Properly Fitting Scleral Contact Lenses
One of the biggest complaints I hear from my new Keratoconus patients is their dissatisfaction with previous contact lens fittings. These patients often had to return to their Optometrist three, four or five times or more for refittings of their contact lenses because the doctor was not able to properly design a lens that would fit properly or comfortably on the eye and provide clear vision to the Keratoconus patient. I am not only a Keratoconus Doctor, but also a Keratoconus patient and so I have always worked hard to find ways to make Keratoconus contact lenses fit and work well from the start. My goal is First Fit Success for Scleral Contact Lenses, and we’re getting very close.
What Is Keratoconus
Keratoconus (pronounced KEHR-uh-toh-KOH-nus) is a progressive eye disease that turns your normally round cornea into a bulging and thinning cone shape. The cornea is an important part of the eye that is responsible for two main things: First, it bends and focuses light so you can see, similar to how a camera uses light to capture photographs. Second, it protects your eyes from dirt, germs and harmful UV rays.
In people with Keratoconus, the light bends in unusual ways depending on what part of the bulging and thinning cornea the light passes through.
Why Scleral Lenses Are Often The Best Choice for Keratoconus
Because corneas with Keratoconus are unusually shaped, a conventional symmetrical contact lens doesn’t fit on it very well. The result is poor vision (blurry vision, double vision, halos, ghosting) and tremendous discomfort for the patient (itching, watery eyes, dry eyes, red eyes, headaches). With lenses like these, a first fit success…or any success…is just not likely.
Scleral contact lenses provide a huge advantage for most Keratoconus patients because rather than a lens resting poorly on the surface of the cornea (like a saucer resting on an overturned tea cup), the Scleral lens is large enough to extend beyond the cornea and rest on the sclera, which is the white part of your eye. The Scleral lens actually vaults over the cornea, never touching it. A special saline fluid is used to fill the space between the lens and the eye, creating very comfortable and clear vision…provided that it fits properly.
The Problem With Scleral Lenses For Keratoconus
In the recent past technology was developed to allow Keratoconus doctors like me to graph up to 100,000 points on a cornea in order to determine a cornea’s shape and imperfections. The problem is that these points only covered about 60% to 70% of the cornea, leaving a large part of the lens’s design up to the dexterity and experience of the Optometrist.
The result is that patients, who were eternally hopeful to see clearly and comfortably, were repeatedly disappointed with new lenses that either didn’t fit right or didn’t correct the vision well enough. These patients seldom experienced a first fit success and could often return to their Optometrist three, four and five times (or more) as the lenses were incrementally improved.
This was a huge inconvenience and expense for the patient, especially if he or she needed to travel far to see their Optometrist.
First Fit Success for Keratoconus Patients
Technology has advanced significantly in the past few years, in particular with the invention of the Eaglet Eye Surface Profiler. This device has the ability to measure over 350,000 points on the eye, which includes 100% of the cornea and nearly all the visible sclera. This digital data, after being analyzed and verified by me, is sent directly to the contact lens laboratory, where the lenses are crafted with near-infinite precision.
The result is that I am now able to achieve a first fit success for my Keratoconus patients over 50% of the time, which makes my patients, very happy. Of those who we don’t fit perfectly at the first fitting, we have an overall 95% fit success by the second fitting.
First Fit Success Stories
To give you an example of how effective my method is in creating and fitting scleral lenses for Keratoconus patients, here are a few stories of some recent patients. Their names have been changed to protect their privacy.
James Works With Numbers…and Keratoconus
James works at a major film studio here in Los Angeles, spending his days pouring over numbers on his computer screen in his finance job. He had been a patient of mine for many years, and had been wearing Scleral lenses that I had prescribed for him years ago using the older technology that allowed him to see clearly and comfortably.
Keratoconus patients are advised to have their eyes evaluated every 6 months, and after a recent visit, it was time for a new set of lenses. This time we used the Eaglet to map his eyes, resulting in a first fit success, improved vision, greater comfort, and longer wearing time with his new Scleral Lenses.
Nighttime Drives To Work With Keratoconus Are Now Easier
Lisa is a 32 year old woman working as a restaurant manager in Orange County, California about 60 miles from my office. She frequently works at night, which is difficult with Keratoconus because the condition has symptoms that include glare, halos, double-vision ghosting and worse. At the time, the best her contact lenses could do for her was to improve her vision to 20/250 — hardly an improvement, and hardly good enough for normal functioning.
She found me and made an appointment to be diagnosed and treated. I used the Eaglet to map her eyes and produce a prescription for her new Scleral contact lenses. Lisa was thrilled with her first fit success with her new scleral contact lenses, but is even more thrilled with her 20/30 vision. Work is easier, life is easier and her drive to work is much less exciting.
This Child With Keratoconus Does Better at School
The link between poor vision and poor performance at school is well known. Thankfully, Ryan, an 11 year old boy in 6th grade in Bakersfield California worked hard to overcome his inability to see the board (or his classmates) very clearly. But his 20/80 vision (measured after correction using his current lenses) and advanced Keratoconus still made things more difficult than they should be for a child.
Because Ryan’s Keratoconus was progressing rapidly, we first prescribed Corneal Crosslinking, a procedure that halts the progression of the disease. After that procedure, we used the Eaglet and other equipment to more accurately diagnose and map his eyes. This was important because if we weren’t able to achieve a first fit success for Ryan, he and his mother would need to make the 200 mile/4 hour round trip several times.
But the new Scleral Contact Lenses fit him perfectly the first time. Ryan now enjoys 20/25 vision and is doing even better at school.
A Diamond Setter With Keratoconus Now Sees and Sets Better
You would think that clear vision would be important for a diamond setter, but Oscar, a 50 year man with Pellucid Keratoconus, had struggled with his poor vision for many years. The best vision he could achieve with a combination of contact lenses and conventional glasses was 20/60.
We mapped Oscar’s corneas and sclera with the Eaglet ESP and were able to produce a pair of contact lenses by his second fitting that brought his vision to 20/25 — near normal clarity with no discomfort.
Is It Your Turn For a First Fit Success?
If you have Keratoconus, then you’ve probably gone through the multiple office visits and fittings in order to achieve the slightly improved vision that you have now. But still, your contact lenses probably aren’t as comfortable as they could be, and you probably can’t see as well as you’d like to.
We are fitting Keratoconus patients with new Scleral lenses all the time now, so let’s see if we can get you seeing clearly and comfortably with your own new Scleral Lenses. For most Keratoconus patients, there is no better Keratoconus treatment than this. Make a Keratoconus appointment today either using our online Keratoconus appointment form or by calling me at 818-891-6711.