Contact lenses for Keratoconus

Luckily for us, there is a wide choice of contact lenses available for those with keratoconus. Fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect plenty of return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress. It’s very unlikely that any lens will fit first time, so patience and perseverance is key.

Here’s a guide to what’s on offer, so you can ask your contact lens fitter what they can offer you:

Custom soft contact lenses

Recently, contact lens manufacturers have introduced custom soft contact lenses specially designed to correct mild-to-moderate keratoconus. These lenses are made-to-order based on detailed measurements of the keratoconic eye(s) and can be more comfortable than gas permeable (GP) or hybrid contact lenses for some wearers.

KeraSoft by Bausch & Lomb lenses can correct up to -30 diopters (D) of myopia and up to -15 D of astigmatism and are available in silicone hydrogel and regular hydrogel materials with high water content (74 to 77 percent). Kerasoft lens are great for early stage Keratoconus and also post graft eyes. KeraSoft IC lenses are designed to fit irregular corneas, including keratoconus, post laser refractive surgery, pellucid marginal degeneration, and other corneal irregularities. Each KeraSoft IC lens is custom-made for your exact needs, and KeraSoft IC lenses can offer increased wear time and improved comfort and are a patented combination of the latest technologies in silicone hydrogel materials using geometries from complex mathematics to offer comfortable wear and excellent vision.

NovaKone lenses (Alden Optical) can correct up to -30 D of myopia and up to -10 D of astigmatism and are available in a hydrogel material with medium water content (54 percent).

Both lenses have a very wide range of fitting parameters for a customized fit and are larger in diameter than regular soft lenses for greater stability on a keratoconic eye.

In a recent study of the visual performance of toric soft contacts and rigid gas permeable lenses for the correction of mild keratoconus, though GP lenses provided better visual acuity in low-contrast situations, soft toric lenses performed equally well in high-contrast acuity testing.

Custom soft toric lenses also can be a good option for part-time wear for people with keratoconus who cannot tolerate wearing gas permeable lenses full-time.

Custom toric soft contacts for keratoconus are significantly more expensive than regular soft contacts

Hybrid contact lenses

Synergeyes hybrid lens

ClearKone® hybrid contact lenses offer all the benefits of rigid gas permeable (RGP) and soft contact lenses without any of the disadvantages for an overall good contact lens experience.

ClearKone® is an NHS approved and FDA-cleared hybrid contact lens specifically designed for the treatment of keratoconus and other corneal irregularities. Using a revolutionary technology, ClearKone® combines the best of both worlds – the crisp vision of a high-oxygen rigid RGP contact lens with the all-day comfort and convenience of a soft lens.

ClearKone® is specifically designed to restore vision to patients with the many types and stages of keratoconus, including post graft lens wear. Because the ClearKone® lens vaults over the cornea, there’s minimal risk of corneal scarring, making ClearKone® hybrid contact lenses a healthy treatment option for keratoconus. In addition, the soft skirt of the ClearKone® design helps to center the contact lens over the visual axis regardless of where the cone is located on the cornea or how large it is, thereby decreasing visual distortions and providing superior vision. The ClearKone® design also prevents dirt from getting under the lens and will not pop out unexpectedly.
Hybrids use soft lens cleaning solutions.

 

Ultrahealth hybrid lenses

UltraHealth, available in 2013, from Synergeyes,  is the only irregular cornea hybrid contact lens with highly breathable, healthy materials and an advanced lens design especially suited for patients with irregular cornea conditions. UltraHealth corrects vision problems, is healthy for your eyes and delivers exceptional comfort, too.

UltraHealth delivers vision benefits only available in hybrid contact lenses. The “rigid” (GP) material optimizes vision; while the soft skirt centers the lens over the cornea, providing enhanced stability and clarity. The soft silicone hydrogel material that surrounds the GP portion of the lens provides longer-lasting comfort for irregular cornea and keratoconus patients. UltraHealth is made with materials that allow very high oxygen transmission. The lens design also promotes tear circulation throughout the day, which delivers even more oxygen to the eye.

