Treating Keratoconus With The cKlear Method™

Do you have Keratoconus or other Corneal Dystrophies? When Dr. Barry Leonard was first diagnosed with Keratoconus in the 1980s, not much was known about diagnosing it, and even less was known about how to treat it effectively. That left Dr. Leonard with dry eyes, red eyes, eternal discomfort from his contact lenses and the inability to see clearly most of the time.

Today, the cKlear Method™ for Keratoconus and other Corneal Dystrophies, developed at the California Keratoconus Center, is the state-of-the-art method for the diagnosis and non-surgical treatment of Keratoconus. So if you have Keratoconus, you finally have the opportunity to see clearly with the cKlear Method™.

What Is Keratoconus?

Keratoconus is a somewhat rare condition where the cornea forms into a cone shape. Normal corneas are symmetrical, smooth and round. In people with Keratoconus, the cornea protrudes in one or more bulges or “cones.” These bulges distort vision and make the eye more sensitive to glare. So, what is Keratoconus? Put simply, it’s a cone-shaped eye.

It isn’t easy to treat Keratoconus with glasses because light entering the eye from the different angles caused by the misshapen cornea is refracted differently by the cornea. Correcting the moving eye with a fixed lens in a pair of glasses is nearly impossible.

And conventional contact lenses don’t work well for Keratoconus either because contact lenses are designed to be mostly symmetrical and to rest directly on the cornea. That doesn’t work well on a bumpy cornea, which results in poor vision and an incredibly uncomfortable lens.

Conventional lenses also don’t work for patients with High-Order Aberrations (HOA) — glare, streaks, ghosting, and halos — that can make your life even more of a challenge than your Keratoconus.

Conventional Methods for Diagnosing and Treating Keratoconus

Today, most Optometrists and Ophthalmologists diagnose Keratoconus much like it was done in the 1980s. They frequently use a Keratometer to examine the cornea, which superimposes rings called “mires” on the cornea. These mires illustrate the elevation of the cornea, much like latitude rings on a globe when viewed from the North Pole. A normal eye will have perfectly round mires, and an eye with Keratoconus will have oblong, irregular and misshapen mires.

The problem with a conventional Keratometer is that it generally looks at the center 3 millimeters of a cornea, which is only about 10% of the cornea and none of the sclera — the white part of the eye. The eye doctor will use his own vision to estimate Keratoconus on the rest of the eye.

Other eye doctors may have a different instrument called a Topographer, which shows the “topography” (bumpiness) of up to 50% of the cornea and 0% of the Sclera. That’s better than a Keratometer but still falls short of an accurate Keratoconus diagnosis. That means the eye doctor still needs to estimate and guess at the complete prescription for a Keratoconus contact lens.

The rest of the Keratoconus is diagnosed visually using a microscope, which typically does not have an integrated camera system. That means the eye doctor must work from notes and memory and then rely on their own experience to design a Keratoconus contact lens.

Keratoconus contact lenses designed this way usually require four, five or more different lenses to be designed, fit, tested, and worn until the fit is “good enough.” That generally means a 1-2 week interval between each fitting, and each requires another visit to the eye doctor for the fitting.

In other words, the process is “Trial and Error…and Error…and Error.”

While this may produce the best that many Keratoconus patients have ever experienced, it’s not nearly as good as is possible with the cKlear Method™.

The cKlear Method™

Our focus at the California Keratoconus Center is to help Keratoconus patients see clearly and comfortably without surgery. So, the cKlear Method™ uses the latest technology, the most accurate instruments and a rigorous 6-Step Process — or a 7-Step Process if you have High Order Aberrations (HOAs) — to deliver the clearest, most comfortable vision possible.

Step 1: Standard Comprehensive Eye Exam

Eye doctors are taught in Optometry school that “People are entitled to more than one problem,” so if you have Keratoconus, it, unfortunately, may not be the only problem you have. That’s why the first step in the cKlear Method™ is a comprehensive eye exam.

This exam can reveal a variety of other issues that require treatment and may affect your Keratoconus treatment. These issues could include…

• Myopia
• Hyperopia
• Astigmatism
• Dry Eyes
• Diabetes
• Macular Degeneration
• Glaucoma
• Cataracts
• Torn or Detached Retinas

…and more. If you’ve recently had a comprehensive eye exam and were referred to the California Keratoconus Center by your doctor after a preliminary Keratoconus diagnosis, we can rely on the prior exam.

