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Reduced HOAs: Before and After a Scleral Lens

Remember when you were a child and you played with a magnifying glass? The glass focused light to a point because its surface was smooth. Imagine the surface was instead pitted or grooved or ridged. Light would no longer focus to a point, it would be smeared or distorted in some unpredictable way, depending on the exact irregularities in the glass. These are called higher-order aberrations.

The same is true of a human cornea that has been damaged by eye injury or by refractive surgeries like Lasik or PRK. If these corneas are not regular, light no longer focuses sharply on the macula, even with glasses or contact lenses. In this case, a scleral lens can restore vision by acting as a prosthetic cornea that provides a smooth anterior surface.

The image below illustrates the reduction in higher-order aberrations before and after a scleral lens.

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Why is it so Hard for Doctors to Get it Right when it comes to Fitting High-Need Patients with a Specialty or Scleral Lens?

Over the years I have received many inquiries from prospective patients about specific specialty contact and scleral lens designs. Most of the inquiries come from patients who have suffered significant vision loss due to keratoconus, corneal transplant surgery, refractive eye surgeries such as LASIK and RK, chronic dry eye, ocular trauma and a host of ocular conditions and diseases.

What must be understood and appreciated is that there are many different lens technologies available to treat these conditions. In addition, these technologies are constantly evolving as is the technology to diagnose and treat these conditions. Because there is so much technology and specialty lens designs available, patients will need to find a doctor with a great deal of experience not only in treating all of these conditions, but also knowledgeable with all of the many specialty-contact and scleral lenses currently available.

Our specialty lens practice, known as the Global Vision Rehabilitation Center, uses the most advanced technologies to help us diagnose and treat all of the conditions listed above. In addition, I approach the selection, design and use of these lenses as an art form. What will work well on one patient’s eye may not work well on another patient. Each lens technology is a tool or instrument that I use to improve vision and ocular comfort. Within each specific lens design or technology, there are fine details that the patient may not be aware of. For example, lenses can be made from different polymers, with each polymer having a specific characteristic. All of the specialty contact lens and scleral lens designs are made with many different curvatures with varying diameters. Any one or all of these lens parameters can be changed as needed during the initial fitting procedure or at any one of the subsequent follow up visits.

Every patient is unique and has vision demands unique to that individual. In addition, every eye is different. Many patients have lost vision and comfort due to LASIK and RK surgeries. Other patients have undergone corneal transplant surgery and have irregular and dry corneas. Other patients have been negatively impacted due to corneal disease and trauma. Every patient is carefully examined by me. After this is done, a decision will be made as to what lens technology will be best suited to restore quality vision and comfort once again. It is important to understand that the fitting procedure is a process. After the patient receives their lenses, careful examinations are done at all of their follow-up visits. At any of these follow-up visits, small adjustments to the lens design may need to be done. It is very important for both the doctor and patient to have patience with the process. As I tell all of my patients, we are embarking on a journey.

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Why I am Passionate about Scleral Lenses

I am often asked why I am so passionate about scleral lens technology. My answer will be a question: How many non-invasive technologies have the ability to provide clear, comfortable vision to a patient who previously suffered from ocular pain along with distorted, non-functional vision? How many non-invasive technologies are there that can dramatically change lives? Our lives revolve around our vision. There are millions of people around the world suffering ocular pain and vision loss due to corneal disease, trauma, ocular surgery and a host of other ocular conditions that can be successfully treated with scleral lens technology.

Scleral lens technology is the fastest growing and the most innovative technology within the contact lens industry. Our specialty scleral lens practice is the oldest and one of the largest scleral lens practices in North America. We have patients with significant vision issues visiting us from over 50 countries around the world. The following photos and images are examples of what a well-designed and fit scleral lens can achieve:

The eyes displayed here belong to patients who had no functional vision until we fit these eyes with scleral lenses. All of these patients are now seeing clearly and comfortably, often years of non-functional vision until they received their scleral lenses.

The following eye cannot close due to an acoustic neuroma. We designed a lens to keep the eye moist at night.

Some eyes are so distorted that it is not possible to provide the patient with a scleral lens using conventional technology. In cases like these we have to take an impression of the ocular surface and then send the impression to a special laboratory where 3D printing technology is used to make this highly customized lens where every “hill and valley” along the ocular surface is replicated onto the back surface of the EyePrint Pro scleral lens.

This is a photo of a scleral lens over an eye with an extremely rare condition known as “Stevens Johnson Syndrome”. This eye was scheduled to undergo surgery several months after this photo was taken. We fit this eye with a scleral lens in order to keep the ocular surface moist and to protect the eye from the environment and the blinking action of the eyelids.

The eyes below developed corneal irregularities after radial keratotomy. These irregularities were either present immediately after the surgery, but could develop many years later.

This eye was damaged due to trauma and surgery.

Scleral lens over a very profound eye with a corneal transplant.

These images show a scleral lens over a corneal transplant. Note the stitches.

This image shows a scleral lens over an eye with keratoconus. The lens vaults over the cone.

