eye. Many times, corneal gas permeable lenses, hybrid lenses, custom soft lenses or scleral lenses are needed to improve their vision.

Over the past 8 years, we have successfully managed her with corneal gas permeable lenses.

In the last few months, she reported that the lenses were starting to slip and move around with increase in discomfort. She reported a long history of dry eyes with excessive mucous strands and her primary care optometrist (Dr. Ochiltree) told her that her gas permeable lenses had protein and deposits building up on the lens surface.

Upon our examination, she had several areas of dellen, SPK with staining, corneal neovascularization and pannus. We also found that her gas permeable lenses had heavy protein and lipid deposits and scratches.

At this point, we reviewed some of the options. The first option is we could keep her into the same corneal gas permeable lens type of lens. We also discussed some of the pros and cons of other lens designs such as hybrid lenses and scleral lenses. After discussing all designs, she chose the custom scleral lens.

Due her dry eye syndrome, corneal neovascularization and high scleral toricity, we felt that she would be most successful in a custom scleral lens.

Patients with dry eye may benefit from scleral lenses. This is due to the fact that there is a layer of liquid that bathes the eye all day. Gas permeable lenses rest directly on the cornea, so they can rub and irritate the eye surface. Scleral lenses do not touch the cornea at all, and rest on the white part of the eye, which has significantly less nerve endings. This results in a very comfortable lens for many dry eye patients.

With the help of Visionary Optics, we were able to design custom scleral lenses using 3D technology.

Switching between GP lens wear and scleral lenses can take some time to get used to. The patient was surprised at the stability of her vision when she looked toward her right and left. She could see 20/20 at distance out of each eye and she was happy with the comfort! Overall, she has been very happy with the change! We are excited to see how she progresses over the next few weeks.

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OD pannus at 800OS cornea and temporal conj irregularity

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cornea OS

Latitude® Custom Scleral Lenses

OD OCT central clearance 152

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OS OCT central clearance 165

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Patient switched into a custom scleral lens design after failing in a traditional scleral lens

We have been working with a 25 yo male with h/o keratoconus OS>>OD s/p CXL. He found us online looking to see if he can improve his vision with scleral lenses. His vision with his glasses was 20/30 in the right eye and 20/400 in the left eye. He was also having problems with night vision.

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Despite multiple changes, there was still excessive seepage into the 12:00 and 6:00 position, indicating a large amount of scleral toricity.

He was first fitted into the ZenLens and was able to achieve 20/20 vision in the right eye and 20/30 vision in the left eye with significant improvement in his night vision. Unfortunately, he was experiencing significant redness nasally and temporally. After several designs of increasing the haptics and vaulting over the pinguiculas, he continued to experience injection after an hour of wear. Due to the limitations of non-custom scleral lens designs, we recommended a custom Latitude lens in order to reduce the redness. When we have to make alterations to the lens design more than 2 times, we will often times switch designs completely.

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We refit him into a custom scleral lens, which fits his eye much better than the traditional scleral lens.

After imaging him with the sMap3D, we found that he had a scleral toricity of almost 400 in both eyes! The average scleral toricity is about 150-170 which can help explain the nasal and temporal redness he was experiencing with the previous scleral lens.
With the Latitude lens his redness significantly improved, only noticing a mild amount at the end of the night. In addition to the improved fit, he was able to achieve 20/15 vision in the right eye and 20/20 vision in the left! We are so thrilled that he is doing so well!

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?

How Do I Get Insurance to Pay for My Scleral Lenses?

How do I get insurance to pay for my scleral lenses?

If you have medical or vision insurance, they may contribute toward the cost of scleral lenses.

Some insurance companies such as VSP or Eyemed will reimburse eye doctors quite well for scleral lenses, and many offices accept this insurance for scleral lenses.

Other insurance plans reimburse eye doctors poorly for scleral lens fittings. Some of them reimburse less than the cost of the lenses! In this case, it is not feasible or realistic to expect your doctor to fit you into scleral lenses.

One way to get your insurance to cover scleral lenses is to have your doctor write you a letter of medical necessity.

This letter should include”

– Patient’s name

– Patient’s date of birth

– Date patient was seen

– Patient diagnosis

– Patient’s vision (uncorrected)

– Patient’s vision (corrected with glasses)

– Patient’s vision (corrected with scleral lenses)

– Abnormal findings

– Recommended treatment and plan

– ICD 10 codes

– CPT codes

– V codes

The letters we write for patients explain to the insurance company why the patient needs scleral lenses. Usually, our patients suffer from a medical eye condition such as keratoconus, corneal scarring, corneal transplants, RK scarring, post LASIK, etc so the reason they need scleral lenses is to improve their vision. Other patients have medical eye conditions such as extreme dry eye, graft-vs-host disease, sjogren’s, stevens-johnson and other disorders related to the ocular surface. Whatever the reason is, we will write a letter explaining to the insurance company the need for scleral lenses.

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Our patient who has extreme dry eye. Notice the major difference in her eyes before and after scleral lenses.

You can also have your doctor give you a list of diagnosis codes, ICD-10 codes, CPT codes, and V codes, along with the pricing for each service. This will allow the insurance company to see what is being requested, and the specific dollar amount needed.

Your insurance company may also request to speak with the doctor. In this case, your doctor will set up a meeting with the insurance company to explain your medical eye condition and explain why scleral lenses are necessary.

With some help from your doctor, you may be able to get a portion or the entire scleral lens fitting covered through your insurances.

Does Insurance Cover Scleral Lenses

Does insurance pay for scleral lenses?

