When most people think of contact lenses, they think of smooth, round and symmetrical lenses that sit on smooth, round and symmetrical eyes. In a normal, healthy eye, the cornea is also smooth, round and symmetrical, which means a regular contact lens will sit on the eye very nicely. But if you have Keratoconus, you know that your cornea isn’t smooth, round or symmetrical, and regular contact lenses just won’t work for you. They not only won’t be comfortable, but they won’t fix your vision problems either. Conventional scleral lenses are a HUGE advancement for Keratoconus patients because they vault over the cornea, but a new development in scleral lenses — Freeform Contact Lenses — is making an even greater impact in clarity and comfort for those with asymmetrical eyes.
When we say that scleral contact lenses “vault” over the cornea, what that means is that the lenses have such a large diameter that they rest on the white parts of the eye, called the “sclera.” A clear fluid fills the void between the back of the contact lens and the front of the eye, creating an extremely comfortable lens that never touches the cornea.
Because of this vaulting over the cornea, we can design prescriptions into scleral contact lenses that are different at every point through which light enters the oddly shaped cornea…and the lens never even touches the cornea.
But conventional scleral lenses are still round, and most eyes are slightly to moderately irregularly shaped. Over the last four years, International use of the Eaglet Eye Surface Profiler, an important instrument we use in the cKlear Method™, has revealed that 93% of sclera have asymmetry, meaning they are not perfectly round. So instead of being shaped like a basketball, they are shaped a bit more like a football (though not quite that severe). As a result, when we design scleral lenses for our Keratoconus patients, we use the Eaglet and other instruments (including the Nidek OPD III and Zeiss OCT) to analyze the shape of each of the patient’s eyes, detecting imperfections down to 2 microns.
Then we use that information to custom-design lenses that will fit more comfortably on the eye, and also that will remain stationary on the eye. To visualize this, think in terms of a mixing bowl being reshaped slightly so that it fits on the eye much like a saddle fits on a horse — shaped differently from front to back than it is from side to side. These directions, which we’ll call “meridians”, are an important part of fitting scleral lenses. When designed properly, scleral lenses will not move, allowing us to very precisely design the right prescription into the lens.
But just as most eyes are not symmetrical, most meridians — the directions across which we have different curves — are not at 90 degrees to each other. In other words, the sclera doesn’t follow the same curve going up as it does going down, or going left as it does going right: the eye just can’t be thought of as four similarly shaped and sized quarters. In fact, in some eyes, the sclera curves differently in every direction.
That makes fitting asymmetrical eyes with symmetrical scleral lenses difficult: scleral lenses are designed to be more-or-less symmetrical along vertical and horizontal meridians, and the labs are built to make them that way.
Freeform contact lenses were invented to give us even more flexibility and power to correct a patient’s poor vision and to also make a more comfortable lens. That’s because Freeform lenses allow us to build almost any curve into a lens along almost any meridian to fit the most oddly shaped sclera. The freeform lens labs were built specifically to make asymmetrical lenses.
We can also think along more than two meridians. So, instead of only thinking about the curvature up and down, and left to right, we can think about four meridians, eight meridians, and if necessary even 16 or more. This allows us to not only design and create a more precise lens, but we can also have different curves on either side of the meridians.
So now, when we map your cornea with the Eaglet Eye Surface Profiler and it creates its extremely detailed 350,000 data points covering 100% of your cornea and 60% to 70% of your sclera, we send it directly to the lens lab, and get back an extremely accurate fit and lens.
So what does all of this technology and precision mean to the patient? To begin with, it all means very little unless you are seeing a doctor that has the technology and is trained to use it properly. But assuming your doctor has those qualifications, FreeForm Lens technology means that we can design a better lens that is more comfortable, better fitting, and produces better vision for the patient. FreeForm lenses also mean that the most accurate and comfortable lens can be produced in a shorter amount of time and with fewer visits.
At the California Keratoconus Center, we are already achieving a first-fit success rate of over 52%, with a second fit success rate of 95%…and it’s continually improving. The end product is vastly superior to what we have been able to achieve in the past.
Several manufacturers make FreeForm lenses. Which one is right for you?
BostonSight calls their FreeForm scleral lenses “Smart360 FreeForm” to emphasize that it uses the Eaglet’s profilometry data to follow the contour of your eye 360 degrees around. These lenses can be designed with channels that are very effective for post-graft corneas, and are excellent for designing scleral lenses for patients with High Order Aberrations.