Step 2: cKlear Diagnostic Exam

The cKlear Method™ Diagnostic Exam is our first look at the topography of your eyes. We use a very precise instrument called the Nidek OPD III to examine and document the surface of your cornea. With the OPD III, we can…

• View and record your corneal topography
• Examine your pupil size in low and normal light
• View the power and elevation maps of the cornea
• Diagnose Dry Eyes
• Look for lumps and bumps of the cornea (called Pterygium and Pinguecula)
• Detect and measure HOAs if you have them

We then use a special Slit Lamp Microscope with a FireFly HD Camera System. With this instrument, we can…

• Look at your cornea
• Check for scarring, hazing and grafts
• Examine previous cataract surgery
• Evaluate your Dry Eyes more completely
• Examine your lids and lashes
• Check for allergy symptoms

If we were to stop here and design lenses for you, your vision and comfort would likely improve over what you have now. But the cKlear Method™ is just getting started.

Step 3: cKlear Method™ Preliminary Treatment Plan

At this point, we can determine if you have Keratoconus, the type, and its severity and have a good understanding of your best Treatment Options. Only in extremely rare occasions might we recommend a visit to an Ophthalmologist for corneal surgery — but this is when the cornea is in very, very poor shape, as with severe corneal scars or hydrops or if your Keratoconus is progressing rapidly.

In the overwhelming majority of cases, we can continue with the cKlear Method™ and recommend treatments for you. These options are based on the best contact lens for your diagnosis and your budget and include four different types of contact lenses.

• Conventional Soft Contact Lenses are most often used for the mildest cases of Keratoconus or for those who cannot or choose not to wear a hard contact lens.
• Rigid Gas Permeable (RGP) Lenses are hard lenses that can work for Keratoconus Patients with low elevations.
• Hybrid Lenses are hard in the center with a soft skirt and are easier for some patients to wear than regular RGP lenses.
• But by far, our most popular, versatile and powerful lenses — and often also the most comfortable- are Scleral Lenses. These larger contact lenses never actually touch your cornea but are designed to rest on the sclera — the whites of your eyes — and vault over the cornea itself. The lens remains stationary on your eye like a saddle sits on a horse’s back, without rotation. This allows us to design a lens for you with a different prescription at every point of the lens to match the exact peculiarities of your cornea.

All of these lenses have their strengths and appropriate uses. We will recommend the best lenses based on our diagnosis and consultation with you. Among the scleral lenses we most often prescribe are:

• ZenLens – ZenLens by Bausch & Lomb gives us many options for your Scleral Lens design. For example, ZenLens can be designed with Microvaults for localized bumps, shunts, pterygiums, and pinguecula.
• BostonSight Scleral – With BostonSight Scleral Lenses, we can put channels in the lenses, which are especially helpful if you’ve had a previous corneal graft. It’s also an excellent lens if you have High-Order Aberrations (HOAs).
• BostonSight FreeForm – The BostonSight Freeform lens, much like the BostonSight scleral lens, also allows us to design channels into the lens. And, like the ScanFit Pro (below), it allows us to design a lens for highly irregular sclera and HOAs.
• ScanFit Pro – The strength of the ScanFit Pro lens is that we can design lenses to fit highly irregular sclera.
• Ovitz Ares – One of the newest lenses on the market is the Ovitz Ares lens, which was developed especially for High-Order Aberrations. Ovitz has even designed its own Aberrometer, an instrument that measures corneas’ aberrations (irregularities).

We will recommend the best lens and alternatives based on your diagnosis, budget and insurance coverage.

Step 4: cKlear Method™ Design Exam

Once we’ve chosen a treatment plan, it’s time we get to the details of your eyes that 90% of other eye doctors don’t have the training, experience or equipment to see.

Zeiss OCT

The Zeiss OCT is an “Optical Coherence Tomographer” that allows us to view your eye to a resolution of 2 microns. We can look at your corneal and scleral profiles around all 360 degrees of your eye and measure the thickness of your cornea, both of which can affect prescription and lens design.

High Order Aberrations Analysis

Based on your symptoms or our prior Nidek OPD III evaluation, we may discuss your High Order Aberrations (HOAs). We can measure your HOA profile on the Nidek or the Ovitz Ares Aberrometer.

We see many Keratoconus patients who were previously fit with Intacs corneal inserts or implants. These are small plastic rings intended to resolve or improve your Keratoconus. However, what often happens with post-Intacs patients is that the back sides of their corneas will bend, resulting in HOAs.

The Nidek OPD III and the Ovitz Ares Aberrometer allow us to see the optical light path into the eye, enabling us to view your High Order Aberrations.

The result is that we can “see what you see,” including streaks, glare, ghosting, double and triple vision and more. When we show our Keratoconus patients the screen on the OPD III’s or Ovitz Ares Aberrometer and ask, “Is this what you see?” we often see tears because this is the first time in their lives they’ve ever been able to share with someone else the vision problems they have.

It’s an emotional time…but it doesn’t compare to what’s coming soon.

The Eaglet Eye Surface Profiler

The Eaglet Eye Surface Profiler is a full-featured topographical tool that allows your Optometrist to take highly accurate measurements of your cornea, Sclera and limbus (the area between the sclera and the cornea). The Eaglet can see and measure over 350,000 separate points across a 20mm area to precisely and accurately map every tiny detail in your eye’s surface, including 100% of your cornea and as much of the sclera as we need.