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The Healing Power of the Scleral Lens

The two photos below are of the left eye of a patient who suffered significant trauma to his body, face and left eye in a car accident. This patient’s upper left eyelid was severed from flying glass. His left cornea had numerous particles of glass which nearly perforated his cornea, but did create a purulent corneal ulceration. Two months ago reconstructive surgery was performed on this patient’s left upper eyelid. One month ago I fit this eye with a scleral lens to protect it from the environment and the blinking action of the eyelid. 7 days ago I refit this eye with a very thin gas permeable scleral lens made with a highly oxygen permeable material that is FDA approved for wear during sleep. Because this patient is unable to close his left eye completely, I asked him to wear this lens during sleeping hours as well as during the his waking hours. He has been wearing this lens all day while taking short breaks during the day to remove the lens, rinsing out his eye with saline solution, cleaning the lens and reinserting it. Look carefully at the photos below. The first photo was taken one month ago when I first met this patient and placed a scleral lens on this eye. Note the inflammation, mucous formations and the opaque, cloudy cornea. At the initial visit, this patient’s best corrected visual acuity was finger counting. The 2nd photo was taken yesterday. Note how much clearer his cornea is. In the 2nd photo you can see his pupil which is barely visible in the first photo. Also note the improved appearance of his upper eyelid in the 2nd photo. With this very thin highly oxygen permeable scleral lens, this patient’s corrected visual acuity is now 20/150. The oculoplastic surgeon who I share this patient with was as surprised as i was at the degree of improvement in such as short period of time. Three months before I met this patient, he was told by a very prominent eye specialist that this eye needed to be removed. Fortunately he and his family decided to obtain another opinion. This patient’s story, his eye and his scleral lens “journey” with me has to be one of the most unforgettable experiences of my career.


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Point Spread Function With and Without Scleral Lenses

Below are 2 sets (or slides) of topographical ring and “point spread function images” (PSF) of the same pair of eyes of a patient that underwent both RK and LASIK surgery.

Although you can see the distorted ring images on the photos (slide) on top, what is most interesting are the “point spread function images” (PSF) that can be seen in the upper portions of both sets of images. Look carefully at both the upper and lower sets of PSF images. These images show how a very small beam of light “spreads” after passing through a pair post-surgical (LASIK) corneas and on the same corneas with scleral lenses (lower set of slides). The very small red dot represents a fine beam of light. In the upper set of images, note the white-grey “web-like” patterns around the red beam of light. This represents how light is “spread out” when passing through a distorted post-LASIK cornea. Note how the left PSF image (the image on the right side of the slide) is significantly more distorted than the right PSF image. This is because the left cornea is more distorted than the right cornea. This is why eyeglasses and soft contact lenses cannot provide the post-LASIK distorted cornea with clear, crisp vision. Note the PSF images of same pair of eyes with scleral lenses on the lower set of slides. Note that the small beam of light has virtually no distortion after passing through the scleral lenses. Also note that the ring images in the lower half of the bottom set of slides are perfectly round. Note how the topographical rings in the lower half of the upper set of slides are significantly distorted. Scleral lenses in effect replace the cornea as an optical surface.


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FAQ: Lasik and Scleral Lenses

I was told that I have corneal ectasia which resulted from LASIK surgeon. My doctor suggested that I have Collagen Cross Linking done. Do you think that this would be advisable?

I have found Collagen Cross Linking to be ineffective for patients who have suffered vision loss due to LASIK induced corneal ectasia. Collagen Cross Linking was first introduced as a way to control or even reduce the progression or keratoconus. Collagen Cross Linking may be an effective technology to treat keratoconus when it is in a progressive state. This usually applies to young patients. I have found that patients with corneal ectasia will have an unstable cornea for a very short period of time, possibly a few days to a few weeks after the onset of the ectasia. After this brief period the cornea will be stable making Collagen Cross Linking an ineffective and meaningless procedure.

I had Lasik last year. I can see clearly outdoors in bright light but when I get indoors in a low light environment, my vision gets very blurry. The same is true when I am out at night. Why does this happen?

What you are experiencing is due to either a very large pupil in a low light environment or to a small or decentered treatment zone. For example, your pupil diameter may be 3 mm outdoors in the daylight but may expand to 8 mm in a dimly lit room or outdoors at night. If the diameter of the treatment zone created by the LASIK surgery is 6 mm, for example, or if this treatment zone is decentered you will experience visual disturbances such as halos, glare and even double vision. My suggestion is not to get involved with any additional surgeries (enhancements) to correct this. With each additional surgery, unanticipated additional visual and ocular problems can occur. In my opinion, scleral lenses are the best non-surgical option to correct this. Please understand that a well fit scleral lens in not only comfortable but will replace your cornea as an optical surface allowing you to see clearly in all lighting environments.

Dr. Boshnick; I lost a great deal of vision due to LASIK surgery. I don’t want to go back into contact lenses again to see clearly. I am looking for a surgical procedure, maybe some sort of laser to fix or repair my eyes. If this is possible, what type of laser surgery will repair the damage that LASIK surgery created? Can anything be done to help me? I am desperate.

