What are Specialty Contact Lenses for Keratoconus?

Keratoconus means “cone-shaped cornea.” Your cornea is the outermost layer of your eye, and it’s normally a nice, smooth curve. However, with keratoconus, the cornea starts to thin and bulge outward like a cone.

Instead of a smooth curve focusing light onto your retina, the cone shape scatters the light all over the place. This causes blurry vision, along with halos around lights, glare, and sensitivity.

Sometimes, the cornea gets so thin it can swell with fluid. This is really uncomfortable and makes things even worse for a while.

What Causes Keratoconus?

We don’t fully understand what causes keratoconus, but it seems to be a combination of genetics and environmental conditions.

There’s often a family history of keratoconus, so genes likely play a role. Things like eye rubbing and allergies⁠—anything that irritates your eyes a lot⁠—can worsen it.

Keratoconus often starts in your teens or 20s and tends to slowly worsen over time. This is why regular eye exams are so key, even if you feel like your vision is “stable.”

Specialty Contact Lenses for Keratoconus Management

Unlike those soft lenses for regular nearsightedness, contact lenses for keratoconus are all about giving your eye a new, smooth surface.

Here’s a rundown of these different lenses:

Hybrid Lenses

Hybrid lenses offer the best of both worlds. They’re like hard lenses with a soft, comfy cushion around the outside. They’re a good option if you want the sharp vision of a hard lens but find them too irritating.

Scleral Lenses

Scleral lenses are larger than your cornea, so they completely vault over the “cone,” making a new, smooth surface for light to focus on. They offer good comfort, especially if your eyes are very sensitive.

Soft Lenses

Soft lenses are still an option early on in keratoconus but may not give you perfectly crisp vision. Their inherent flexibility may not fully correct the visual distortions from irregularly shaped corneas.

However, soft lenses are easy to handle and comfortable. This makes them a preferred choice for some people, especially those with mild keratoconus.

RGP Lenses (Rigid Gas Permeable)

These rigid lenses offer excellent visual acuity and are a good alternative for those who find other rigid lenses uncomfortable. They’re durable and maintain their shape well, providing consistent vision correction.

What Lens Should I Choose?

Here’s a table that can help you choose the best lens for your condition:

Lens Type	Key Features	Benefits	Considerations	Ideal For
Hybrid Lenses	Rigid gas permeable center, soft outer skirt	Good visual acuity, comfortable	Moderate ease of use	Those who want the vision of a hard lens but with more comfort
Scleral Lenses	Large diameter, vaults over the entire cornea	Excellent comfort, especially for sensitive eyes	Requires practice to handle	Sensitive eyes, advanced keratoconus
Soft Lenses	Soft, flexible material	Comfortable, easy to handle	May not fully correct vision in advanced cases	Mild keratoconus, early stages, or those prioritizing comfort
RGP Lenses	Rigid gas permeable material	Excellent visual acuity, durable, good alternative to other rigid lenses, maintains shape well for consistent vision	Less comfortable than soft or hybrid lenses	Those who want excellent vision and find other rigid lenses uncomfortable

Advanced Treatment Options and Considerations

Sometimes, even with the best-fitting contact lenses, keratoconus may still worsen. That’s when we start thinking about more advanced options:

1. Corneal Collagen Cross-Linking (CXL)

The procedure involves applying eye drops containing riboflavin (a type of vitamin) and exposing the eye to ultraviolet (UV) light. This process strengthens the collagen within the cornea, aiming to halt the progression of keratoconus.

The good news is that it’s usually a quick outpatient procedure, but your vision might take a few weeks to get back to normal.

2. Refractive Surgery

Doctors sometimes use a laser treatment like LASIK⁠—but with extra tech to reshape your cornea. They can also put tiny rings in your cornea to flatten it.

Refractive surgery can be good if your keratoconus is mild. However, there are more risks, and they may not be the best long-term solution if things change.

3. Corneal Transplant

A corneal transplant replaces your cornea with a healthy donor cornea. It can give the best vision if everything goes well, but it’s a major surgery with a long recovery time and the potential for complications, including rejection of the transplant.

Here’s a quick comparison of specialty contact lenses and the advanced treatments:

Treatment	Potential Visual Improvement	Halts Keratoconus Progression	Comfort Level	Potential Risks
Specialty Contact Lenses	Often good, but varies	No	Varies depending on the lens type	Minimal
Corneal Collagen Cross-Linking (CXL)	No, but may preserve the existing vision	Yes	Some initial discomfort	Low
Refractive Surgery	Good potential	Uncertain	Discomfort is similar to typical eye surgery	Risk varies depending on the procedure, but potentially more risks than CXL
Corneal Transplant	Best potential	Yes	Post-operative discomfort	Highest risk⁠—may include rejection of the transplant, infection, etc.

Unfortunately, keratoconus can be unpredictable. It’s important to see a cornea specialist regularly because sometimes, a combination of treatments is the best approach.

For example, CXL early on can stop things from worsening, but it’s possible to still use specialty lenses to help you see clearly. You may also consider surgery at some point down the road, but only if it becomes necessary.

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