If you’re reading this, you or someone you care about may have been recently diagnosed with keratoconus. We’ve compiled a few commonly asked questions about keratoconus to help you understand what it is, what causes it, and how your eye doctor can help.

1. What Is Keratoconus?

Keratoconus is a progressive, non-inflammatory disease that causes the cornea to thin and bulge, resulting in a cone-shaped cornea. Over time, this bulge leads to myopia and irregular astigmatism, and vision becomes progressively distorted. Ongoing treatment is crucial to prevent significant vision loss.

2. What Are the Symptoms of Keratoconus?

Many patients aren’t aware that they have keratoconus, which typically begins during the teenage years.

Symptoms of keratoconus include:

• Difficulty seeing at night
• Blurry vision
• Halos and glare around lights
• Increased sensitivity to bright light
• Headaches or eye irritation associated with eye pain
• Progressively worsening vision that’s not easily corrected

3. What Causes Keratoconus?

While there is no one cause of keratoconus, a paper published in Biomed Research International (2015) identified these risk factors:

• Genetics. About one in 10 people with keratoconus also has a family member with the condition.
• Inflammation. Irritation and inflammation from allergies, asthma and other atopic eye diseases can lend to the development of keratoconus.
• Frequent eye rubbing. Intense and frequent eye rubbing is thought to thin out the cornea and can worsen the condition.
• Underlying disorders. Keratoconus has been associated with several conditions, including Down syndrome, Ehlers-Danlos syndrome, Leber congenital amaurosis, Marfan syndrome and Osteogenesis imperfecta.
• UV light. UV light can cause oxidative stress, which weakens the corneas in predisposed eyes.
• Weak collagen. In a healthy eye, small protein fibers called collagen help keep the cornea in a dome-like shape and free from bulges. In the case of keratoconus, the collagen fibers become weak and therefore can’t maintain the shape of the eye, which causes the cornea to bulge.

4. How Is Keratoconus Treated?

Scleral lenses are the most common and successful treatment for patients with keratoconus. These are specialized rigid, gas permeable contact lenses that have a very wide [diameter] and vault over the entire corneal surface, making them effective and comfortable for people with keratoconus.

5. Is There a Cure for Keratoconus?

Currently, there is no cure for keratoconus. However, in most cases, it can be successfully managed.

For mild to moderate keratoconus, scleral contact lenses are typically the treatment of choice, as they provide clear, comfortable vision.

A relatively non-invasive procedure called corneal cross-linking (CXL) can stabilize and strengthen a thinning and irregularly shaped cornea.

At Gulf Coast Vision Center, Inc, we can recommend the best treatment options for your keratoconus, to help preserve your vision, and ensure the highest level of comfort and visual acuity. Call to schedule an appointment to start discussing your keratoconus treatment options.

Gulf Coast Vision Center, Inc serves patients from Houston, SugarLand, Bellaire, and Missouri City, all throughout TX.

Q: Can You Go Blind If You Have Keratoconus?

• A: Keratoconus does not typically cause total blindness. However, as keratoconus progresses it can cause visual impairment including blurred distance vision, distortion, glare, astigmatism, extreme light sensitivity and even vision loss that can be classified as “legal blindness.

Q: Does keratoconus affect both eyes?

• A: Yes, in approximately 90% of keratoconus cases, the disease will manifest in both eyes. However, the rate of progression and the timing of the onset of the disease is different for each eye.

Scleral contact lenses have been called “life-changing” and “transformative” by patients who wear them.

What makes these contact lenses so revolutionary?

What Are Scleral Lenses?

Scleral lenses are contacts that vault over the entire cornea and rest on the white part of the eye (sclera). Their diameter is much larger than standard lenses, which adds to their comfort and compatibility with hard-to-fit eyes.

Here’s why they’re gaining popularity in the contact lens world and why patients and doctors are calling sclerals a big deal.

1. Sclerals are Ideal for People with Corneal Irregularities or Dry Eyes

There was a time when patients with corneal irregularities or severe dry eye syndrome weren’t able to wear contact lenses at all, due to the discomfort associated with direct corneal contact. Nowadays, patients with keratoconus, other corneal aberrations or dry eye can successfully wear scleral contact lenses and enjoy comfortable and crisp vision.

Scleral lenses are also great for patients with corneal dystrophy, high astigmatism, Sjorgren’s syndrome, corneal trauma and corneal ectasia, or who have undergone cataract surgery.

2. They’re Completely Custom-Made

Each pair of scleral contact lenses is custom-designed to gently and securely rest on your unique eyes. The fitting process for scleral lenses starts with corneal topography, where the optometrist creates a digital map of your eye’s surface. This information is then used to customize your perfectly fitted pair of sclerals.

