Hartsdale Keratoconus and Specialty Contact Lens Center
- Severe Dry Eye
- Corneal Complications from Surgery
- Severe Astigmatism
- Irregular Corneas
What Causes Keratoconus?
Often beginning in teens, keratoconus usually progresses into the 20s or 30s before stabilizing, although in severe cases it can continue to worsen. In these cases, the cornea continues to thin and bulge outward, creating even greater blurred vision. Scarring of the cornea can spontaneously develop.
More than 1 in 1,800 people have keratoconus, according to researchers. In ten percent of cases, patients report a family member who has keratoconus, Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus may affect more than one member of the same family but keratoconus has no race or gender correlation.
Research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.
Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.
Many keratoconus patients also suffer from hayfever, eczema and asthma. Some researchers feel that eye rubbing may increase the progression of keratoconus. Although it hasn’t been proven that eye rubbing exacerbates keratoconus, it is still a good idea to refrain from rubbing your eyes. Dr. Schwartz may prescribe eye drops to minimize eye itching symptoms.
Our Specialty Services
We provide specialty eye care services for individuals who have eye issues that cannot be corrected by traditional eyeglasses and contact lenses or other chronic eye diseases. Our optometrist, Dr. Schwartz, has witnessed first-hand hundreds of patients that have experienced the life-changing effects of our specialties. Our optometrist has extensive training and experience in vision therapy, myopia control, and scleral lenses for Keratoconus and corneal irregularities. Dr. Schwartz has extensive relationships with other Optometrists, Ophthalmologists, Occupational Therapists, and general care doctors that refer specialty patients because they know they can count on her professional knowledge and patient care.
What Kind of Contact Lenses can Help Someone With Keratoconus?
Scleral contact lenses
If you are looking to wear contact lenses but have always had problems with comfort or have been told you’ll never be able to wear contact lenses because of an irregularly shaped cornea or other eye problem, it may be time to look into a type of contact lens known as a “scleral lens.” Scleral contact lenses are large diameter rigid gas permeable contact lenses designed to pass over the cornea entirely, resting comfortably on the white of your eye, also known as the sclera. This allows scleral lenses to essentially replace the irregular surface of the cornea with a perfectly formed optical surface, giving you the kind of perfectly crisp vision you may not even be able to accomplish at all with eyeglasses or other forms of vision correction.
Besides for treating keratoconus, Scleral lenses can also provide a healthy, comfortable lens-wearing experience for patients experiencing extreme dry eye or post-LASIK ectasia.
Because of proficiency and belief in the effectiveness of Scleral lenses, we are currently using the three main brands for Scleral lenses;
- Zen lens
- Boston sight lens
These novakone lenses are thicker soft contact lens designs that are able to offer comfort and clear vision in many cases when regular soft contact lenses are not able to successfully correct the high degree of astigmatism associated with keratoconus and other corneal eye disease.
RGP contact lenses are most commonly prescribed. If eyeglasses or soft contact lenses cannot control keratoconus, then gas permeable (GP) contact lenses are usually the preferred treatment They provide a smooth, artificial surface to mask the “peaks and valleys” of the keratoconic cornea, in turn providing the best vision. The keratoconus center at Hartsdale Family Eyecare uses a variety of lens designs, and the best contact lens for you will be determined following a complete evaluation. But GP contact lenses can be less comfortable to wear than soft lenses. Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.
Hybrid contact lenses have a relatively new design that combines a highly oxygen-permeable rigid center with a soft peripheral “skirt.” Manufacturers of these lenses claim hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses. Hybrid lenses are also available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.
What's new in Keratoconus Treatment?
Selected keratoconus patients may be candidates for large-diameter scleral contact lenses. Scleral lenses are typically the size of a nickel to quarter. These specialty lenses rest on the white part of the eye, or sclera, and trap a fluid cushion between the cornea and contact lens, providing a smooth, artificial front surface to bend light. While scleral lenses have existed for a while, only more recent technological advances have made these designs available in clinics that routinely manage irregular corneal conditions such as keratoconus.
Not only do scleral contact lenses vault the cornea, but the design fits the sclera far better. There are specialty toric designed scleral lenses that match the curve of the cornea and sclera. This means that we have various materials and coatings for these lenses to provide greater comfort & wetness for dry eye patients and sensitive eyes.
Dr. Schwartz works closely with ophthalmologists who perform corneal crosslinking and identify keratoconus early to slow the progression of this eye disease.
Hartsdale Kerataconus and Specialty Lens Center also prescribes special soft contact lenses for keratoconus including KeraSoft IC and Alden Lenses. These lenses are thicker-than-normal lenses which help minimize the irregular eye surface of keratoconus and results in clear comfortable vision.
Specialty contact lenses are the first-line treatment of choice for keratoconus, but for some patients surgery may be needed. A small number of keratoconus patients get corneal transplants, but this is a last resort. An alternative to transplants is Intacs® prescription inserts, also known as intrastromal corneal ring segment implantation. Intacs are generally an option when a wearer cannot tolerate GP lenses, but the keratoconus has not progressed to the point of needing a transplant. Glasses or contacts may still be needed after such a procedure; but soft contact lenses might provide acceptable vision in these circumstances, Scleral lens design is also an option when other lens choices do not offer acceptable vision.
Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes. Intacs might delay but can’t prevent a corneal transplant if keratoconus continues to progress.
C3-R (corneal collagen cross-linking with riboflavin): ThisFDA approved procedure, is a non-invasive procedure involves placing eye drops containing riboflavin (vitamin B2) on the cornea, which are then activated by ultraviolet (UV) light to strengthen links between the connective tissue (collagen) fibers within the cornea.This is still an investigational procedure, but it’s getting a lot of attention in the professional eye care community because of positive results in clinical trials.
Corneal transplant: Some people with keratoconus can’t tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.