Ideal for Patients with:

  • Irregular cornea
  • Keratoconus
  • Ectasia
  • Intacs®
  • Post-Surgical

Eyebrids

The launch in France of the first range of Hybrid Contact Lenses, combining quality of vision with rigid lens wearing comfort soft lens was announced by the French laboratory LCS (Contact Lens Service) in early 2013. The new patented range of lenses named EyeBrid is the result of four years of research by teams at LCS. These innovative lenses need renewal every 4 months but also offer a high oxygen permeability (Dk strong). This new lens is as comfortable as a soft lens and offers the visual quality of a hard lens.

Gas permeable contact lenses or RGP

By far the most widely used contact lens for keratoconus, with the most popular RGP being the RoseK. it is essential RGP lens are fitted by an expert.
If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment. Their rigid lens material enables GP lenses to vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface to improve vision.

Rose K was established to market the Rose K lens invented by Paul Rose, an optometrist from Hamilton, New Zealand.  Paul was concerned about what could be done for patients with keratoconus – a progressive condition in which the surface of the cornea becomes cone shaped.  Realising that the problem with traditional contact lenses was that they did not fit unusual corneal shapes or mimic the eye shape well, he sought to develop a contact lens that would be more comfortable for patients, be easier to fit and provide better vision to those with the condition. Paul Rose began developing the Rose K keratoconus lens in 1989.  After testing 700 lenses and 12 different designs, he produced a set of 26 lenses from which all patients are fitted.  A further two years was spent to perfect the lens design before it was launched in the New Zealand market.  In 1995, the Rose K lens gained approval from the Federal Drug Administration (FDA) of America.

Since then advances in technology have resulted in the introduction of the Rose K2 lens, the Rose K2 Irregular Cornea (IC) lens and the Rose K2 Post Graft lens designed for patients with specific conditions.  These conditions include Pellucid Marginal Degeneration, Keratoglobus, Lasik Induced Ectasia and for patients who have undergone Penetrating Keratoplasty.

The Rose K family of lenses are now manufactured in 13 countries, distributed in over 60 countries and have become the most frequently prescribed lenses for keratoconus in the world. RGP contact lenses can be less comfortable to wear than soft contacts, and really need expert fitting and patience. Looked after they are durable and cost effective.

“Piggybacking” contact lenses.

Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for a person with keratoconus, some eye care practitioners advocate “piggybacking” two different types of contact lenses on the same eye.

For keratoconus, this method involves placing a soft contact lens, such as one made of silicone hydrogel, over the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Your eye care practitioner will monitor closely the fitting of “piggyback” contact lenses to make sure enough oxygen reaches the surface of your eye, which can be a problem when two lenses are worn on the same eye. However, most modern contacts — both RGP and soft — typically have adequate oxygen permeability for a safe “piggyback” fit.

Scleral or ‘sceral’ lens (spelling)

Many optometrists and ophthalmologists recommend scleral contact lenses for a variety of hard-to-fit eyes, including eyes with keratoconus. The first scleral lenses were made in glass, blown and fashioned into shape by craftsmen in the 1880’s. They were also the only lens available up until the 1950s.

In cases of early keratoconus, a standard RGP lens can be used. However, if the lens does not centre properly on the eye, moves excessively with blinks and causes discomfort, switching to a large-diameter scleral contact lens may solve the problem. Scleral lenses were made in rigid gas permeable (RGP) materials in 1983, and today are highly oxygen permeable.

Scleral lens are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, so these lenses often are more comfy for a person with keratoconus. Scleral lenses are designed to fit with little or no lens movement making them more stable on the eye, compared with traditional corneal gas permeable RGP lenses.
The newest scleral lens is the ICD 16.5. With only three fitting zones, ICD™ 16.5 is easy to evaluate, consistent in lens performance and is the “go-to” lens for problematic corneas.

Scleral Lenses for Other Eye Problems

In addition to keratoconus, scleral lenses can be used for eyes that have undergone a cornea transplant, and for people with severe dry eyes caused by conditions such as Sjogren’s syndrome, graft-versus-host disease (GVHD) and Stevens-Johnson syndrome.

