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Posts Tagged ‘keratoconus treatment’

Christian’s Keratoconus Story – “ClearKone Changed the Way I See Life”

Thursday, June 23rd, 2011

My vision challenges began in junior high school when I started to wear glasses. Although my vision was fine at that time, things started to change when I entered high school. I began to notice that I wasn’t able to read the chalkboard. Even though I sat in the front row, I found it difficult and frustrating to read the teachers’ notes. I went back to my optometrist, who gave me another pair of glasses with a stronger prescription. Unfortunately, the new glasses only helped for a period of time. By the time I was in my junior year, my vision was a problem again. The new glasses no longer corrected my vision. I decided it was time to see a new optometrist. 

In my senior year of high school my new optometrist, Dr. Barry Leonard, diagnosed me with keratoconus. While I was glad to have found out the cause of my vision problems and learn that contact lenses could improve my eyesight, I could never have imagined the contradictions that came with contact lens wear. My doctor fit me in RGP lenses, which did improve my vision, but the lenses were so uncomfortable. My eyes were often irritated, so I would try to function without wearing the lenses. Unfortunately, my vision was so poor without them that I could not drive, see faces of friends at a distance, or read a book with small font. Keratoconus was truly affecting my daily activities!

Dr. Leonard then recommended that I try the ClearKone lens from SynergEyes. He explained that the rigid center would give me the visual acuity I needed, while the soft skirt would keep my eyes comfortable throughout the day. It sounded like a great option! As we began the fitting process, it was difficult for my lids to open wide enough for the lenses to be inserted. My eyes were so sensitive that my lids would close whenever the lens got near my eye. Thankfully, Dr. Leonard was very patient with me, and after many attempts, was able to insert the lenses.

Once I began wearing the lenses, I was amazed. My vision was clear and crisp, and the lenses were so comfortable that I could wear them all day long without irritation. It really was the best of both worlds!

I have now been wearing the lenses for several months, and my life has changed in so many ways. I can distinguish faces from a distance and see their expressions, which is so wonderful! I am also able to drive, use the computer, and read books with small font. I feel like I now have a normal life without the frustrations of poor vision. ClearKone lenses have truly changed the way I see life!

Melanie’s Keratoconus Story – “Life Inside an Impressionist Painting”

Tuesday, December 21st, 2010


ClearKone Sharing Vision Grant Recipient

Melanie's Keratoconus Story

I live inside an impressionist painting, where colors smear across the canvas and ghost images hover around any large object I can actually identify. At night, my world is ablaze with eight-pointed stars that spring from every source of light – headlights, streetlamps, neon signs and even candles on the altar at church. When I try to focus on your face, I see a double image of your features; your eyes and nose and mouth run together like melting wax. Like a blind person, I focus on your voice, your height and weight, and the way you move. I miss seeing you smile and roll your eyes and grimace – all the nuances that nurture communication. Because I can’t see you clearly, I often misunderstand. I’m a writer and graphic designer, but I can’t read the words on the monitor as I type them. I can’t read a letter or take legible notes when I talk on the phone. The more I enlarge the letters on my monitor, the more they smear. I squint. I turn my head, and try to capture a pinpoint of light that will fall on my retina at just the right angle and reflect a clear impression of what’s before me.


I’ve lived for 39 years as a classic myope, “seeing” new places and people and experiences through my enormous collection of novels, reference and business books, textbooks, biographies, and books on art, psychology and spirituality. At one time, I could take out my contact lenses before I went to bed, put on a pair of bottle-bottom glasses, and settle under my down comforter to read myself to sleep. Since having RK surgery some 17 years ago, however, there’s not a lens in the world that can filter light through my damaged corneas and hit the sweet spot on my retinas. If I want to read these days, I must wear both contact lenses and reading glasses, and maintain a powerful squint.

Now I’m locked into a smeared world filled with beautiful works of art and brilliant literature, as well as the simple pleasures and necessities of sight – the daily newspaper, the buttons in the elevator, the menu at the meat-and-three, the birthday card from a friend, the calorie count on a carton of yogurt. I can’t see any of them clearly enough to use them. Bursts of light are excruciating for my damaged corneas. Sometimes it’s seemed easier just to stay in bed in despair and sleep the days away.

To adequately explain why ClearKone® lenses made such a difference in my life, I have to explain the impact of my RK surgery. I started wearing glasses when I was eight and contacts when I was 12. I could always read without correction, but the glasses and/or contacts were critical if I needed to see anything beyond my books. When RK surgery came to the forefront in the early 1990s, I jumped on the bandwagon and had one major procedure and one “touch-up” performed on each eye by one of the city’s most prominent ophthalmologists. For a few weeks, I lived the miracle of 20/10 vision. I could see the lighted display on my clock in the middle of the night. I no longer had to baby expensive contact lenses or endure the pain of getting debris caught under them. I could move from reading to driving to computer work seamlessly, ride freely in a convertible without worrying about dirt flying into my eyes or my contacts drying out, swim and see at the same time, and best of all – my vision was better than it had ever been in my whole life!

