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Keratoconus/Scleral Lens

Keratoconus

Keratoconus is a progressive eye disease affecting one or both eyes, causing a non-inflammatory protrusion or ectasia of the cornea. Recent studies have demonstrated that about 1 in 2000 people may be affected by keratoconus. Early forms of the disease can be undetected unless advanced scans of the surface of the eye are done. In general, keratoconus causes the cornea to become thinner and steeper with time causing decreased vision, which can range from mild to severe.
For mild forms of keratoconus, eyeglasses or soft contact lenses may be able to provide the patient with clear and comfortable vision. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, eyeglasses or soft lenses no longer provide adequate vision correction. Corneal rigid gas permeable lenses can provide a better alternative to improve visual acuity but do not protect the ocular surface. If the lens does not center properly on the eye or moves excessively with blinks and causes discomfort, switching to a large-diameter scleral lens may solve the problem.

What is the Treatment for Keratoconus?Photo of patient
Dr. Sagona recommends scleral contact lenses to resolve this issue. The scleral lens does not touch the irregular cornea; it is fitted in a way to vault the cornea. For that reason, these lenses are often more comfortable for a person with keratoconus. The space between the back of the lens and the front surface of the cornea is filled with a non-preserved sterile saline solution. It maintains a constant reservoir of fluid between the lens and the cornea to ensure that it remains lubricated. Moreover, this fluid layer also compensates for the surface irregularities, leading to improved vision. This modality can provide the comfort of a soft lens with the optical quality of a gas permeable lens. Also, scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses. Scleral lens designs currently available are considered the best option to provide health benefits and increased comfort compared to smaller corneal rigid lenses and, in this case, soft lenses.

Corneal Collagen Crosslinking treatment for Keratoconus and Post-Lasik Ectasia
Collagen Crosslinking (CXL) has been shown to be an effective treatment for Keratoconus and Post-Lasik Ectasia.
This minimally invasive in-office procedure is intended to strengthen the corneal tissue by creating strong bonds (or cross-links) between corneal collagen fibers. The goal of the procedure is to prevent further progression of the keratoconus or ectasia. Clinical research has shown that cross-linking not only stops the progression of keratoconus, but it also induces flattening of the cornea and visual improvement Collagen Crosslinking involves the installation of riboflavin (a B vitamin) drops on the cornea after removing the epithelium. Once saturated with riboflavin, the cornea is irradiated with ultraviolet (UV) A light for about 30 minutes. The patient will likely still need to wear the specialty contact lenses or scleral lenses following the procedure.

Scleral Contact Lenses

Scleral lenses are a specially designed type of contact lens used to correct vision and/or restore the ocular surface, often when other treatments are not effective. Scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems. Patients who cannot obtain good vision or comfort with glasses or conventional contact lenses can benefit from using scleral lenses.

Each scleral contact lens is custom-made for the patient. The lenses need to be fitted to vault over the cornea to maintain a constant reservoir of fluid between the lens and cornea. This design ensures the eye remains hydrated during the entire time the lens is worn. In addition, the fluid layer helps compensate for any irregularities in the shape of the cornea, which improves vision.

Dr. Sagona specializes in fitting scleral lenses. Our scleral lenses are highly permeable to oxygen and provide the comfort of a soft lens while achieving the higher optical quality of a rigid gas permeable lens. In most cases, patients report no sensation or awareness of the lens while wearing it. The all-day comfort of scleral lenses is one reason for their increased popularity.

The Design of Scleral Contact Lenses
In comparison with other contact lenses, scleral lenses have a larger diameter. The lenses sit on the white part of the eye (the sclera) and vault over the cornea. The larger design delivers the desired vision benefits without requiring the lens to sit on the cornea itself. Lenses that sit on the cornea are typically less comfortable than scleral lenses and are problematic for patients with corneal irritation or irregularly-shaped corneas.

Scleral contact lenses are considered the best option on the market for health benefits and increased comfort. These lenses eliminate blurred and distorted vision, promote healing of the ocular surface, and protect the cornea from the surrounding environment and eyelids.

Dr Sagona works closely with our patients to determine the optimal fit for scleral lenses. We know how hard it can be for this unique class of patients to find effective vision treatments. We are passionate about creating custom scleral lenses that have the potential to change one’s quality of vision and quality of life.
At this time, scleral lenses are the highest technology available for the patients we serve. We are proud to make these lenses a core focus of our practice.
Here are a few of the conditions that can be treated using scleral lenses:

  • Dry Eye Syndrome
  • Chemical and burn injuries
  • Keratoconus, Keratoglobus and Pellucid Marginal Degeneration
  • Corneal degenerations and dystrophies
  • Eyelid abnormalities
  • Radial Keratotomy (RK), Photorefractive keratectomy (PRK)
  • Stevens-Johnson Syndrome
  • Graft vs Host Disease
  • Sjogren’s Syndrome
  • Corneal ectasia and other complications from LASIK and LASEK
  • Post-corneal transplant

Scleral contact lens cost varies from patient to patient. Please contact our office today for more questions.

For Existing Patients with Scleral Lenses

If you are used to wearing standard contact lenses, it can take some time to become accustomed to wearing scleral lenses. Because they are larger than standard lenses and sit on the eye a bit differently, scleral lenses don’t have the same insertion and removal processes. To learn how to insert or remove your scleral lenses, watch the educational video below.
How to Insert and Remove Scleral Lens?
Step-by-Step instructional video on how to insert and remove scleral contact lens.