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Keratoconus Patients Can Avoid Corneal Surgery With Scleral Lenses

All surgical procedures come with risks, which is why they are usually prescribed as a last resort after trying other interventions.

This is equally true for keratoconus—an eye disease that causes the cornea to become misshapen. Although corneal surgery is generally safe, it can at times lead to complications like infection, permanent corneal scarring, transplant rejection and corneal haze.

Research has shown that patients with severe keratoconus who wear scleral lenses significantly reduce their need for corneal surgery.

Below, we’ll cover the ins and outs of keratoconus and explain how scleral lenses can safely and effectively manage the condition.

What is Keratoconus?

Keratoconus affects approximately 0.05-0.25% of the global population. It is a progressive eye condition that causes the cornea to thin and become cone-like in shape, affecting how light enters the eye. It usually affects both eyes but may lead to differing vision in each eye if a single eye is affected.

Symptoms of keratoconus include:

  • Blurred or distorted vision
  • Increasing sensitivity to light or glare
  • Red or swollen eyes
  • Increasing nearsightedness or astigmatism
  • Frequent changes in lens prescription
  • The inability to wear standard soft contact lenses

The exact cause of keratoconus isn’t well understood, but risk factors for developing the disease include genetics, oxidative damage, eye rubbing and certain health conditions like allergies, asthma, Down syndrome and retinitis pigmentosa.

In the early stages of keratoconus, soft contact lenses or glasses may be enough to successfully correct vision. But over time, the cornea becomes so misshapen that these methods are no longer effective. Surgical procedures performed on keratoconus patients include corneal cross-linking, refractive surgery and keratoplasty (corneal transplant).

What are Scleral Lenses?

Scleral lenses have a larger diameter than standard soft lenses and cover most of the sclera (the white part of the eye).

Because they don’t put any pressure on the cornea or sclera, they are very comfortable to wear—even for patients with corneal disease. The lens prevents the bulging cornea from rubbing against the eyelid and protects it from environmental irritants.

The space between the scleral lens and the eye is filled with a nourishing liquid that allows oxygen to reach the eye while keeping it hydrated. It also acts as an artificial cornea that helps focus light into the eye, providing sharp and clear eyesight.

Scleral lenses are tailor-made for each eye to ensure the patient achieves the best vision possible.

How Scleral Lenses Can Reduce the Need for Corneal Surgery

In a study involving 51 eyes with severe keratoconus, 40 of them were able to avoid surgery by wearing scleral lenses. While all patients in the study were candidates for corneal transplants, scleral lenses cut the need for keratoplasty by more than half over a 5-year span.

In fact, the study found that managing stage 4 keratoconus with scleral lenses was more effective and safer than keratoplasty.

The features of scleral lenses are ideal for keratoconus patients in several ways. Because they don’t touch the cornea, the rate of scar formation slows down and the cornea isn’t irritated. Moreover, scleral lenses are very stable and fit securely to the eye’s surface. This prevents them from moving around with each blink (as standard lenses do), making them much more gentle on the patient’s sensitive eyes.

If your or a loved one has been diagnosed with keratoconus or is experiencing any of the associated symptoms, we can help. A consultation with Dr. Farkas, Dr. Kassalow, and Dr. Resnick will help determine the best-suited treatment for your eyes.

Schedule an appointment by calling one of our friendly staff members at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates today.

Our practice serves patients from New York City, The East Side, Roslyn, and Nassau County, New York and surrounding communities.
Request An Appointment
Call Our Offices

Learn More About Scleral Lenses

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What You Should Know About Corneal Disease

The cornea, the eye’s transparent cover, refracts light, which enables the eye to see clearly. A healthy cornea is vital to good eyesight, so damage to the cornea can cause pain, sensitivity to light, blurriness, inflammation, headaches and vision loss.