My 20/10 days lasted for about a month, and then the unthinkable happened. My vision began to deteriorate, both at near vision and at a distance. My new crystal-clear world slipped away from me day by day, and I began what would be a 17-year quest to regain my sight. My doctors tried every contact lens available. While I could see fairly well with gas permeable lenses, they were pure misery to wear, rubbing against my RK incisions and forcing me to take them in and out, over and over, every day. My vision fluctuated so much in the course of a day that no prescription glasses ever gave me clear vision at any distance. With menopause, my dry eyes dried out even more. I had my tear ducts cauterized. I tried wearing nothing but glasses for months in hopes that my vision would stabilize and adapt to the glasses, but it didn’t work I moved to another city and new optometrists tried to help me. We tried various soft lenses, but they only draped themselves over my flat cornea and many incisions and did little to help me see, although they were more comfortable than gas perms. My optometrist tried piggy-backing a gas perm lens over a soft lens, but the lenses wouldn’t center. I spent endless hours on the internet and phone, talking with specialists throughout the country, trying to find the one doctor who might have a rare and unpublicized solution for failed RK procedures.

Finally, with the dawning of the new century, the first hybrid lenses came on the market, and after weeks and weeks of fittings and trial and error, for the first time, I had decent vision and decent comfort with monovision Soft Perm lenses. I still couldn’t be corrected with glasses, so I was heavily dependent on my contacts to read, drive, and work. Because my RK incisions were so prone to irritation, the hybrid lenses would periodically cause one or more of the incisions to open up. That was agony, both because of the pain and because I would be unable to wear the lens (and thus become visually disabled) until the incision healed enough for me to tolerate it again. This year I developed yet another problem with my hybrid lenses. Almost as soon as I’d insert them, they would cloud over with a thick, gluey substance. I spent more time taking them out and cleaning them than I spent actually wearing them!

Having moved back to Birmingham, I went back to UAB Eye Care and met Dr. Adam Gordon, who told me about ClearKone® hybrid contact lenses. From the first moment I felt that lens on my eye, I knew it was the answer I’d been searching for. Because the lens floated on a layer of fluid above my RK incisions, they were incredibly comfortable, and my visual acuity was better than it had been since my one-month bout of 20/10 vision 17 years earlier.

SynergEyes Grants Life Changing Gift for Holidays: Ability to Distinguish Family Faces Keratoconus Patients Granted New Hybrid Contact Lens Technology

Tuesday, December 21st, 2010

Carlsbad, CA (December 20, 2010) – This holiday season patients are receiving the life-changing gift of clear and comfortable vision thanks to the Sharing Vision Grant Program sponsored by SynergEyes, Inc. This program was created to bring the new technologically advanced ClearKone® hybrid contact lens to keratoconus patients who may otherwise not have access.  Keratoconus is a degenerative eye disease that occurs 1 in 1,000 people causing substantially distorted vision and in many cases changes how they live their lives. Patients can apply for the program on at www.TreatKeratoconus.com.

Cassidy Randle was a successful college student looking to go to nursing school, after graduation. Just as any young girl, she wanted to get rid of her glasses and therefore underwent refractive eye surgery in 2003. Initially her vision was okay and then it started deteriorating. In no time she was almost blind in her left eye and had poor vision in the right eye.  She had seen many cornea specialists and tried many type of lenses, but unfortunately, none of the lenses gave her the comfort or the vision back. It came to a point that she was unable to drive a car and her hopes of nursing school were fading.  “I began to worry and think to myself: ‘How will I be able to focus in school if I am unable to see?’” Cassidy said.  And her worries were more personal as well. “The worst feeling imaginable is being unable to distinguish my family’s faces and see their expressions.”

After Dr. Gupta at the University of Texas Medial Branch (UTMB) Eye Center volunteered her time and provided a free fitting for Cassidy in ClearKone® lenses, provided free by SynergEyes, Inc., Cassidy is now able to see again. “When I tried on the lenses for the first time I knew the difference in my vision was going to be life-changing,” said Cassidy.  Thanks to the Sharing Vision Grant Program and Dr. Gupta, Cassidy can see her father’s face again and she can pursue her dream of becoming a nurse.

Currently, over 15 patients are enrolled in the program; receiving free lenses from SynergEyes and free fitting from participating eye care practitioners. One of these patients is Melanie LeMay who is working with Dr. Adam Gordon to achieve clear vision for the first time in 17 years. “I can’t think of a better Christmas gift than a pair of ClearKone® lenses!” said Melanie. “These lenses will be life changing for me and for others as well.”


The ClearKone® hybrid contact lens is the only hybrid lens of its kind for keratoconus and is having a significant impact on thousands of patients.   Available for less than a year, this new technology offers both clear vision and comfort for patients who would otherwise have to compromise their vision.  SynergEyes is the only company that makes a hybrid lens which has a “hard” center for the clear vision, and a soft outer skirt that provides comfort.