Large-Diameter Contact Lenses
LENS DIAMETER* CLASSIFICATION EXAMPLES
12.9 to 13.5 mm Corneal-scleral SoClear (gt_eq13 mm; Art Optical, Dakota Sciences)
13.6 to 14.9 mm Semi-scleral Tru Scleral (gt_eq13.5 mm; Tru-Form Optics)
Perimeter (14 or 14.8 mm; Abba Optical)
Dyna Semi-Scleral (gt_eq13.5 mm; Dyna Lenses)
14.5 mm Hybrid
(RGP center with a silicone
hydrogel skirt that rests on
the sclera)
ClearKone – for keratoconus
Duette – indicated for use in healthy eyes, up to ±20 D
sphere, astigmatism of lt_eq –6 D
Duette Multifocal – indicated for healthy presbyopic
eyes (all hybrid examples, 14.5 mm; SynergEyes)
15 to 18 mm Mini-scleral Jupiter† (15 or 18 mm; Visionary Optics, Abba Optical)
Maxim (16 mm; Accu-Lens)
18.1 to 24 mm Scleral Jupiter† (18.8 or 22 mm; Abba)

*Upper and lower boundaries are approximate; sizing and terminology vary among lens makers.
†Manufacturers of RGP materials with FDA-approved lens designs provide the raw material to multiple labs, which produce the lenses under their own brand.

http://www.aao.org/aao/publications/eyenet/201201/feature.cfm?RenderForPrint=1

Lens care

Contact lens case

Whatever lens you wear It is important to clean your contact lenses daily to maintain the highest standards of comfort and visual clarity. Each day after you remove your lenses, you must clean them prior to overnight storage.
Always use the correct solution, never use tap water. Change your contact lens case regularly as bacteria will happily live in the little damp case, that could damage your eyes and cause infections.

Try not to overwear your lens especially in the early days of getting used to them. If they hurt – take them out and clean them, and let your eyes rest. Try to avoid aircon and get fresh air to your eyes when you can. There are various rewetting and comfort drops available from pharmacies and your doctor. Always check that they’re suitable to use with your type of contact lens.

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1 Year, 10 Months Post-Op (Corneal Transplant Update)

Originally posted on Life's a Performance:

It’s been a while since I last updated you guys, but here we are again.  You know how they say that no news is good news right?  Well you can probably expect why I’m writing.

This is a post that I had hoped I wouldn’t have to write.

Today I had made an appointment at my ophtalmologist’s office to talk about surgery for my left eye.

I went into the doctor’s office as usual.  The assistant gives me the usual vision test, and I did pretty well.  Then the doctor came in and looked at my eyes and said that my cornea was rejecting.  He asked me what drops I was using and how often, and I told him that I wasn’t because he told me I could go off my eye drops unless I was sick.  He proceeds to tell me that he never said that, implying that this…

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KERATOCONUSGB The biggest most active keratoconus community online

How as 2014 for you?

We hope you had a good year and that having KC was not too troublesome. If you would like to share your keratoconus story or chat with other KC’ers in 2015 get in touch with us here, or or one of our social sites:

Facebook Page https://www.facebook.com/KeratoconusGB

Facebook Group https://www.facebook.com/groups/keratoconusGB/

Twitter – find us at https://twitter.com/KeratoconusGB Follow us @KeratoconusGB

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We now have over 8,500 members right across the world! Join us and get support and learn more about #keratoconus! plus this blog now has

We published and shared over 90 keratoconus and eye related blog posts in 2014- that’s a lot of information! The most popular post was http://keratoconusgb.com/2014/03/23/what-is-it-like-to-have-keratoconus/ with over 5,000 views alone. Over 26,000 people have visited this blog in 2014.

174776_129809837064072_2666397_n1.jpgThanks!

2004-2010 – The missing years…

Originally posted on My Life With Keratoconus:

These are the years I can say I was truely depressed, not knowing what was wrong with my vision, believing it ws something serious about to strike me down was soul destroying.

