Keratoconus is a degenerative or progressive disorder that affects the cornea. The cornea is the clear membrane that covers the colored part of the eye and pupil. The cornea is the “window” of the eye and is the most powerful lens in the eye as well. Keratoconus is a corneal disease that causes structural changes within the cornea which cause the cornea to thin and bulge outward into a steeper, irregular, more conical shape than its normal gradual curve.

Keratoconus can cause substantial visual loss of vision, image distortion, streaking of lights, sensitivity to light, and multiple images, etc. Keratoconus affects approximately one person in a thousand. However, the exact cause of keratoconus is uncertain. It has been linked to genetic factors and associated with detrimental abnormal enzyme activity in the cornea. However, the findings are still inconclusive.

Many patients with keratoconus may be treated with corrective lenses, glasses, contact lenses, intrastromal corneal ring segments, and as a last resort, corneal transplantation. In order to stabilize the cornea, keep the keratoconus from progressing and even avoid having to have a corneal transplant, many patients now have chosen to travel around the world to have corneal collagen crosslinking, also known as "CXL."

At Eye Care Center, we proudly announce that we work closely with the world-class experts in the field of keratoconus. At our office in College Station, we maintain extensive diagnostic technology to diagnose and track the progression of keratoconus. When surgical intervention is needed, we work with our colleagues in Houston at Slade & Baker Vision Center. As leaders in the field, Slade & Baker were the first FDA Approved site for clinical trial in Houston, Texas and are still currently involved in this study. Our patients in the Bryan / College Station participated in this cutting edge study and are still seeing excellent results today.

If you or someone you know has been diagnosed with keratoconus and you live in or near the Houston area, please feel free to contact us for more information. We encourage you to visit our Crosslinking page for more information on this procedure and its wonderful results.

Contact lenses are fit for many reasons including correcting nearsightedness, farsightedness, astigmatism, and presbyopia. They are also used for therapeutic purposes such as after refractive surgery or for keratoconus. Athletes, young patients who are not yet ready for refractive surgery, and patients who need bifocals but do not wish to wear glasses can also benefit from wearing contact lenses. In many of these patients, vision is actually better in contact lenses rather than glasses / spectacles. Below are several types of contacts we recommend and use daily on our special fit patients.

If you've been told in the past that you cannot wear contact lenses because of an irregular cornea or other problems, you may want to get a second opinion and ask your eye doctor about scleral contact lenses.

Scleral contacts are large-diameter gas permeable contact lenses specially designed to vault over the entire corneal surface and rest on the "white" of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by keratoconus and other corneal irregularities.

Also, the space between the cornea and the back surface of a scleral lens acts as a fluid reservoir to provide comfort for people with severe dry eyes who otherwise could not tolerate contact lens wear.

Many optometrists recommend scleral contact lenses for a variety of hard-to-fit eyes, including eyes with keratoconus. Scleral contacts are noticeably larger than standard gas permeable (GP) contacts and have a diameter equal to or greater than that of soft contact lenses. The smallest sclerals are approximately 14.5 mm in diameter, and the largest can be up to 24 mm. When most people think about putting a large contact in their eyes, they assume the comfort will be poor. With our patients at Eye Care Center, we have found the response to be quite the opposite. The lenses provided excellent comfort.

In cases of early keratoconus, a standard GP lens may be used. However, if the lens does not center properly on the eye or moves excessively with blinks causing discomfort, switching to a large-diameter scleral contact lens may solve the problem.

Because scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with keratoconus. Also, scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses.

If you or someone you know is interested in trying scleral lenses for keratoconus or other ‘hard-to’fit’ eyes, please contact us at (979) 779-9000 or schedule an appointment today.

If you have keratoconus or another irregular cornea condition, traditional contact lenses can sometimes be problematic. Many people experience limited wear time, discomfort after a few hours of wear or glare from their current contact lenses. Most of the traditional lenses do not allow for good, stable vision and leave the patient frustrated (and blurry)!

With KeraSoft® IC there is an alternative. Its innovative design uses the latest technologies to create a soft contact lens that fits many unusually shaped corneas – one you can wear comfortably. Dr. Belinda Dobson enjoys the benefits of the lens with her patients because it is customized to specific corneal shape and prescription needs, its designed to provide excellent comfort and vision, and ensures a high, healthy level of oxygen.

Gas permeable contact lenses are rigid lenses made of durable plastic that transmits oxygen. These lenses also are called GP lenses, rigid gas permeable lenses, RGP lenses and oxygen permeable lenses. For many patients, they offer outstanding benefits over soft lenses. For one, because GP lenses are made from a firm plastic material, they retain their shape when you blink, which tends to provide sharper vision than pliable soft lenses.