About SynergEyes®:

SynergEyes®, Inc. was founded in 2001 with a recognized need for a hybrid contact lens that combined the superior visual acuity of a rigid gas permeable lens with the comfort of a soft contact lens. The patented SynergEyes® hybrid technology with FDA market clearance is providing comfortable clear vision through the services of more than 5000 eye care practitioners throughout the United States, Canada, Puerto Rico and the United Kingdom.

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Contact Lens Options for Keratoconus

Monday, October 18th, 2010

Author:  Dr. Anderson, OD, FAAO

Keratoconus is a bilateral, progressive corneal thinning disorder which manifests as irregular, asymmetric astigmatism. Symptoms include blurred, subacute distorted vision which is usually more pronounced in one eye than the other. Refraction is often difficult and patients may not be adequately corrected with spectacles. Contact lenses are the best form of visual correction in most cases of clinically significant keratoconus. There are many different types of contact lenses available for keratoconus. Depending on the degree of clinical significance, lifestyle and ocular health, the optimal contact lens can be determined for each patient. This article describes the different design options currently available, along with the goals to keep in mind when fitting these patients.

Soft Toric Lenses

Many times, patients in the early stages of keratoconus do well with soft lenses. A satisfactory baseline refraction, which will most likely have a moderate amount of cylinder, is necessary in order to determine the soft lens prescription, which will most likely be toric. Occasionally, a spherical equivalent will produce good visual results. Patients with forme fruste keratoconus may also do well with soft toric lenses since adequate spectacle refraction is often possible.

Rigid Gas Permeable (RGP) Lenses

RGPs are the most commonly prescribed lenses for keratoconus. Traditionally, these lenses were fit with small diameters, three-point touch and variable edge lifts to improve comfort. However, this type of fit often results in a low-riding lens, decentered inferiorly over the pupil which induces aberration. More recent RGP designs for keratoconus have incorporated aspheric or biaspheric optics to decrease aberration, along with larger diameters to improve centration.

Piggyback Systems

Keratoconus patients who are currently fit with RGP lenses oftentimes experience discomfort and decreased wearing time as their condition progresses. The cone steepens and the apex thins to the point of inflammation, abrasion and irritation from RGP bearing. A simple way to halt this cascade of events is to place a soft lens beneath the RGP. Using a low minus power will flatten and protect the corneal surface as well as improve the comfort and wearing time. High Dk soft and RGP materials work well to maintain corneal integrity by decreasing the incidence of neovascularization.

Hybrid Lenses

These lenses consist of an RGP center with a soft skirt edge. They combine the benefits of rigid lens optics, including better lens centration and decreased aberrations, along with the comfort of a soft lens. The results are improved vision and increased wearing time. This is especially beneficial in keratoconus patients whose cone apex is very steep, thin and decentered. Traditional small diameter RGP lenses tend to decenter downward over the apex, inducing bothersome aberrations over the pupil. SynergEyes is currently the only manufacturer of hybrid lenses in the U.S. The designs available for keratoconus include the SynergEyes A, KC and ClearKone. Patients with mild to moderate keratoconus may fit into the A lens which has a spherical RGP center. The KC lens has an aspheric RGP center and is reserved for more advanced cones. ClearKone consists of a reverse geometry RGP center which is fit upon elevation or sagittal depth rather than base curve. This allows for clearance, centration and stabilized vision over a decentered cone. Because it achieves clearance by vault, ClearKone offers lower powers and reduced aberrations as compared to lenses fit according to base curve.

Scleral/Semiscleral Lenses

Rigid gas permeable lenses with diameters of 13mm or greater fall into this category. The benefits of these large diameter RGPs in keratoconus are a large,well-centered optic zone, minimal movement with blink, stabilized vision and improved comfort. Fitting these lenses requires a great deal of skill, which is acquired from experience. The dynamics are quite different from corneal lenses. The parameters of the larger periphery determine the patient’s ability to wear the lens comfortably and must be fit independently of the central base curve. The ultimate goal in fitting any keratoconus patient with contact lenses is good vision and comfort. This is relatively easy to achieve in early cones and becomes more difficult as corneal thinning and steepening progress. Determining the best lens to fit in order to achieve these goals is as much of an art as it is a science. For example, a patient who has worn small diameter RGPs unsuccessfully may do better in a hybrid or semi-scleral design. Regardless of lens design, finding the best lens begins with careful measurement of corneal curvature and diagnostic lens fitting.

Keratoconus Treatment Options

Friday, September 3rd, 2010

By Dr. Brandon Ayres, MD

Keratoconus causes progressive thinning and distortion of the cornea that affects approximately 1 in every 2000 people.  It tends to affect younger people sometimes starting in the early teen years and progresses most rapidly through the fourth decade.  As the dystrophy progresses the cornea takes on an irregular cone like shape and may develop scar tissue.  The changes in the cornea seen in keratoconus lead to “irregular astigmatism.”  Irregular astigmatism means that light is not able to focus on the retina even with the use of glasses or traditional soft contact lenses.