3. They Offer Optimal Visual Clarity and Comfort

The liquid reservoir that sits between the lens and the eye helps enhance the visual optics of the lens. Moreover, scleral lenses are made of very high-grade materials and don’t place any pressure on the cornea, delivering ultimate all-day comfort. Many patients have reported that they comfortably wear sclerals for up to 14 hours a day, which is longer than the wear time for standard soft contact lenses.

4. They Promote Eye Healing

Scleral contact lenses protect the eye by surrounding it with an oxygen-permeable, liquid-filled chamber. This hydrating environment gives the eye the moisture and oxygen it needs to stay healthy and ward off outside irritants.

This can also explain why scleral lenses promote healing of the eye’s surface, whether after a corneal transplant or when recovering from a chemical burn or other eye injury.

If you or a loved one have been diagnosed with a corneal condition that prevents you from wearing standard lenses, consider scleral lenses. To schedule an appointment or to learn more, call Gulf Coast Vision Center, Inc in Southwest Houston today!

Gulf Coast Vision Center, Inc serves patients from Houston, SugarLand, Bellaire, Missouri City and throughout TX.

Q: #1: How long do a pair of scleral lenses last?

• A: Scleral lenses can last 1-2 years before requiring replacement. Your optometrist will provide you with instructions on how to wear and care for your lenses to keep them feeling fresh and clean, day in day out.

Q: #2: Are scleral lenses expensive?

• A: Just like any other customized product, scleral lenses tend to be more expensive than standard soft contact lenses. Although they have a higher price point, most patients who wear them will tell you that their comfort, visual clarity and stability make them worth the cost.

From the time Kenneth was 11 years old, he wore glasses to correct his quickly deteriorating vision. He was always forced to sit at the front of the classroom and felt embarrassed by it. This time in his life marked the beginning of seemingly endless visits to various eye doctors to try and figure out what was causing his vision problems.

Four years later, at the age of 15, Kenneth was diagnosed with keratoconus, a progressive eye disease that affects the shape and condition of the cornea. Kenneth was referred by his ophthalmologist to an optometrist who [specializess] in treating keratoconus.

The optometrist explained that keratoconus is a condition that causes the cornea to thin and bulge out in a cone-like shape, leading to visual impairment. The early stages of this progressive eye disease usually cause mild to moderate vision problems that can be corrected with eyeglasses. But as the cornea’s shape continues to distort, glasses are no longer suitable and rigid contact lenses must be prescribed.

The optometrist prescribed rigid gas permeable contact lenses, which significantly improved Kenneth’s vision. But Kenneth sometimes found his contacts hard to manage, and even uncomfortable at times. People would tell him to just ‘switch back to glasses’ and ‘stop wearing the lenses if they give you so much grief.’

That wasn’t possible. He simply couldn’t see without the contacts.

Thankfully, before Kenneth’s condition progressed to the point where cornea surgery was required, new technology gave him fresh hope.

At the age of 20, Kenneth was fitted for scleral contact lenses for the first time. The day of the fitting was an emotional one for him and his family, as he was truly able to see the world around him in detail—and with great comfort.

Kenneth walked out of the optometrist’s practice, looked around, and saw leaves on the trees for the first time in 5 years. Prior to this, his perception of trees were brown stumps with green shrubbery—but never leaves.

He noticed that the cars driving past him on the street looked astonishingly clean. Nothing seemed faded anymore. Colors were vivid, lines were sharp.

The detail and clarity of each object were genuinely overwhelming for him. His mom, who also suffers from keratoconus, was overcome with emotion as she watched her son visually experience his surroundings in a whole new way.

From that day forward, Kenneth’s life changed drastically. His scleral contact lenses enabled him to function normally and achieve his goals. Wearing his sclerals allows him to work, exercise, socialize and be his authentic self.

Kenneth confesses that when he doesn’t wear his sclerals, his entire personality changes. He becomes timid, quiet and apprehensive.

Having keratoconus will no longer hinder Kenneth from living his best life, and it doesn’t have to hinder you or an affected loved one.

To a person with corneal disease, scleral lenses can be truly life-changing. If you or a loved one has keratoconus or other corneal irregularities, contact Gulf Coast Vision Center, Inc today.

Gulf Coast Vision Center, Inc serves patients from Houston, SugarLand, Bellaire, and Missouri City, all throughout TX.

Q&A

Q: #1: How do scleral lenses work?

• A: Scleral contact lenses are hard lenses that have a much larger diameter than standard soft contact lenses. They vault over the entire cornea and rest on the sclera (the white of the eye) so that no part of the lens is touching the cornea itself. The lens holds a reservoir of soothing and nourishing fluid between the eye and the lens, providing the best in visual clarity and comfort.

Q: #2: What other conditions do scleral lenses help with?