Conditions and diseases harmful to the cornea include:

  • Injuries and trauma
  • Keratitis, an inflammation of the cornea resulting from an injury, bacteria, viruses, fungi, or parasites. (One form, neurotrophic keratitis, is a rare degenerative disease characterized by corneal numbness, thinning, ulceration and perforation.)
  • Dry eye, resulting from the eyes not producing enough tears or tears of subpar quality
  • Shingles, herpes and other viruses
  • Iridocorneal endothelial syndrome, causing corneal swelling, glaucoma and changes in the iris
  • Pterygium, a growth of tissue on the cornea
  • Stevens-Johnson syndrome (erythema multiforme major), a serious skin disorder that also causes conjunctivitis, corneal blisters and erosions, holes in the cornea and painful blisters on the eyelids
  • Corneal dystrophies (such as keratoconus, lattice corneal dystrophy, map-dot-fingerprint dystrophy and Fuchs’ dystrophy), which cause parts of the cornea to become cloudy starting in childhood
  • Allergies and minor scratches

Lowering Risks to the Cornea

According to the National Institutes of Health’s National Eye Institute, you can lower the risk of corneal injuries by wearing protective eyewear while playing sports, doing yard work, working on home repairs, using machines and handling chemicals. You can prevent keratitis and other corneal infections by properly cleaning, disinfecting and storing your contact lenses.

Diagnosing Corneal Damage When It Does Occur

If you suspect you have sustained corneal damage of any kind, contact Dr. Farkas, Dr. Kassalow, and Dr. Resnick to examine for corneal abrasions and corneal diseases. This is important because many eye diseases have no early symptoms or warning signs. Indeed, having a dilated eye exam is important even if your eyes seem healthy.

Treating Corneal Diseases

Treatment options depend on the medical condition. They include:

  • Eye drops and ointments
  • Cenegermin, a medication for treating neurotrophic keratitis
  • Oral antiviral medications
  • Laser surgery to treat corneal erosions and dystrophies by reshaping and restoring the cornea
  • Partial corneal transplant, in which one or two layers of the cornea are removed or are replaced by a layer from a donor
  • Corneal transplant for some patients with keratoconus, severe corneal scarring, certain corneal dystrophies, edema after cataract surgery and any failure of the cornea after eye surgery
  • Artificial cornea for those who cannot undergo a corneal transplant

One of the most common ways to treat corneal problems is with scleral contact lenses, which vault over the cornea and rest upon the sclera, the eye’s white surface. These customized lenses can help patients with corneal abrasions, diseases and injuries by protecting the cornea’s surface and keeping the cornea hydrated. Scleral lenses also allow the cornea to recover from a corneal transplant, and are the preferred treatment for keratoconus, severe dry eye and other conditions.

Our practice serves patients from New York City, The East Side, Roslyn, and Nassau County, New York and surrounding communities.

References:

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What Is Keratoconus?

Keratoconus (keh-rah-toe-cone-us) is a condition in which the structure of the cornea is not strong enough to maintain its spherical shape, causing the cornea to bulge outward into a shape resembling a cone. This leads to a host of symptoms, including blurred and double vision, as well as halos around objects and streaks of light.

Below you’ll learn more about this condition and discover how Dr. Farkas, Dr. Kassalow, and Dr. Resnick at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates can offer a wide range of successful options, so you can keep enjoying clear and comfortable vision.

What is Keratoconus?

Keratoconus is a progressive eye disease in which the dome-shaped cornea thins, causing the cornea to develop a cone-like shape. The misshapen cornea deflects light, causing distorted vision and may result in blurred vision, double vision, myopia, irregular astigmatism and sensitivity to light.

This rare eye condition affects 1 out of every 2,000 people and typically begins in the teenage years and early 20s, with vision deteriorating over a period of about 10 to 20 years. It’s common for people with this disease to see prescription changes with each eye exam.

Keratoconus often runs in families, so if you or your children are at risk or are experiencing any of the symptoms mentioned below, contact The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates for an eye exam. Keratoconus can only be diagnosed through a thorough eye exam, where Dr. Farkas, Dr. Kassalow, and Dr. Resnick will examine your cornea and measure its curvature.

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What Causes Keratoconus

Your cornea is held in place by very small collagen fibers. When they are weakened, they cannot preserve the spherical dome-like shape of your cornea. The exact cause of keratoconus, however, is still unknown.