The primary treatment options fall into two categories:  contact lenses and surgery.  This article outlines both options.

Glasses and Contact Lenses

In the very early stages of keratoconus patients may notice a change in their prescription glasses or contact lenses.  Often times what is seen is an increase in astigmatism.  If the keratoconus progresses only minimally, all that will be needed is modification of the glasses prescription or possibly a soft contact lens that also corrects for astigmatism.

Keratoconus Contact Lenses

Once patients with keratoconus are dissatisfied with there vision with traditional glasses or soft contact lenses a special keratoconus contact lens may be necessary.  Most commonly this contact lens will be either a hybrid or rigid gas permeable (RGP) contact lenses.  It is important to understand that contact lenses may allow excellent vision, but do not actually treat or stop the progression of the underlying dystrophy.

A rigid gas permeable contact lens is able hold it’s spherical shape vaulting over the irregular cone shape of the irregular cornea.  This gives a new smooth surface to refract light, restoring good vision.  The use of an RGP is an excellent, non surgical, technique to restore vision in keatoconus,  but the fitting of the lens can be quite challenging.  Each patient with keratoconus has a uniquely shaped cornea and the shape may change over time.  Many different designs of RGP’s are available for patients with keratoconus and patience is needed to get the right fit.  Most people with keratoconus are able to be successfully fit with RGP’s, however, some have persistent foreign body sensation or difficulty with the lenses falling out of the eye.

Hybrid contact lenses work on a similar principal as RGP’s.  This style of contact lens has a rigid gas permeable center that is fused to a soft contact lens “skirt” and therefore a hybrid of hard and soft contact lenses.  By fusing the two styles of contact lenses the visual benefit of a RGP is combined with the comfort of a soft lens.  As with the traditional RGP, these lenses must be specially fitted to ensure function, comfort, and safety.

Surgical Options

Collagen Crosslinking (CXL)

Collagen crosslinking is a technique that is currently under FDA trial here in the United States, but widely available outside the country.  Collagen crosslinking is a technique where vitamin B2 (also known as riboflavin) in liquid form is placed on the cornea.  The cornea is then exposed to ultravioled light (UV-A).  The combination of vitamin B2 and UV light increases the “linkages” in the corneal collagen.  This has been shown in laboratory studies to “stiffen” the cornea.  The goal of collagen crosslinking is to prevent progression of the keratoconus, not to reverse or cure it.

INTACS® Corneal Inserts

INTACS corneal inserts are small inserts that are placed in the cornea.  These inserts help “flatten” the central cone of the cornea in patients with keratoconus.  Once surgically implanted in the cornea the inserts are almost invisible and they cannot be felt.  INTACS have been shown to help with improvement in corrected and uncorrected vision.  INTACS can also be helpful in improving contact lens tolerance by reducing the conical shape of corneal in patients with keratoconus.  Recent studies have shown continued improvement in patients having INTACS placed over the course of 1 year and there is some suggestion that they may help stabilize the cornea.

Corneal Surgery

Approximately 20% of patients with keratoconus will have progression to the degree where corneal surgery is necessary.  The most common procedure performed is a full thickness corneal transplant also know as a penetrating keratoplasty (PKP).  In this surgery the diseased corneal is removed and replaced by a human donor cornea.  Luckly, transplantation of the cornea is the most successful of all organ transplants with a low rejection rate.  The vast majority of patients will achieve excellent vision after a transplant though it may take 12 to 18 months to achieve.  Many patients will still need the assistance glasses or contact lenses for optimal vision.

A second surgical option for keratoconus is a deep anterior lamellar keratoplasty (DALK).  This procedure is essentially the same as a corneal transplant except that the very thin innermost layer of the patient’s cornea, called the endothelium, is spared.  The surgery will look and heal very similar to a corneal transplant except that there is a lower chance for transplant rejection.  The surgery is technically much more challenging for the surgeon and sometime has to be converted into a full thickness transplant.

Most recently there has been an interest in using a laser to make the incisions for both corneal transplants and DALK surgical procedures.  The laser-guided incisions allow for an exact match of the patient and donor corneas.  The exact fit allows for a stronger wound and possibly faster healing with less residual astigmatism after the surgery.

I’ve Just Been Diagnosed With Keratoconus

Sunday, August 1st, 2010

By: David Kading, OD, FCLSA, FAAO

If you have just been diagnosed with keratoconus, let me first of all reassure you that there have been many recent advancements in the realm of keratoconus to equip eye care professionals with the proper tools to help you.

Keratoconus is a vision disorder that affects the front surface (cornea) of the eye.  The changes that take place occur because the cornea becomes thinner in certain areas.  The condition causes the normal regularly shaped cornea to become microscopically irregular in shape.  This causes light to scatter in irregular ways causing vision to be blurry, distorted, warped, and haloed as opposed to crisp and clear.  Because glasses and normal off-the-rack contact lenses cannot help to make the surface of the eye even and regular, for most keratoconus patients, they are not able to provide ideal vision.  Additionally, lasik surgery is not an option for patients with this thinning disorder because lasik surgery thins the cornea in an effort to correct vision.  Therefore it would only make the condition worse.