• A: Any patient with irregular corneas can benefit from scleral lenses. They’re also suitable for patients with severe dry eye syndrome, as the fluid reservoir helps maintain comfort and ocular hydration. They’re also great for patients with very high refractive errors (high myopia, hyperopia, or astigmatism). Speak to your eye doctor if you think scleral lenses may be right for you.

Many people can’t wear standard contact lenses. This is especially true of patients with severe dry eye syndrome, keratoconus, irregular astigmatism, among other conditions.

That’s why eye doctors often prescribe scleral lenses to such patients. These specialized rigid, gas permeable contact lenses have a very wide diameter and extend over the entire corneal surface, making them effective and comfortable for people with irregular corneas.

At first, some patients may find scleral lenses to be difficult to insert and remove. However, after some practice, you’ll find it easy to care for your sclerals!

Safety and Hygiene for Scleral Lenses

Handling scleral lenses incorrectly can increase your risk of eye infection. Additional risk factors include improper lens cleaning, poor hygiene, and smoking. Therefore, it’s important to follow your eye doctor’s instructions on how to handle your lenses hygienically.

Before handling, inserting, or removing scleral lenses, make sure to:

• Always wash your hands thoroughly with non-oily soap or antibacterial-based pump soap and dry them with a clean lint-free towel or paper towel.
• Sit at a desk or table and place a lint-free cloth down to insert and remove lenses. Avoid bathrooms, as they often contain more germs than other rooms in the home.
• Inspect your lenses for chips or cracks and protein deposits on the lens surface. If you notice any defects or are unsure whether your lenses are damaged, don’t wear them until your eye doctor has inspected them.

How to Insert Scleral Lenses

1. Remove your scleral lenses from their storage case and rinse with them with saline. If you’re using a hydrogen peroxide solution, wait at least 6 hours from when the lenses were placed into the storage case for the solution to neutralize. Always rinse with saline before placing the lens on the eye.
2. Either place the scleral lens between your middle, forefinger, and thumb — known as the tripod method — or secure the lens to a suction tool (plunger) supplied by your optometrist.
3. Fill half the bowl of the lens with preservative-free saline solution to prevent air bubbles from forming between your eye and the lens. Insert the lens directly onto the center of your eye in a facedown position.
4. Dry and wipe your lens case with a tissue and leave the case lid off to air dry.

How to Remove Scleral Lenses

There are two methods to remove scleral contact lenses: with your fingers, or with the aid of a plunger. First, to detach your scleral lenses from your eye, press firmly with your finger on your bottom eyelid just below the edge of the lens, then push upwards.

Method 1 – Manual Removal

1. 

   Insert a drop of preservative-free saline solution or artificial tears to loosen the lens.

2. Look down onto a flat surface (a mirror or towel can be placed there).
3. Use your middle finger to open your eyelid wider than the lens diameter.
4. Apply pressure to the middle of the lid — as close to the lashes as you can — and push down on the eyelid to move your eyelid under the lens and lever it off the eye.

Method 2 – Suction Tool

1. While looking at a mirror in front of you, hold your bottom lid open. Wet the tip of the suction tool to allow for better adhesion and attach it to the bottom of the lens.
2. Using the suction tool, remove the lens by tilting the lens up and out of the eye.

How To Care for Your Scleral Lenses

The number one rule in contact lens care is always to follow the professional advice of your optometrist. If you need any clarification, always contact their office first.

Never ever use tap water in any area of lens care, whether to rinse or fill your lens case. Tap water contains a multitude of dangerous microorganisms, including acanthamoeba, that can cause a severe, painful, and sight-threatening infection. Be sure that your hands are fully dry after using a lint-free towel prior to handling your lenses.

Remove Before Going to Sleep

Most people can comfortably wear scleral contact lenses for up to 12-14 hours at a time. Approximately an hour before going to sleep is the best time to remove the lenses. If your lenses fog up in the middle of the day, it’s best to remove them and try various methods to clear up the fogginess before reinserting.

Use a Peroxide Cleaner

You can sterilize your scleral lenses by immersing them in 3% hydrogen peroxide. Over a period of 6 hours, the catalyst in the case transforms the hydrogen peroxide into water and oxygen gas. This gives your lenses a deep clean and removes the need to rub them, thus decreasing the risk of accidental breakage. Do not use the lenses until they have been immersed for 6 hours, as the un-neutralized peroxide will painfully sting your eyes. Leave the lens case to dry when not in use.

Use a Filling Solution That Is Preservative-Free

When inserting scleral lenses, use unpreserved sterile saline solution by filling the bowl of the lens upon insertion. Don’t use tap water or a preserved solution as these can lead to an eye infection.