It was around this time that my parents got the internet package from NTL (virgin) and I was able to hook my pc up, instead of helping myself by looking up things related to the vision problem I took to playing Wolfenstein:Enemy Territory.

Somehow I was a very good natural aimer on this game, I ended up making my own clan, had our own servers and gained many friends along the way. but what they didnt know was the person they played with was sat there depressed, comfort eating, gaining weight, becoming more unhealthy by the day, I would literally play untill 5 am and sleep untill 1pm. It had become my life, my only life.

I ballooned…

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2012 Birth of my daughters and vision progression.

Originally posted on My Life With Keratoconus:

March 23rd 2012 my fiancee gave birth to our twin daughters, this was likely the best thing that has happened to me. However it all but ended my training.

I was now required to help look after two babies, I often felt like a zombie version of the milk man, getting up at all hours to make endless bottles of milk for feeds, yawning my way through days living in our one bedroomed council flat.

I cannot deny it took its toll on me, we had no lift so I was literally carrying a double buggy up flights of stairs then the lack of sleep with two babies sharing my bedroom.

I remember I got up out of bed to make a feed, it must have been around 2 am, from the kitchen window I could see a lamp post to my disbelief I could see not just 2-3-4 glowing…

View original 646 more words

2012-2014 Hope

Originally posted on My Life With Keratoconus:

Since diagnosis, I have had so many appointments with eye specialists, optometrists, corneo plastic surgens, contact lens fitting, cornea scans that it would fill a whole book to go through each one in any detail.

One of my worst memories of these last two years was in March 2013, we went to Butlin’s in Minehead as part of my mother in laws Birthday celebration’s, I was already suffering frontal headaches the week leading up to this, but thought I could handle it.

I remember the first night there we went to a bar they call Centre Stage on the Butlin’s camp, it was dark with the only lights being those neon type lights that lit up the bar, and all around the room, as well as having pillar supports dotted around also completely lit in neon.

I walked up to the bar and ordered a drink for myself and fiancee…

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Latest CXL cross linking for keratoconus developments October 2014

Lots has been going on in the world of keratoconus in the past few months. Collagen crosslinking, still an investigational treatment in the United States, was first performed in Europe in the late 1990s for the treatment of ectatic corneal conditions. The treatment combines riboflavin and ultraviolet A (UVA) light, allowing the formation of reactive oxygen species, with the goal of halting the progression of corneal disease. There are 2 types, epi on and epi off cxl.

SANYO DIGITAL CAMERA

The Dresden technique, or “epi-off” crosslinking, is initial removal of the central 9 mm of epithelium, followed by 30 minutes of riboflavin administration. Subsequently, UVA light is applied for 30 minutes, followed by bandage contact lens placement. Epi-off crosslinking is shown to be effective in reducing keratometry readings.

Chicago conference

Results from 1 year of follow-up show that transepithelial corneal crosslinking (CXL) with iontophoresis appears to be ‘safe and effective in arresting the progression of keratoconus‘, according to Paolo Vinciguerra, MD.

Dr. Vinciguerra presented outcomes data from 20 eyes of 20 patients—all with documented progressive ectatic disease—during Refractive Subspecialty Day at the annual meeting of the American Academy of Ophthalmology. The treated patients were 18 years of age and older and were seen at serial visits at 1, 3, 6, and 12 months, said Dr. Vinciguerra, of the ophthalmology department, Istituto Clinico Huanitas Rozzano, Milan, Italy.

Overall, the results showed significant improvement of best-corrected visual acuity accompanied by reductions in higher-order aberrations and average keratometry readings. Safety data showed that pachymetry measurements and endothelial cell counts were stable. Some Complications were frequent epithelial defects and a case of epithelial burn.

FDA

We are still waiting for the FDA in the USA to fully approve collagen cross linking for keratoconus. The delay is crazy. especially as this safe and effective treatment is widely available in Europe and elsewhere.