Keratoconus affects thousands of Americans and people all across the world.  It is believed that there may be a genetic component to the disease as it has been seen in identical twins.  However many keratoconus patients develop the condition after a mild accident, trauma to their eye or after years of eye rubbing.  Many other patients are not able to trace the condition to a family member or any type of eye trauma.

The first thing that you should do when you are diagnosed with the condition is ensure that you are under the care of an eye care practitioner who is knowledgeable about the condition.  A knowledgeable practitioner will know, understand, and be able to decide on the best course of treatment for you.  Although many keratoconus patients appear similar when they present to an eye care office, no two patients are alike.  Each has specific needs related to the shape of their eyes and how they use their vision on a daily basis both for work and recreation.  It is critical that your practitioner knows both you and your eyes.

In order to get the best idea of what the shape of your eye is, your practitioner may consider using an instrument called a corneal topographer.  This allows them to measure the specific areas of the eye in order to get the best assessment of the shape and contours of the eye.  This is extremely helpful in order to properly diagnose, and decide on the proper treatment options.

In mild cases of keratoconus, eyeglasses can still be used to help correct vision.  However, in most all cases of the condition, proper vision correction is best achieved with the use of specially designed contact lenses.  Depending on the shape of the eye, type of prescription, and discussion with you, your eye care practitioner will decide on an initial contact lens type.  In order to get the proper contact lens for you, a contact lens fitting must be performed.  This is often times performed as a separate visit to the office.  Following this visit, the lenses will be ordered from a contact lens laboratory or manufacturing plant.  Typically contact lenses can be made in several days, but it can take up to 2 weeks in some cases for the lenses to arrive back in the office.

Once the lenses arrive in the office, an additional visit is usually scheduled to ensure that the lenses are fitting on the eyes correctly and giving the optimal vision.  At this visit you are typically instructed on how to insert and remove the contact lenses.  Many times a wearing schedule will be described to you so that you can begin to adjust to the lenses.  As with most medical devices and things that are new to our bodies, it may take several days to weeks to adjust to the comfort, vision, and feeling of the new lenses.  This is very typical in most cases.  Most offices will request a follow up visit within one to three weeks to ensure that the lenses are fitting correctly.  Make sure to wear the lenses for several hours prior to this visit as an assessment of the lenses is best done after the lenses have been worn for at least three hours.  It is critical to ensure that the fit of the lenses is correct as they can cause damage to the eye if they are incorrect.  On occasion the initial type of lens that is tried does not work.  This is not uncommon and should not cause alarm.  Fortunately as stated earlier, there are many options.  The practitioner may switch you from one type of contact lens type to another if your eyes were not able to adapt to the initial lens type.

In very severe cases when contact lenses cannot provide ideal vision, there are also surgical options available.  These surgical options are progressing and are showing improving results.  However they are not a perfect solution, they require a significant healing time and most patients still must wear specialty designed contact lenses following the procedure.

Keratoconus is a condition that will last a lifetime.  Within the past 10 years dramatic insight, knowledge, and research has come out regarding the condition, its diagnosis, and treatment options.  Find a practitioner that you can trust and is up to date with the most recent advancements.  Make sure that they know everything there is to know about your eyes and vision, but most importantly, they should know you.  This is the type of relationship that will last a lifetime.

Keratoconus Causes and Treatment Options

Saturday, July 31st, 2010

By: Clark Chang, OD, MS, FAAO

Keratoconus Causes

Keratoconus is a non-inflammatory, progressive corneal condition associated with corneal thinning, weakening, and steepening, resulting in corneal optical irregularities (cone shape) and poor vision. An incidence rate of 1:2000 has been reported with no known sexual or ethnic predilection. In addition, familial inheritance has been reported in 6-24% of cases and co-morbidities such as atopic disease and connective tissue diseases have also been reported in the literature. Thus, genetic predisposition, acute eye allergies, and eye rubbing (often as allergic response) have all been proposed as potential underlying causes of keratoconus development. However, no definite causative factor(s) have been proven.

As keratoconus progresses in severity, the increasingly irregular shape of the eye causes optical side effects known as higher order aberrations (think of static noise for TV signals). These aberrations are primarily responsible for the reduction in one’s visual functions.  Corneal transplant has traditionally been utilized as the choice of medical treatment for the misshapen cornea. However, the reconstructed tissue interface does not always restore the cornea to its normal (spherical) shape, which means contact lenses are still needed to treat keratoconus after corneal transplantation1. Therefore, with the recent advancements in contact lens technology, non-surgical management methods have been recognized as the leading treatment choice in visual rehabilitation for keratoconus patients. Surgical options are currently being preserved for individuals who either cannot tolerate contact lenses or cannot achieve satisfactory vision with contact lenses2.