Yes. In many cases, insurance will cover the cost of scleral lenses. This is especially true if you have a medical eye condition, such as keratoconus. Both vision insurance and medical insurance may cover scleral lenses.

If you have a non-medical eye condition such as myopia, hyperopia or astigmatism, insurances will probably not cover scleral lenses. In this case, you would be responsible for all of the fees associated with the scleral lens process.

If you are identified as a good candidate for a scleral lens, your doctor will likely call both of your vision insurance and medical insurance plans. They will give them your diagnosis, along with the ICD 10 codes, and also some of the CPT codes and V codes to see if insurance will cover scleral lenses.

Then, their office will contact you to review what the insurance will and will not cover. From there, you can make a decision on whether or not scleral lenses are a good option for you.

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Your doctor’s office will review the total costs associated with scleral lenses prior to proceeding with the fitting.

Some insurances cover scleral lenses plus all of the costs associated with your fitting, dispense, insertion and removal training, and follow up care.

Some insurances will only pay for the scleral lenses, but none of the services. That means that you would be responsible for paying for the fitting, dispense and follow up care. Check with your doctor’s office to see how much you would be responsible for.

Other vision insurances cover medically necessary contact lenses, however the reimbursement is so low, that it cannot be used for scleral lenses. Scleral lenses are typically 10x higher in cost than a traditional gas permeable lens, and many insurance companies reimburse less than the cost of the lens! For instance, if the lens cost to your eye doctor is $500 and the insurance only reimburses $100, it would not make sense for that doctor to use the insurance to pay for scleral lenses. They would actually be fitting scleral lenses at a loss. In other words, it would cost your doctor money to fit you into scleral lenses!

This is why many doctors cannot accept vision or medical insurance plans for scleral lens fittings.

You can certainly check the provider network within your insurance company and call some of the eye doctors on the list who fit scleral lenses to see if that is a covered service within their practice.

At our clinic, we bundle the service and the lenses together into one lump sum. This fee covers the consultation, scleral lens fitting, dispense, insertion and removal training, follow up care plus the cost of lenses. We find this easier than charging patients every time they are seen.

Each doctor has their own way of figuring our their unique fees.

Bottom line: medical insurances and vision insurances can cover scleral lenses. Check with your eye doctor’s office to find out what your total cost (if any) would be.

Next: How Do I Get Insurance To Cover Scleral Lenses?

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!

Is there a genetic test for keratoconus?

Many patients ask us about some of the risk factors for keratoconus.

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Recently, a new genetic test for keratoconus launched, and we are incredibly excited to offer this service to patients! AvaGen is available to patients wanting to understand their genetic risk factor for keratoconus and other corneal dystrophies.

The process is very simple, easy, and pain free.

First, you will arrive to the office and answer a few questions about your medical history and family history. Then, you will rinse your mouth with warm water. This will remove any food or other particles from your mouth that may contaminate the test.

Next, the doctor or technician will gently swab the inside of your cheek with a cotton swab. Then this sample is sent to the laboratory for testing.

The laboratory will analyze your genetic sample and generate a report that allows us to view your genetic risk for keratoconus. This information can be very helpful to your doctor so they can manage your specific care at a customized level.

For instance, you maybe have been flagged as a keratoconus suspect in the past, but want to find out what your genetic risk for keratoconus is. If your results come back as “very high genetic risk,” your eye doctor may want to see you more frequently or perform additional tests during your visits.

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Think of it like this: If you have a family history of breast cancer, and your genetic risk factor is also deemed very high, your doctor may want to see you more often to ensure that you do not develop breast cancer. Or if you do develop breast cancer, you can be treated quickly, which is usually the key in stopping or slowing the disease in an early state.

Another example would be if you have keratoconus and you want to find out if your child is at risk. If your child ends up with a very low genetic risk for keratoconus, your eye doctor may feel comfortable seeing them on a less frequent schedule.

This information is incredibly helpful and useful for your eye doctor! If you have keratoconus and want to find out if your family members are at risk, please contact us today to find out more about this test!

Heartwarming story about a keratoconus patient

Touching stories like these will NEVER get old!

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We saw a 21 year old boy with keratoconus yesterday for a contact lens fitting. I had originally seen him at my office in Arizona a few months back for an initial consultation, and his father has worked very hard the past few months to save up money for the contact lens fitting.

He had corneal crosslinking in both eyes, and he also has intacs (plastic rings placed into the cornea) in the left eye. His best corrected visual acuity was 20/200 in the right eye and 20/400+2 in the left eye. He complained of very blurry and distorted vision, along with ghosting and issues with glare.

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We decided to fit him into the Ampleye scleral lens. With the 4200 sag on the right eye and 4400 sag on the left eye, we were able to achieve central clearance. Both lenses had excessive clearance, but instead of swapping out the lenses, I just consulted with the experts at Art Optical to adjust the vault.

With an over-refraction, he was able to achieve 20/20 vision in the right eye and 20/25 vision in the left eye! He was so amazed at how well he could see! His father was so happy that he started crying in the office. He told us “I just want my son to be able to see the stars.” What an amazing Dad!

Such an incredible and heartwarming case. We are so grateful and honored to help these patients achieve their best vision through specialty contact lenses.

Thanks again to the Art Optical team with your help designing the lenses.

We also recommended that his family members get screened for keratoconus by using a simple in-office test to find out genetic risk for keratoconus. If we discover a sibling’s genetic risk factor is very low, we might only need to see them for an eye exam yearly. If we discover a sibling’s genetic risk factor is very high, we may consider seeing them more than once a year. This is a great test to help doctors manage keratoconus risk at a very high level.

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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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