The Eaglet gives us a 3D image or map of your complete eye that we can rotate and tilt to show you the exact surface of your eye. For the first time, you will be able to see your Keratoconus. We use this same information in meticulous detail to design your lens.

If we have chosen either the BostonSight FreeForm lens or the ScanFit Pro lens, data from the Eaglet is sent directly to the contact lens labs, where your custom lens is manufactured. While we may need or want to make minor tweaks and adjustments on rare occasions, these lenses get us 98% of the way to a perfect fit.

In other words, the days of “Trial and Error…and Error…and Error” are over.

These first four steps in the cKlear Method™ typically happen within your first visit to the California Keratoconus Center and generally last about an hour to an hour and a half. At this point, we will design and order your new Keratoconus contact lenses. We will schedule your next visit, called the Dispensing Visit, in about 5 to 10 days when your lenses are created. Sometimes, we can even rush lenses to be ready in as few as two days.

You are sitting in front of a mirror at our Contact Lens Training Station. You’ve received your lesson on how to put in your lenses, and you’re putting them in for the first time. Sure, it may take a time or two to get used to doing it, but they’re now in, and you’re opening your eyes and…

And…WOW! Who is that good-looking person on the other side of that mirror? It’s YOU! It’s YOU like you’ve never seen before! For many of our patients, it’s the first time they’ve seen themselves clearly in a lifetime. And almost all of them quickly turn around to gaze across the room. “Hey,” they say. “I can read the sign on that wall over there!” and “Wow…I’ve never seen actual strands of hair on people before…just hairy blobs on heads.”

Some patients quickly walk into our front office and stare at the colorful displays around the room. Still, others rush outside to see the trees. They can’t believe what they see. LEAVES! Yes, many of our patients have never actually seen leaves on trees before.

And if they were driven to their appointment by someone they love — and that’s often the case because many Keratoconus patients are too afraid to drive, especially at night — they turn to that person and give the biggest smile of their lives because they’ve never seen someone so beautiful.

It’s a VERY emotional time for our patients. And hopefully will be for you, too.

Before you rush out of the office to explore the world, we want to check one other thing: the fit. Because it’s not just enough for you to see clearly, we want you to see comfortably, too. We’ll check the fit, the comfort and even the physiology. We’ll put you back on the Zeiss OCT and examine how well your lens fits your eye. If your lenses aren’t perfectly comfortable, we’ll make another set at our expense.

But with the cKlear Method™, more often than not, our patients experience First-Fit Success with their Keratoconus contact lenses.

It’s at this point that you may want to make a short testimonial video, so you can tell the world about what it’s like to see clearly and comfortably. We’d love to add your story to our library of cKlear Method™ patients.

Step 6: cKlear Method™ Progress Checkup

Even though you are seeing more clearly and more comfortably than you ever have in your life, you’re not done with us. We’ll schedule the next step in your treatment, the cKlear Method™ Progress Checkup, a couple of weeks after your Dispensing Visit and then at 3-to-6-month intervals. We want to ensure your Keratoconus isn’t progressing, that no new eye issues arise and that your lenses continue to fit well and allow you to see well.

At this point, your lenses are feeling great, and you are enjoying better vision than you’ve ever had. Apart from your Progress Checkups, the cKlear Method™ is complete for most patients.

However, if you also have High-Order Aberrations, there is one more step in the cKlear Method™.

Step 7: cKlear Method™ High-Order Aberrations Design

High-Order Aberrations (HOAs) occur at specific locations on your eye. That means that resolving them can only happen after we’ve got a perfect fit for your scleral lenses, which are designed to remain stationary on the sclera of your eye.

So, after your Progress Checkup, we will order a special “alignment lens” shaped exactly like your new contact lens. You will come in for a special cKlear Method™ High-Order Aberrations Design visit, during which we will put this alignment lens on your eyes and use our aberrometer to precisely measure your HOAs as they pass through your eyes and lenses. We use this additional data to fine-tune your scleral lenses.

When your new lenses arrive, you’ll return to try them on. Over time, as you go about your daily life — including driving at night, being outside with city lights all around you, movie theaters or among other bright lights — you will experience life with little, if any, issues with HOAs. And if any remain, we can schedule another follow-up visit to refine your lenses and improve your vision even more.

Make Your Appointment to See Clearly with the cKlear Method™.

We hope you understand the cKlear Method™ a bit better now and why it is so much more advanced than any other non-surgical Keratoconus treatment available. If you have Keratoconus and are ready to see clearly and comfortably for the first time in your life, make your cKlear Method™ appointment today by using our online appointment form or calling the California Keratoconus Center at 818-891-6711.