Keratoconus Contact Lens Treatment Options

Rigid Gas Permeable lenses (RGP) provide good visual outcomes, which make it the most widely utilized method in rehabilitating an irregular corneal surface. The firm structure of an RGP lens allows a layer of tear fluid to form beneath the lens; the tear layer fills in the irregularities between the cornea and the lens, and the combination of the smooth outer lens surface and the tear layer neutralizes the visual distortions. However, the advantages of good visual outcome and ease of lens handling may not always outweigh the amount of time it takes to adapt to RGP lenses and the issues of discomfort and the potential for RGP lenses to “pop out” of the eye. Therefore, alternative non-surgical treatment options have been developed to overcome such issues.

Because most soft lens materials are flexible they drape over the cornea. If the cornea is irregularly shaped, a soft lens will take the shape of the irregularities hence, this treatment option is only used for patients with very mild keratoconus. Nonetheless, recent custom soft keratoconus lens designs employ enhanced lens thickness in an attempt to mimic the optical benefits offered by RGP lenses. While oxygen permeability may be a concern until new material becomes available, the soft keratoconus lens provides a viable alternative for patients with mild to moderate keratoconus who cannot tolerate an RGP lens.

RGP intolerance mainly stems from irritation caused by the lens touching the eye.  A carefully selected bandage soft lens can be placed under the RGP lens in a piggyback system, which decreases irritation and helps stabilize the RGP lens on the eye. However, handling the two-lens system can be complex and inconvenient as there is a potential for reduced oxygen supply to the eye3.

Hybrid lens technology has enabled the bonding of an RGP lens with a soft lens so a single lens system offers both improved visual quality and increased wearing comfort. The recent advances in the 4th generation hybrid lens, ClearKone®, utilize a uniquely designed RGP lens shape to expand on its previous fitting parameters to include patients through all stages of keratoconus. Fitting success rates up to 86.9% have been reported utilizing hybrid lens platforms on keratoconus patients.

Recently improved oxygen permeability in RGP lens materials led to the clinical resurgence of scleral lenses. Scleral lenses comprise the largest diameter lenses within the family of non-surgical treatment options. A scleral lens design can often be more comfortable than its smaller RGP counterpart because a scleral lens design allows its lens edge to rest on sclera (white part of the eye), which has much lower sensitivity than one’s cornea. In addition, similar to the 4th generation hybrid lenses, sclera lenses are designed so the lens does not bear on the cornea, which minimizes irritation. Up to a 93% fitting success rate has been described with modern scleral lens designs1.

Because of the larger lens diameters in both the hybrid and scleral lenses, in comparison to the conventional RGP lenses, the insertion and removal process is different and requires practice during the initial adaptation period. This can hold true even for patients that have worn contact lenses before.

A well-fitted contact lens not only defers the need for more invasive surgical procedures but also significantly improves the quality of one’s vision and life. However, this process requires the combined ingredients of a physician’s clinical expertise and a patient’s determination. Further, it is essential for both the physician and the patient to recognize that no single lens design currently encompasses the complexity of all fitting situations. An open and honest discussion regarding one’s visual expectations and daily functional tasks performed in real life environment can be meaningful in the selection of a tailored management choice from the many non-surgical options that exist today.

Reference

1. Rosenthal P. Evolution of an Ocular Surface Prosthesis. Contact Lens Spectrum. 2009 Dec: 24(12):32-38

2. Garcia-Lledo M, Feinbaum C, Alio JL. Contact lens fitting in keratoconus. Compr Ophthalmol Update. 2006 Mar-Apr; 7(2):47-52.

3. Rosenthal P. Evolution of an Ocular Surface Prosthesis. Contact Lens Spectrum. 2009 Dec: 24(12):32-38.

4. Garcia-Lledo M, Feinbaum C, Alio JL. Contact lens fitting in keratoconus. Compr Ophthalmol Update. 2006 Mar-Apr; 7(2):47-52.

5. Nau AC. A comparison of Synergeyes versus traditional rigid gas permeable lens designs for patients with irregular corneas. Eye Contact Lens. 2008 Jul;34(4):198-200.

6. Abdalla YF, Elsahn AF, Hammersmith KM, Cohen EJ. SynergEyes lenses for keratoconus. Cornea. 2010 Jan;29(1):5-8.

Contact Lenses vs. Surgery for Keratoconus

Saturday, July 31st, 2010

Contact lenses with a rigid surface are the undisputed gold standard for restoring vision in keratoconus.  Despite recent advances in surgical treatment — including collagen cross-linking, intracorneal ring implants (Intacs), and partial-thickness corneal transplants — none of the currently available surgeries can make the distorted keratoconic cornea quite as smooth as the surface of a rigid contact lens.  The uniform surface of a rigid lens masks the distorted, irregular cornea in keratoconus, allowing light to properly focus into the eye.  Simply put, the rigid surface neutralizes the optical turbulence of the keratoconic eye.  This is why many of the top corneal surgeons first refer their keratoconus patients to a contact lens specialist before operating.  Of course surgical treatment has its place.  However surgery for keratoconus often has a secondary role in relation to less invasive contact lens treatments.