Weakening of the cornea tends to happen in those with a genetic predisposition, which is why keratoconus may affect several people in a single family.

Keratoconus has also been linked to:

  • Excessive exposure to UV rays
  • Excessive eye rubbing
  • Difficulty wearing contact lenses
  • Certain eye injuries
  • Retinitis pigmentosa
  • Marfan syndrome
  • Ehlers-Danlos syndrome

Symptoms of Keratoconus

As the shape of your cornea begins to bulge, it alters your eyesight. Your normally smooth corneal surface becomes wavy and expands, becoming cone-shaped. This causes irregular astigmatism or nearsightedness. The condition tends to begin in one eye and later develops in the other eye as well.

Typically, one’s prescription will change frequently as vision worsens, over time it will also become more difficult to wear contact lenses due to the changing shape of the cornea. If the contact lenses are not properly fitted on someone with Keratoconus, the lenses may rub against the most vulnerable part of the cornea. The excessive rubbing then causes symptoms to worsen by aggravating the already thin cornea. When the symptoms of keratoconus intensify, the cornea can begin to swell and form scar tissue. This scar tissue can result in worsening visual distortion and blurred vision.

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Symptoms during the early stages of keratoconus:

  • Mild blurred vision
  • Slightly distorted vision (straight lines appear bent or wavy)
  • Some sensitivity to light and glare
  • Red-eye and/or swelling
  • Chronically irritated eyes

In its later stages, one tends to experience:

  • Increased blurred and distorted vision
  • Nearsightedness or irregular astigmatism
  • Inability to wear regular contact lenses

Keratoconus Treatments

There are several ways to treat this condition. When the symptoms are still mild, you can correct your vision using eyeglasses. As the condition progresses, there are several treatment options.

  • Scleral contact lenses. For improved visual acuity, gas permeable scleral lenses are usually the preferred treatment. Scleral lenses vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface that provides clarity and comfort.
  • Custom soft contact lenses. These customized soft lenses are specially designed to correct mild-to-moderate keratoconus.
  • Piggyback contact lenses. For those with keratoconus, fitting a gas permeable (hard) contact lens over a cone-shaped cornea may at times prove uncomfortable. “Piggybacking” involves placing a soft contact lens over the eye and then placing a GP lens over the soft lens. This increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.
  • Hybrid contact lenses. These lenses combine a highly oxygen-permeable rigid center with a soft peripheral “skirt”. Some hybrid lenses are specifically designed for keratoconus, with the central GP area of the lens vaulting over the cone-shaped cornea.
  • Intacs. This small curved device is surgically placed in your cornea to help flatten the corneal curvature and improve vision.
  • Corneal collagen cross-linking. Used together, special UV light and eye drops can strengthen the cornea, thus flattening your cornea and preventing further expansion.
  • Corneal transplant. As a last resort, you may be advised to undergo a corneal transplant, where all or part of your distorted cornea is replaced with healthy donor cornea tissue. Even after a transplant, however, you may still need to wear glasses or contact lenses for clear vision.

Contact Dr. Farkas, Dr. Kassalow, and Dr. Resnick at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates to find out whether scleral lenses are right for you.

Our practice serves patients from New York City, The East Side, Roslyn, and Nassau County, New York and surrounding communities.
Request An Appointment
Call Our Offices

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Corneal Collagen Cross-Linking for Keratoconus

Corneal collagen cross-linking (CXL) is currently the only treatment that may slow down the progression of keratoconus. This is a minimally invasive procedure to strengthen corneal tissue and stabilize the cornea’s shape.

If you have been diagnosed with keratoconus, or if you are concerned that your condition might be deteriorating, contact Dr. Farkas, Dr. Kassalow, and Dr. Resnick at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates to evaluate whether CXL is the best option for you.

What Is Corneal Collagen Cross-Linking?

Corneal collagen cross-linking is a surgical procedure performed by a corneal specialist or ophthalmologist to stabilize the shape and firmness of the cornea. By applying riboflavin (vitamin B2) eye drops and ultraviolet light, the surgical treatment promotes the building of new collagen fiber links within the cornea. In many cases, it helps prevent the need for a corneal transplant.

