Keratoconus contact lenses with Dr. Jennifer Lyerly - A State of Sight #97

Scleral supported contact lenses can work very well for patients with keratoconus. Watch this episode of A State of Sight with special guest Dr. Jennifer Lyerly to learn more about this specialized type of rigid gas permeable contact lens.

In keratoconus, other types of contacts can be difficult to fit properly and may not give the comfort and vision that scleral lenses can offer. Fortunately, there are several options available that may work for these patients.

For more info about scleral contact lenses and other uses for this type of lens, watch A State of Sight #67:

Dr. Porter: Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care from Raleigh. Today, we have a very special episode. I’m very happy to have our guest, Dr. Jennifer Lyerly with us. She is with Triangle Visions and you should check out her blog, EYEdolatry, it’s a great educational blog. Welcome Dr. Lyerly.
Dr. Lyerly: Thank you so much for having me Dr. Porter, I appreciate being here.
Dr. Porter: No problem, I’m glad you could be here. Dr. Lyerly is going explain options for contact lenses for keratoconus. First, tell us how patients with keratoconus can benefit from contact lenses.
Dr. Lyerly: Keratoconus is a corneal degeneration of the eye. If you have watched a lot of Dr. Porter’s videos, you know how the cornea becomes misshapen, kind of like a little mountain coming out, towards the bottom of the cornea.
When light hits the cornea in keratoconus, it’s going to be bouncing in a lot of different directions. This can degrade and blur vision. It can be very aggressive as it progresses and these patients can end up not seeing well, even with glasses.
When we think of contact lenses we typically think of a soft contact lens, which is what most people wear. However, a soft contact lens is going to form over the surface of the cornea and not correct the corneal shape, which is what we want to achieve with a contact lens.
My best tool with contact lenses for keratoconus is a hard contact lens. A lens that has it’s own natural shape. I’m going to try to create a new cornea for that patient, if you will, where lights going to hit it and pass evenly into the eye to restore clear vision.
When we think about a traditional hard contact lens, it usually is a smaller shape lens that sits right on the surface of the eye, about 10 mm in diameter. The contact lenses I use for keratoconus are a little bit different in size, so when people first see this it’s a little scary to see a lens that’s larger.  
We are talking about a 14, 16, or maybe even 18 mm contact lens, depending on the person’s eye. The goal with a contact lens of this diameter is to create a whole new surface on the eye. It completely goes over top of their cornea, it doesn’t touch the cornea at all and only sits on the white of the eye.
There are some benefits to that because the white of the eye has much less nerve endings. Therefore, you can have better comfort as compared to a smaller rigid gas permeable contact lens bouncing up and down on the cornea. It’s also going to fit well because it sits directly under your top and bottom eyelids and the optics are going to be incredible. This is the lens that I really like to use when I have a patient with keratoconus.
Dr. Porter: Excellent. I know we want to keep the patients cornea as long as possible because it has a much longer lifespan than a transplant would have. So if we can keep our keratoconus patients in contact lenses, we can preserve their cornea and obtain good vision. That’s something we always want to do, but if we need to go to corneal transplantation or other procedures down the road, that can be an option for the patients that need it.

Thanks again for joining us, if you have any questions about contact lens options for keratoconus please post as we will be happy to answer them. We hope to see you again soon, next time on A State of Sight.