Remove Debris Using Multi-Purpose Lens Solution

Once you’ve thoroughly washed and dried your hands, remove your scleral lenses and rub them for 2 minutes in a contact lens case filled with saline solution. This effectively removes microorganisms and deposits, lowering your risk of infection. While scleral lenses are strong, too much force or an incorrect technique can cause them to break.

After rubbing your lenses, thoroughly rinse them using the solution for 5-10 seconds. Then place them in a case filled with fresh solution and leave them to disinfect for at least 4 hours.

Routinely Clean and Replace Your Lens Case

Regularly clean and replace your lens case to prevent infection due to bacterial contamination.

It is recommended to clean the storage case on a daily basis and to replace it monthly or as advised by your eye doctor.

Your optometrist will recommend when to get a new pair of scleral lenses, and will advise you when to schedule follow-up appointments. Failure to show up for scheduled appointments can compromise the lenses’ efficacy.

At Gulf Coast Vision Center, Inc, we can recommend the best wearing schedule for your contact lenses to ensure the highest level of comfort and visual acuity. Always follow the instructions provided by your eye care professional. Call to schedule an eye exam and a scleral lens fitting today.

Gulf Coast Vision Center, Inc serves patients from Houston, SugarLand, Bellaire, and Missouri City, all throughout TX.

Q&A

 

Q: Why do I need to use preservative-free solutions to fill the lens?

• A: Long-term exposure to preservatives can cause corneal toxicity or sensitivity that results in irritation and redness.

Q: How long do my application and removal plungers last?

• A: Plungers should be replaced every 3 months, or sooner if necessary.

Scleral lenses are ideal for patients with corneal irregularities, dry eyes, and hard-to-fit eyes. Their uniquely large circumference offers the best in visual comfort and clarity. But wearing and caring for your scleral lenses can take some getting used to.

Below are our top 5 tips for anyone who wears scleral lenses. If you have questions about scleral lenses or any other optometric matter, Gulf Coast Vision Center, Inc in Southwest Houston is here for you.

1. Lens Hygiene is Top Priority

Keeping your scleral lenses hygienic and free of buildup is key in ensuring the clearest possible vision. When you remove them from your eyes, rub them for several seconds with lens cleaner to remove surface debris and bacteria. Then, rinse them on both sides with saline solution before storing them.

Another hygiene tip: Before handling your lenses, be sure to wash your hands with soap and water, and to rinse and dry them with a lint-free cloth or paper towel. Good hygiene will significantly minimize possible complications and keep your eyes feeling fresh.

2. Manage Your Dry Eye

Many patients with dry eye syndrome (DES) choose to wear scleral lenses for their hydrating and soothing properties. While sclerals can offer substantial relief from their dry eye symptoms, patients shouldn’t forget to seek treatment for their DES.

That’s because scleral lenses help manage dry eye, but don’t actually treat it. So, it’s best to follow up with your eye doctor about any eye drops, medications, or at-home remedies to support healthy tears.

3. Use a Cotton Swab For Cleaning

Patients with long fingernails can find it challenging to thoroughly clean their scleral lenses. Rubbing the inside bowl of the lens with a cotton swab and cleaning solution can effectively remove the buildup from the lens. Then, rinse off the cleaning solution with saline to remove the cleaning solution and any lint from the cotton swab.

4. Try Different Insertion Tools

Is your current insertion method not working as smoothly as you’d like? No worries! Ask your eye doctor about different tools you can use, such as the O-ring or applicator ring.

But please only insert your lens with tools that your eye doctor recommends!

5. Follow Up With Your Eye Doctor

Because scleral lenses are customized, they often require a few visits with your optometrist to optimize their fit. Even after the fitting process is complete, follow-ups will help ensure that your lenses are still in good condition.

If your scleral lenses are giving you any trouble at all, we can help. To schedule your scleral lens consultation, call us today!

Gulf Coast Vision Center, Inc serves patients in Houston, SugarLand, Bellaire, Missouri City, and throughout Houston.

Frequently Asked Questions with Our Scleral Lenses Expert in Houston, TX:

Q: How do scleral lenses work?

• A: Scleral lenses rest and vault over the entire sclera (white of the eye), encasing a hydrating reservoir in between the lens and the cornea (front surface of the eye). This allows people with irregular corneas to wear contact lenses, since the lens isn’t in direct contact with the cornea itself.

Q: How long do scleral lenses last?

• A: Scleral lenses generally last 1-2 years, depending on how well you care for them and how your tear film reacts with them. Even so, check-ups every 6 months are recommended to ensure they still fit well and provide clear vision.

References

• https://www.guilfordeye.com/eye-care/4-must-know-tips-for-scleral-lens-wearers/
• https://www.clspectrum.com/issues/2019/february-2019/scleral-lens-tips-and-tricks
• https://www.ouh.nhs.uk/patient-guide/leaflets/files/11038Pscleral.pdf