Keratoconus Part 3 – Vision Correction Options

There are multiple options for correcting vision – from spectacles in mild keratoconus to different contact lens technologies, in addition to surgical options.

Spectacles

In the early stages of keratoconus, spectacles can often correct vision. As keratoconus progresses and the front of the eye becomes more irregular, the vision in glasses decreases. In moderate keratoconus, the spectacles may correct a fair amount of the prescription suitable for wearing around the house and as back-up to contact lenses.

Contact Lenses

    • Rigid (hard) gas permeable contact lenses
    • Hybrid contact lenses
    • “Piggyback” rigid contact lens on top of a soft contact lens
    • Soft contact lens

Depending on your level of keratoconus and history of contact lens wear, your optometrist will recommend the ideal contact lens type for you. To read about these contact lenses, head to our contact lens blog. The most common type of contact lens fit for keratoconus are rigid lenses, which are custom-made. There are different sizes of rigid lenses, and more advanced keratoconus often require larger diameter lenses (such as mini-scleral). If you have a history of nonadaptation to contact lenses for your keratoconus, we can offer a range of options to find what suits your eyes best. Popular options include the larger diameter rigid lenses compared to smaller lenses, as these have less movement on the eye and your eyelid does not rub against the lens as much. In some cases a hybrid or piggyback contact lens, which have a ‘soft’ component can improve comfort.  It is best to discuss your contact lens options directly with your optometrist during your eye examination.

When being fitted with contact lenses it is important to be aware of the adaptation process and multiple appointments initially. This can be somewhat time-consuming at first, as it is a new process. 

Just like tying your shoes for the first time when you were little, with more practice and assistance we can ensure you become confident and comfortable wearing your contact lenses!

In most cases, the first appointment involves taking measurements of the eye shape and sometimes a trial lens fitting, where we assess the best contact lens design. Once this is ordered, there is an appointment to teach you how to apply, remove and care for the lenses. There can be several appointments for review if the contact lens design requires tweaking for the best fitting lens possible and/or improve your vision – this is covered in the warranty of rigid lenses.

It is very important that your contact lenses are fit appropriately by an optometrist experienced with contact lens fitting and keratoconus. Most optometrists may see keratoconus 1-2 times/year and thus have limited experience with contact lens fitting for keratoconus.  If these are not fit appropriately, they can cause harm to your eye such as permanent scarring. As experienced contact lens fitting experts, we ensure that your contact lens fit is safe and will closely monitor your keratoconus and eye health. Optometrists and ophthalmologists in Australia and internationally refer patients with keratoconus for contact lens fitting here at Gerry & Johnson Optometrists. We offer clinical experience and expertise in contact lenses and keratoconus, and are heavily involved in contact lens research and education for our optometric colleagues.

Surgical

If you are interested in surgical options, Intacs, implantable collamer lens (ICL) or in some cases laser eye surgery may be options to correct your vision.

In severe cases of keratoconus with poor vision, corneal transplants may be considered. These can be full thickness or a partial layer corneal transplant. This is generally avoided unless necessary, due to risks of corneal rejection and replacement when needed as they do not last forever. After the transplant procedure, the vision is often foggy in the eye for the first year until it clears and regular eye drops are required. The incidence of corneal grafts has significantly reduced with time due to the advanced technologies in contact lenses which allow people with keratoconus to live a relatively normal life.

Pellucid Marginal Degeneration (PMD) – often referred to as the ‘sister of keratoconus’ also causes thinning of the cornea, and an irregular eye shape. One of the primary differences, is that age of onset is generally 20 – 40 years of age. The vision correction options, particularly with rigid contact lenses for PMD are similar to those available for keratoconus.  

Many patients with Keratoconus and PMD ask if they will likely be able to continue driving, continue their daily tasks and keep their independence. Yes – if your eyes are managed appropriately with an optometrist experienced in keratoconus/PMD and contact lens fitting.

For a thorough eye exam and discussion of options for your eyes, call us on (07) 3210 1822 to arrange your appointment.

Natalie_bio

About Natalie

Natalie Buckman is a clinical optometrist, educator,  professional leader and ophthalmic medicines prescriber, who enjoys exploring the world and hitting the dance floor in her spare time.