Keratoconus is best managed with contact lenses when all options are available including rigid gas permeable, hybrid, piggyback, scleral, and specialty custom soft keratoconus contact lens designs. This recent case shows how a patients who has not been treated properly in the past was able to achieve success with a custom designed soft keratoconic contact lens at North Suburban Vision Consultants (NSVC). Each day at North Suburban Vision Consultants (NSVC) we see numbers of patients with keratoconus and other conditions with irregular corneas. These patients often present to us with great frustration regarding their treatment and are looking for alternatives that hopefully do not involve corneal surgery. Our contact lens specialty service looks for options that provide our keratoconus patients with clear vision, comfort while wearing their keratoconus lenses, and appropriate eye health response to lens wear.
An example this week was for one of our new keratoconus patients, a 34 year old young woman who was first diagnosed with the disease about 8 years prior. She had initially been fit in soft disposable astigmatism contact lenses, but had frequent changes to her prescription and lens fit until adequate vision was not attainable. She then was fit into “hard” contacts that never were fit properly and were quite uncomfortable. She finally gave up and was wearing glasses that provided poor vision.
Following our comprehensive evaluation and analysis of the cornea with instruments such as Pentacam corneal analysis and wavefront aberrometry with Discovery System we were able to determine that the vision would need to be improved with some sort of “masking” of the irregular surface with a contact lens. This could be done of course with a rigid lens, but other options include hybrid lens technology (rigid center soft periphery such as SynergEyes), or a specially designed keratoconic soft lens. We evaluated a keratoconic custom soft lens which has a central optical zone that is thicker than the periphery so that it will mask the corneal irregularity. The outcome was outstanding. We designed the lens with a correction on the front surface for residual astigmatism and with the lens on each eye the patient was capable of 20/20 vision with both eyes and 20/25 vision with each eye individually. The patients was comfortable wearing the lens for upwards of 14 to 16 hours per day and has had an excellent eye health response to lens wear so far. We will continue to monitor her condition at regular intervals.