Glasses which used to do the job are no longer sufficient. At this stage in the game the right keratoconus contact lenses may bring about very real improvements in clarity, comfort, and daily life confidence. What works best for each patient is different. It depends on the stage of the cone, the degree of irregularity present, also if the eye will do better with a rigid lens or a more customized fit.
What Is Keratoconus?
Keratoconus is a condition in which the cornea becomes thinner and to the point of bulging out into a conical shape. Due to the fact that the cornea’s no longer a round and smooth surface, light does not focus well thus vision is distorted and blurred.
At first patients may notice mild blurring or increasing astigmatism, then as the disease progresses they may have issues with ghosting, glare, and poor night vision. In the early stages of keratoconus glasses may still help but as the cornea’s shape becomes more irregular at some point glasses will stop to give sharp vision.
Why Keratoconus contact lenses Help
Keratoconus contact lenses, which is what we use for these patients’ treatment, create a smooth front surface which in turn allows for much clearer light to hit the retina.
Also because the base of the irregular cornea is covered up by the tear layer and the contact lens design which in fact what we mean by masked that is why many patients which may have had issues with vision while wearing glasses do much better with keratoconus contact lenses. For some people the results are so good that it delays or gets rid of the need for surgery.
Types of Keratoconus Lenses
There are several types of keratoconus lens options, and each has its place
| Lens type | Best for | Main benefit |
| Custom soft lenses | Mild to moderate keratoconus. | More comfortable and easier to adapt to. |
| Rigid gas permeable (RGP) lenses | Moderate keratoconus. | Excellent clarity because they create a smooth optical surface. |
| Piggyback lenses | Patients who need RGP vision but cannot tolerate direct lens wear. | Combines comfort of a soft lens with clarity of an RGP lens. |
| Hybrid lenses | Patients need both sharp vision and better comfort. | Rigid centre with soft skirt. |
| Scleral lenses | Advanced or irregular keratoconus, or lens intolerance. | Very stable, comfortable, and vaults over the cornea. |
How Each Lens Feels in Real Life
Soft keratoconus lenses do in fact tend to be the most easy to adapt to but they may not correct vision as well in more advanced disease. They work best when the cornea is only slightly out of the normal shape and the patient still prefers a soft feel.
RGP lenses usually provide the best visual acuity in many keratoconus patients as the rigid front surface does a great job at correcting corneal irregularities. That said they may take some time to get used to and some patients report that they are more aware of the lens in the eye.
For very advanced cases the best option is often the scleral lens which rests on the white of the eye and in turn vaults over the cornea. Also the pocket of fluid which forms under the lens is a big plus which helps with dryness which is a great benefit for many patients.
How To Choose The Right Lens
Choosing out the best type of keratoconus contact lens begins with a comprehensive corneal exam and topography. The doctor will look at the steepness of the cone, the stability of the disease and also if the patient has dry eye or lens intolerance.
A practical approach is usually:
- Mild keratoconus: At first we’ll try glasses or custom soft lenses if vision is still good.
- For moderate keratoconus: RGP, hybrid, or piggyback lenses are usually recommended.
- In advanced or uncomfortable cases we see more of a preference for the scleral lenses.
Also the final choice will depend on the patient’s daily routine. A student, a driver, and a person with very dry eyes may each present with a different solution even if their corneas look the same.
Benefits Of Keratoconus Contact Lenses
The greatest benefit is that of imperfect vision which glasses do not usually correct we are able to provide that is better vision quality. We see reports of more clear definition, less ghosting, and improved night vision from our patients.
Other benefits include:
- Better in advanced stages with scleral lenses.
- Improved vision stability as compared to glasses in case of irregular cornea.
- Delay of surgical intervention in many patients.
- Better daily performance at work, driving, and reading.
When Contact Lenses Are Not Enough
If your keratoconus progresses it may not be stopped by contact lenses alone. In which case we may discuss corneal cross linking, and for more advanced cases other procedures may be done.
That is why follow up is so important. A lens can improve vision but the base corneal shape is a cause of ongoing issue and must still be monitored.
Keratoconus Care At Vasan Eye Care
At Vasan Eye Care we do a detailed corneal assessment which is the base for our lens fit for patients with keratoconus. We look at vision, comfort, dryness of the eye and which of either special keratoconus eye glasses or specialty keratoconus contact lenses will work best for the stage of the disease the patient has.
Also we may evaluate if there is a need for other eye treatments in addition to lenses which may include corneal support procedures or we may give counseling on corneal ulcer treatment in the best eye specialist hospital if the eye surface is in poor health. Our goal is always to protect vision and at the same time make sure the lens is a practical solution in the patient’s daily life.
Key Takeaways
Keratoconus contact lenses which are very much the best solution when keratoconus eye glasses fail to improve vision.
RGP, hybrid, piggyback, and scleral are the primary specialty types which may be used and which one to use depends on the degree of the disease and what will be most comfortable for the patient.
Scleral lenses in particular are very helpful in advanced keratoconus or dry eyes as they cover the cornea and in that way provide a stable tear environment.
Also very important is regular follow up as while these lenses do improve vision they do not stop the progression of keratoconus.
Frequently Asked Questions
In the early stages of the disease glasses may help but as the cornea becomes more irregular which is a feature of keratoconus they usually stop providing sharp vision. At that point many patients require keratoconus contact lenses for better vision.
There isn’t a single best choice for all. RGP lenses tend to do very well, at the same time scleral lenses are very comfortable for advanced disease or dry eyes.
Scleral lenses do in fact for many people provide better comfort which is a primary issue in advanced keratoconus and dry eye. RGP lenses do at times provide very good vision although may at first be less comfortable.
No. Contact lenses improve vision but do not in any way stop the disease from progressing. If we see progression of the disease other treatments like cross linking may be required.
Reference Links
- PMC / NIH – Contact lens in keratoconus
https://pmc.ncbi.nlm.nih.gov/articles/PMC3775075/ - National Keratoconus Foundation – Contact Designs for Keratoconus
https://nkcf.org/contact-lenses-for-kc/ - Johns Hopkins Medicine – Treatments for Keratoconus
https://www.hopkinsmedicine.org/wilmer/research/cornea/keratoconus/treatments