GP lenses also are extremely durable. Although you can break them (for instance, if you step on them), you can't tear them easily, like soft lenses. In addition, they are made of materials that don't contain water (as soft contact lenses do), so protein and lipids from your tears do not adhere to GP lenses as readily as they do to soft lenses.

There are some disadvantages of RGP lenses for patients with irregular corneas and most of these deal with discomfort and poor fit. Because of the shape and curvature of more keratonic corneas, the RGP lens has a difficult time centering, thus creating movement of the lens, and therefore blurring vision and making the lens uncomfortable.

Corneal Crosslinking offers a solution for slowing or halting the progression of keratoconus. For patients who have keratoconus, crosslinking provides an attractive and minimally invasive tactical approach to slow the disease. At Eye Care Center, Dr. Belinda Dobson examines the cornea and determines if one is a candidate for crosslinking. If we determine corneal collagen crosslinking is an option for the management of keratoconus, we perform the pre-operative examination and carefully work with Dr. Slade’s office to orchestrate the treatment phase.

Purpose:

Corneal Crosslinking (CXL) is an investigational treatment for Keratoconus patients and Post Lasik Ectasia patients that experience corneal thinning after Refractive Surgery. This trial is studying if this one-time treatment will strengthen the cornea so that the progression of Keratoconus and Corneal Ectasia is slowed or stopped.

Background:

Corneal Collagen Crosslinking (CXL) has been proven in studies outside of the US to strengthen a weakened corneal structure, as in keratoconus. CXL is currently in US Food and Drug Administration (FDA) clinical trials to seek FDA approval.

Keratoconus/Effects:

The cornea is the clear membrane that covers the colored part of the eye and pupil. The cornea is the “window” of the eye and is the most powerful lens in the eye as well. Keratoconus is a corneal disease that causes structural changes within the cornea causing the cornea to thin and bulge outward into a steeper, irregular, more conical shape than its normal gradual curve. Keratoconus can cause substantial visual loss of vision, image distortion, streaking of lights, sensitivity to light, and multiple images, etc.

Keratoconus affects about one person in a thousand, and yet the exact cause of it is uncertain. It has been associated with genetic factors and linked to detrimental abnormal enzyme activity in the cornea; however, the findings are still inconclusive. Many patients with keratoconus may be treated with corrective lenses, glasses, contact lenses, intrastromal corneal ring segments, and as a last resort, corneal transplantation. In order to stabilize the cornea, keep the keratoconus from progressing and even avoid having to have a corneal transplant, many patients now have chosen to travel around the world to have corneal collagen crosslinking, also known as "CXL."

Goal:

Crosslinking (CXL) has been shown to increase the number of corneal crosslinks within the cornea. These links are like the natural anchors in the cornea and are responsible for preventing the cornea from bulging outwards and becoming steep and irregular. The goals of crosslinking are to stop the progression of keratoconus, decrease the severity of the corneal bulging, and allow the patient to continue or resume contact lens wear. By decreasing the severity of the corneal bulging, doctors are better able to fit the patient for contact lenses.

Study Parameters:

You may be eligible for this study if you are 12 years of age or older and have been diagnosed with Keratoconus or diagnosed with Corneal Ectasia after refractive surgery (e.g. LASIK, PRK). There are specific inclusion and exclusion criteria that patients must meet in order to be considered participants in the clinical trial. We will be happy to discuss these with you.

Procedure:

The crosslinking treatment is an outpatient procedure performed in the surgical laser suite using numbing eye drops. During this study, the surgeon uses an ultraviolet-A illumination device (UVA light treatment), called the KXL system in combination with VibeX (vitamin B2) eye drops to treat the cornea (front of the eye). First, in the Epithelial Off procedure, the outer layer of the cornea, the epithelium, is prepared for the procedure. If a patient is having the Epithelial On procedure, this step is skipped. Next, vitamin B2 (riboflavin) eye drops are instilled in the eye and the patient is asked to look at an ultraviolet light while lying comfortably in a reclining chair. The entire procedure generally takes only a few minutes. The patient’s eyes are numbed through the use of anesthetic drops.

After treatment:

Post operatively, most patients start to notice the effects in their vision 4-8 weeks after the traditional (epithelial-off) procedure and the final effects usually take 3-6 months. Every patient is different, visual results may differ.

If you are interested in learning more about CXL or keratoconus, please call us at (979) 779-9000 and ask for Madeline.

Please visit the National Keratoconus Foundation's website to see all the approved CXL sites in the United States.