Collagen plays a vital role in creating and maintaining the smooth round shape of the eye’s surface. The tightness of the woven collagen fibers determines the strength of the corneal tissue. A weak cornea is prone to deformation, causing keratoconus to progress.

CXL is also effective in treating corneal ulcers in cases where topical antibiotics did not produce results. Several other corneal infections have also successfully been treated with CXL.

Your Optometrist Prepares You for CXL

A few steps need to be taken before you undergo corneal collagen cross-linking. Dr. Farkas, Dr. Kassalow, and Dr. Resnick can assess whether you are a candidate and get you ready for the surgical procedure.

1) We’ll Evaluate If You Need CXL

At The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates, we will inquire into your patient history to determine whether any previous eye surgeries might prevent you from undergoing CXL. We will also examine several other factors, such as keratoconus progression and corneal thickness. In case you have dry eye, this needs to be treated appropriately before scheduling the CXL procedure.

2) Connecting You With The Right Surgeon

Following your eye exam and the evaluation of your suitability for CXL, we will connect you with an ophthalmologist to schedule the actual procedure. We at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates work with the finest corneal specialists in the area because we want you to be in good hands.

3) Pre-Op Exam With Your Optometrist

Just before the surgery, you will have a short pre-op examination at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates. Lens wearers are required to remove their contact lenses a few days prior to this examination so that measurements can be entirely accurate.

We will gather measurements about visual acuity, refraction, the shape of the corneal surface, and intraocular pressure. The data generated in this examination will be used for comparison in every future examination, and provide background for follow-up should the keratoconus continue to progress after the surgical intervention.

The CXL Procedure

seniors smiling 2 640The ophthalmologist will first apply riboflavin eye drops (vitamin B2) to the surface of the eye. This substance is conducive to photo-enhancing; in other words, it improves light absorption. Next, the practitioner will expose the eye to a specific ultraviolet light to activate the development of new collagen cross-linking. This will cause the collagen fiber to thicken across the entire cornea and reinforce it.

There are two types of corneal cross-linking procedures:

  • Epithelium-on cross-linking or transepithelial cross-linking. In this procedure, the doctor applies the eye drops onto the outer layer of the cornea, called the epithelium.
  • Epithelium-off cross-linking. To allow the riboflavin to penetrate more easily into the lower layers of the cornea, the doctor removes its outer layer before applying the drops. This surgical intervention has a slightly higher risk, as it could cause the disruption of surface cells in the epithelium.

We Provide Post-Op Care

The success of the one-hour surgical treatment depends as much on the quality of postoperative care as it does on the procedure itself. Careful management of eye health is essential for rapid rehabilitation of visual clarity and to reduce the risk of complications.

Follow-up care provided at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates includes three main objectives, of which the speedy healing of the corneal surface is primary. Generally, patients are prescribed temporary soft contact lenses to protect the eye surface during the healing process. The lenses also serve the purpose of minimizing potential pain.

To prevent infections, Dr. Farkas, Dr. Kassalow, and Dr. Resnick will provide topical antibiotics and other medications that may be needed to protect the cornea and ensure a safe and fast recovery.

Who Can Undergo Corneal Collagen Cross-Linking?

The surgical treatment is recommended for patients who have recently been diagnosed with keratoconus and patients with a rapidly worsening condition. The sooner the treatment is applied, the better the chances of strengthening the cornea or even improving its shape.

Because CXL does not restore lost vision, early treatment is critical to prevent visual acuity from declining. This can also increase the chances of wearing traditional contact lenses later on.

Patients with stable keratoconus, a thin cornea, or a scarred cornea may not benefit from CXL and can potentially delay or avoid the procedure altogether.

Contact Dr. Farkas, Dr. Kassalow, and Dr. Resnick at The Scleral Lens Center at Drs. Farkas, Kassalow, Resnick & Associates for additional information or to schedule an eye exam.

Resources:

Our practice serves patients from New York City, The East Side, Roslyn, and Nassau County, New York and surrounding communities.
Request An Appointment
Call Our Offices

Learn More About Scleral Lenses

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