Like the BostonSight lenses, the Gaudi HyperGeometric Scleral Lenses also give us tremendous flexibility in designing lenses for patients with High Order Aberrations. Gaudi has the newest technology to use data directly from the Eaglet in the manufacturing process for their lenses, and uses data from the Ovitz Ares Aberrometer, another important part of the cKlear Method, to create the HOA corrections.
EyePrint prosthetics is a leader in developing scleral lenses. Their EyePrintPro method for designing properly fitting scleral lenses is extremely advanced, but used a mold placed on the eye, which was not a pleasant experience for most patients. They then worked with the California Keratoconus Center to utilize data from the Eaglet Eye Surface Profiler in place of the data scanned from the mold.
Together, we developed a process that used the Eaglet data to produce a new type of lens called the ScanfitPro. We like to prescribe the ScanfitPro lens for eyes with bumps, lumps and shunts. Read more about the ScanfitPro here.
Here at the California Keratoconus Center, we are at the forefront of Scleral Lens Design because we work with the labs intimately to help create not only the lens, but also the process for creating the lens. Our patients are often the first in the world to wear certain lenses.
The flexibility and modularity of the technology in our cKlear Method, in addition to our experience in training other doctors in the design of Scleral Lenses and our relationships with the labs keeps us at the forefront of Scleral Lens technology.
And so we have the opportunity to try the best new techniques on patients, when warranted. Here are three notable recent results.
We recently re-fit a patient who had been wearing scleral lenses prescribed by another doctor a couple of years ago. By his own admission, he wasn’t doing great. The lenses were not as comfortable as he wanted, and his vision was poorer than he deserved.
He happened to be a CPA who spent his day looking at numbers on a screen, and who spent his leisure time on a sailboat. His vision was making both of those activities more difficult.
We took him out of his lenses for 72 hours in order to get good scans on the Eaglet and Nidek that were unaffected by his old lenses. We then took him step-by-step through the cKlear Method, and prescribed Gaudi Lenses.
We dispensed the lenses to him just the other day. He immediately began seeing two lines better on the eye chart — specifically from 20/40 vision to 20/25 vision. His comment to me was “Just WOW!”
This case study is very personal to me because I am the patient. As you may already know, I was diagnosed with Keratoconus in the mid 80’s while in Optometry school. Since that time, I have dedicated myself to the study, treatment and innovation for patients with Keratoconus.
I had been wearing the same Scleral Lenses for over a year, and I wanted to see better and feel better, too. I refrained from wearing my scleral lenses for 72 hours and spent the time at home looking at my mobile phone 6 inches away from my face. Even then, it was a struggle and a great reminder about how important the work is that we do for our Keratoconus patients.
On Monday I was driven to my office, where Dr. Villalobos took me through the cKlear Method and scanned my eyes with the Eaglet Eye Surface Profiler. A few days later, my new BostonSight FreeForm lenses arrived. I didn’t tell Dr. V I was wearing them, but the first thing he said to me that day was “Did you get your new lenses? Your eyes look better…less red!”
They feel better, too, and my vision has never been better.
We see a steady stream of Keratoconus Patients at the California Keratoconus Center, but Monday is a day I spend in my home office, reviewing patient files and making recommendations to other doctors who have asked for my expertise with their patients.
We had a new patient who could only come in on Mondays. So Dr. Villalobos and our staff took the patient through the cKlear Method, including analysis with the Eaglet Eye Surface Profiler and Nidek OPD III. All of the data was transmitted to my home office, where I analyzed the data remotely. Complicating the issue was that this patient had a Cataract in one eye.
From there, I selected the best type of lens for the patient and designed the lenses.
His new BostonSight Smart360 FreeForm Lenses arrived at the Center, and he came in the following Monday. This patient can now see three lines better on the eye chart, from 20/60 to 20/25. He couldn’t be happier, saying that he is more comfortable driving and that using a computer is now easier than ever.
If you have Keratoconus and have struggled with conventional, RGP or even scleral contact lenses in the past, you might be a good candidate for FreeForm contact lenses. Contact the California Keratoconus Center at 818-891-6711 for an appointment, or use our online appointment form for Keratoconus Patients. Let’s discuss your case and figure out if FreeForm Scleral Lenses are right for you, and maybe you will be our next case study.