“Since this was first presented virtually 2 decades ago, cross-linking has certainly become an accepted modality worldwide for the treatment of keratoconus,Peter S. Hersh, MD, said during a keynote lecture at the Refractive Surgery Subspecialty Day preceding an American Academy of Ophthalmology meeting. “We as ophthalmologists and patients in the U.S. are looking forward to approval and complete adoption of this important treatment option.”

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CXL in the U.S. is not FDA-approved. However, numerous procedures have been done and are being done under formal clinical trial protocols at over 100 clinical practices throughout the U.S.,” Hersh said.

Additionally, Avedro submitted a new drug application to the FDA for CXL in September. The company is sponsoring two multicenter studies in the U.S. with a total of 452 eyes. Avedro announced the resubmission of its New Drug Application to the U.S. Food and Drug Administration for the riboflavin ophthalmic solution/KXL system. Avedro anticipates a March 2015 application action date, according to the release.

A US clinical trial on cxl with LASIK (LASIK Extra) for high myopia is also scheduled for launch in early 2015, Hersh said.

ESCRS

The 32nd congress of theEuropean Society for Cataract and Refractive Surgeons (ESCRS) was held at London’s ExCeL on September 13–17. 
A hot topic at this year’s ESCRS was minimally invasive corneal procedures, with a number of presentations related to collagen cross-linking (CXL) for keratoconus. Professor Farhad Hafezi, from the University of Geneva in Switzerland, told delegates that CXL studies show that’ approximately 95% of patients are stable post-op’, therefore, adults probably need only a single treatment although children may need repeated treatments.

New study

A study published in The British Journal of Ophthalmology found that corneal collagen crosslinking appeared to be an effective procedure in the management of superficial microbial keratitis.

The study looked at 15 eyes of 15 patients with microbial keratitis—9 who had bacterial keratitis and 6 with fungal keratitis. The patients were treated with antibiotics and antifungals, and those who did not respond to at least two weeks of topical medications underwent corneal collagen crosslinking, plus the same preoperative topical medications afterwards. The patients were checked every third day to watch the microbial keratitis.

According to the study, six of the nine patients with bacterial keratitis and three of the six patients with fungal keratitis resolved after the corneal collagen crosslinking procedure. However, patients with deep stromal keratitis or endothelial plaque failed to resolve. All of the patients had resolution of pain on the first day post-op.

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Keratoconus my story by Kirsty, UK

After a normal visit to my optician I was told that I would need to go to the Eye Hospital to be referred for further investigations and this is where I was first diagnosed with keratoconus at the age off 22.

I was told I would need to wear soft contacts in both my eyes as they both had the disease. It was quite a wait as this was on the NHS but I can’t fault the hospital I was being treated at.

I carried on fine with my soft lens for about four years and had regular check ups at the hospital until one day I just couldn’t tolerate them in my eye anymore and this is where I was referred back to hard contact lenses.

I found this all quite a different challenge for me dealing with havjng kc and not being able to see properly became quite hard for me when I was driving at night I started seeing ghosting and doubles of stuff and other headlights would dazzle my eyes and it was quite a scary experience.

While waiting for my hard contacts to be made I developed hydrops in my left eye which had become very advanced and had a lot of scarring and I was then put on the waiting list for a corneal transplant. Having hydrops was extremely painful and caused me to have a ‘white mist’ over the front of my eye. It is very hard to explain as I couldn’t really see very well out of that eye and it is very blurry on the best of days without any contacts or glasses.

220px-Kc_simulation

My better right eye has now progressed from a -1 to a -7.5 from October 2013 and I’m now waiting for cross linking to be done at the Western Eye Hospital later on this year but as I developed hydrops my left eye became a top priority to get the graft done as soon as possible when originally my surgeon wanted the cross linking done first to establish it.

Despite having keratoconus I have still been able to work a full time job and drive up until January this year and do all daily tasks from washing and cleaning and going on holiday. I do have my down days where I get very upset and angry I have his disease but I look on the bright side this isn’t a thing I will have forever in my eyes.

I’m now looking to my operation in the next couple of weeks and I hope that the outcome from that will gradually improve my vision so I can regain driving and carry on have a normal life.

Kirsty Boylan, UK

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