A historical challenge with rigid or “hard” contact lenses is that some wearers, even those without keratoconus, have difficulty overcoming the initial awareness of the lens edge interacting with the eyelid.  If you have keratoconus and can’t wear even optimally prescribed rigid lenses, you may be stuck between a rock and a hard place.  That’s because glasses and corneal surgery by themselves can’t approach the quality of vision afforded by rigid optics, at least not typically.  Furthermore, while soft contacts are initially more comfortable than their rigid counterparts, the soft material conforms to the irregular “peaks and valleys” of the keratoconic cornea, leaving the visual distortions largely unaddressed.

So what can your eye doctor do in the aforementioned situation?  Your doctor may recommend UltraHealth or ClearKone® hybrid contact lenses which combine the clarity of a rigid center with the comfort of a soft outer skirt.  These  lenses were designed specifically for keratoconus.  For selected patients, properly prescribed UltraHealth  lenses can afford a new-found freedom that no other treatment can approach.  UltraHealth  is an important option for some keratoconus patients who are unable to wear rigid lenses.  Yet UltraHealth  also has a role for many other keratoconus patients, especially those active in sports where resistance against lens dislodgement and visual stability are desirable.  Many of the contact lens specialists at the forefront of keratoconus treatment are certified to prescribe UltraHealth.  These contact lens specialists tend to interact regularly with corneal surgeons, using a team-approach to treat keratoconus both non-surgically and surgically as dictated by the particulars of each case.

Another alternative is scleral lenses, which are rigid contacts that are unusually large — larger in diameter than most soft contacts.  Scleral lenses often provide improved initial comfort over smaller diameter rigid lens designs, however they can require greater expertise by the practitioner and patient for successful wear.

For those already wearing more common rigid lenses, but who are experiencing the unavoidable rubbing on the sensitive corneal surface from the lenses, your eye doctor may prescribe a “piggyback” system.  In piggyback systems, breathable soft lenses are worn underneath the rigid lenses not for improving vision, but for protecting against mechanical chaffing and the resulting discomfort.  Your eye care professional can determine the appropriate contact lens modality for your specific circumstance, including whether lens wearing discomfort is due to sensitivity of the lens edges, lens chaffing of the cornea, or some other reason.

Ultimately, the practitioner’s experience and skill are more important than the contact lens design used for treating keratoconus.  Many eye doctors do not routinely prescribe medically-necessary contact lenses and will refer you to one of their colleagues with such expertise.  Since the pattern of corneal distortion in keratoconus is as unique as a fingerprint, there isn’t a single lens design that works for every eye.  Contact lens prescribing for keratoconus is a process which can span many visits before all refinements to the lens parameters are completed.  Due to the chair-time required and custom nature of the prescribing, it’s not uncommon for the services and lenses to cost over $1,500 without third party coverage.  Many medical insurances fail to understand that contact lenses for keratoconus are non-elective and medically-necessary for rehabilitating vision.  Consequently, keratoconus patients often shoulder most of the financial responsibility for their contact lens treatment.

An Introduction to Keratoconus

Friday, July 30th, 2010

Keratoconus in an eye disease that is characterized by thinning and steepening of the cornea. The cornea is the front surface of the eye and the most important focusing element of the vision system. In patients who have keratoconus their cornea is cone shaped. The name keratoconus is derived from the Greek word for cornea (‘kerato’) and cone shaped (‘conus’). Keratoconus results in visual distortion often not correctable by traditional glasses. The thinning and steepening of the cornea causes the front surface to become progressively more irregular in shape. The corneal surface irregularity is what induces the distortion and blurriness of vision experienced in keratoconus.

Keratoconus Conical Cornea

Keratoconus Conical Cornea

Keratoconus is found in approximately one in two thousand individuals, and as such can be considered a relatively common eye disease. New, more sensitive diagnostic techniques will likely increase the prevalence rates of keratoconus found in future studies. There is strong evidence that keratoconus has a genetic basis. Though studies have shown variable rates of keratoconus among family members of patients with the disease, it is felt that significant genetic components do exist. There is virtually no gender predilection in keratoconus with equal incidence in males and females. Typically keratoconus is initially diagnosed just after puberty and can progress through the third to fourth decade of life, however individual cases can present at any age and progress throughout life. Keratoconus most often is found in both eyes, but commonly more advanced in one versus the other. Cases of true unilateral (one eye only) keratoconus do exist, however they are the rare exception to the rule.

Commonly reported risk factors for keratoconus include: atopic allergic disease (when someone is highly sensitive to allergens), especially a history of eye allergies, and vigorous eye rubbing. The severity of the disease is quite variable. Some cases develop only to a mild stage and do not progress further. Patients with this form of the disease often can achieve adequate vision correction with the use of glasses or soft contact lenses. Other cases may progress significantly and result in dramatic distortion of vision which requires treatment with specialized contact lenses (typically rigid gas permeable, hybrid, or scleral lenses). The most advanced cases of keratoconus can develop corneal scaring and require surgical corneal transplantation. New medical technologies such as collagen corneal cross-linking with riboflavin hold promise for controlling progressive cases of keratoconus.

Author: S. Barry Eiden, OD, FAAO

President and Medical Director of North Suburban Vision Consultants, Ltd.

Website: http://www.nsvc.com

EyeVis Eye and Vision Research Institute

Immediate Past Chair of the Contact Lens and Cornea Section of the American Optometric Association



READ “How is Keratoconus Diagnosed?”

Questions Keratoconus Patients are Asking

Friday, July 30th, 2010

Q: I am a Keratoconus patient and have been wearing Soft Perm contact lens for over 10 years. I have now been fitted with the new ClearKone Synergeyes lens in both eyes. I get great vision with these contacts and comfort for the most part however my contacts cloud up at times, especially my left eye.  I know that these lenses are high in oxgyen – like 7 times more oxygen is received by the conrea compared to the Soft Perm – could this be the adpatation period? Shak

A: Shak, you bring up a very common issue faced by SynergEyes and other contact lens patients: “cloudy vision.”  There are several reasons for cloudy vision including an improper contact lens fit.  Please tell your contact lens fitter about this issue so that he/she can check the fit and make sure that it is correct.   More commonly, many patients experience cloudy vision because of the surface of their lens drying out or hazing over.  The surface of contact lenses requires extreme care in order to keep it wetable.  There are several steps that you may want to take in order to enhance the surface of the lenses.  1. Use the proper soap.  The soap that we use can have oils that cause the surface of the lens to become non-wetting.  Use lanoline free soaps that are free of perfume and fragrances.  2. After washing your hands, rinse your fingertips with the contact lens solution that you use prior to handeling your contact lenses (Unless you use a hydrogen peroxide solution such as Clear Care) 3. If you are getting cloudy vision consider switching to a different contact lens solution that creates a more wettable surface.   As always consult your contact lens fitter on any changes that you make to your lens wearing routine or solution use. Dr. Kading


Q: Since part of the hybrid lens is rigid, will I feel the lens in my eye?

A: If you’ve never worn contact lenses before, or if you have only worn soft lenses, there may be a period of adaptation. Typically this adaptation period lasts for 3-5 days.

Your practitioner may want to build up your wearing time over a few days, and they will be able to recommend a wear schedule customized for you.

Q: I have had keratoconus for 4 years and it continues to get worse.  At what point should I consider surgery?

A: Approximately 20% of patients with keratoconus will have progression to the degree where corneal surgery is necessary.  The most common procedure performed is a full thickness corneal transplant also known as a penetrating keratoplasty (PKP).  In this surgery the diseased cornea is removed and replaced by a human donor cornea.  Luckily, transplantation of the cornea is the most successful of all organ transplants with a low rejection rate.  Many patients will still need the assistance of glasses or contact lenses for optimal vision. This is why many of the top corneal surgeons first refer their keratoconus patients to a contact lens specialist before operating. Answer by: Dr. Chou

Q: I’ve thought about getting Intacs, but I’ve heard that you still need to wear contact lenses after you’ve had Intacs surgery. Is this true?

A: Intacs is a relatively newer surgical method to address the corneal irregularity found in keratoconus. It involves the implantation of tiny plastic segments within the cornea. The result is to make the optical surface of the cornea relatively more regular, thus reducing the degree of vision distortion. This technology is only indicated for keratoconic corneas without scaring, yet have become contact lens intolerant. Results with Intacs have been encouraging, but once again are not a total solution for this disease. As with PK, patients who have had Intacs implanted most often still require contact lens correction for maximum vision. By making the corneal surface more regular contact lens fitting may be more successful following Intacs.

Keratoconus patients contemplating Intacs surgery should first consult with a qualified contact lens practitioner to investigate less invasive and potentially more effective treatment. Click here for an article on surgical options.  Answer by: Dr. Eiden.

Q: What is the best solution to use with my ClearKone® lenses?

A: There are several care systems approved for use with hybrid contact lenses.  You should always follow the instructions provided by your eye care professional with regard to caring for your lenses.  SynergEyes, the manufacturer of ClearKone lenses also has some recommendations that you can find on this website.

Q: Can I sleep in ClearKone® lenses?

A: ClearKone lenses are approved by the FDA for daily wear only.  Therefore you should never sleep in your lenses.   You should remove your lenses at the end of the day clean them and store them overnight.

Q: What do you suggest for dry eyes?

A: Use re-wetting drops approved for soft lenses like Optive to help with dryness.  It is also very important to digitally clean your lenses – ignore the “no rub” on solutions. Also using the non preserved products for insertion does seem to help as well, rather than using a multipurpose solution.

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Ask an Expert!

To submit a question, please send an email to askanexpert@synergeyes.com. We will review all questions and post an answer each week.

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about vision, vision care and vision correction. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs.

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