Over the years I have received questions and pleas for help on this order from many patients. There just are not any surgical procedures either with or without lasers that will repair your damaged corneas to their pre-surgical condition. Also, there are no surgical procedures either with or without the use of lasers that will restore your vision to the pre-surgical state. Any surgical procedure will involve the removal of corneal tissue. This is unavoidable. These life altering surgically induced complications cannot be fixed. Any surgical attempt to do so will only increase the risk of additional complications.

There are many LASIK surgeons advertising on the internet laser surgeries that will repair your damaged corneas. Procedures with names such as “All LASIK Laser” or “Custom Contoured Ablation” or “Wavefront Guided LASIK” and so on. More than a few of these LASIK surgeons are advertising “new” technologies that will repair your vision after a “botched” LASIK surgery. Once again, I am writing these words after many decades of experience in treating thousands of hurt patients permanently damaged from a variety of refractive surgical procedures such as LASIK, Radial Keratotomy, PRK, ALK, CK and so on.

The questioner states that he/she does not want to go back to contact lenses. I can understand this comment. After all, a great deal of money was spent in eliminating the need for contact lenses. The lenses that I recommend for almost all of my post-LASIK patients are gas permeable scleral lenses, specifically GVR Scleral lenses since these are the lenses we design with the use of special computers and proprietary software. Scleral lenses are not contact lenses in the strict sense of the word, since there is no “contact’ with the cornea. These lenses vault over the compromised corneal tissue and rest on the white portion of the eye known as the sclera. The comfort of these lenses is the same as with a soft lens. Because the lenses do not move they cannot pop out of your eye. There is a liquid reservoir between the back surface of the lens and the front surface of the cornea. Optically, these lenses replace the cornea as an optical surface. The irregular damaged cornea will not affect your vision any longer. These special lenses will allow you to see almost exactly how you saw before undergoing LASIK. Almost all of our patients wearing the GVR Scleral lens are able to wear their lenses all of their waking hours.

One final word: Recently, several of my post-LASIK patients asked me about two refractive surgeries. One is called ICL (Implantable Contact Lens) and the other is called RLE (Refractive Lens Exchange). These surgical procedures involve either removal of the natural lens in the eye or the implantation of a special contact lens inside the eye. Vision loss due to post-LASIK complications is due to damage to the cornea. These two refractive surgeries will do nothing to address these issues. Therefore the resultant vision after these two procedures will not be any better than before and possibly worse.

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FAQ For Dry Eyes and Scleral Lenses

I suffer from chronically dry eyes due to arthritis and the multiple medications that I need to take to address other health issues. Every time that I blink, it feels like there is sandpaper rubbing against my eyes. Can scleral lenses help me with my eye comfort?

The answer to this question is yes. In addition to providing clearer vision, a scleral lens serves as a therapeutic device. The lens acts as a buffer between the dry, compromised cornea (the front surface of the eye) and the eyelids. When you blink, the eyelids will no longer be rubbing against the irritated, dry cornea but against the outside surface of the scleral lens. In addition, the scleral lens does not touch the cornea. Instead, the scleral lens vaults over the cornea and comes to rest on the white portion of the eye (the sclera). Pure, unpreserved saline solution acts as a liquid reservoir between the back surface of the scleral lens and the front surface of the cornea. In many cases, the irritated cornea will heal due to the protective nature of the scleral lens. Comfort and vision in almost all cases is excellent.

I was diagnosed with dry eyes and have difficulties wearing soft lenses. I have tried gas permeable lenses but can only tolerate them for a very short period of time. Will scleral lenses help me?

Yes. Almost all patients who have been diagnosed with dry eyes have issues with the tear film coating the cornea and protecting the cornea from the environment and the blinking action of the eyelids. All soft lenses act as sponges by soaking up the tear film on the corneal surface making your dry eyes even drier. Scleral lenses vault over the compromised cornea and come to rest on the white portion of the eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with sterile, unpreserved saline solution. In other words, your dry corneas are always in a liquid environment. The very special scleral lenses that we design serve 3 purposes: 1. Vision. Visual acuity with scleral lenses is almost always excellent and stable both during the day and at night. 2. Therapeutic. Because the corneas are always in a moist environment, the dry, irritated corneas have the opportunity to regain a much healthier appearance. 3. Protection. Most eyes that have been diagnosed as dry have a corneal surface that is irritated and compromised. Scleral lenses do not move on the corneal surface like a gas permeable lens does. In addition, the scleral lens protects the cornea from the environment and the blinking action of the eyelids.

I have read about dry eyes and how it can impact contact lens wear. Can you elaborate on this? Can scleral lenses address this issue?

The majority of contact lens problems, including intolerance and limited wearing time are related to the tear film lying over the cornea. These difficulties are caused by disruption of the tear film and increased evaporation of the tear film caused by the contact lens. In addition to contact lenses affecting the tear film, there are other causative factors including medications used by the patient, and medical conditions that may be affecting a patient’s tear film. In the strictest sense, scleral lenses are not really contact lenses in that there is no “contact” with the cornea. Because the scleral lens does not touch the cornea, there is no disruption to the tear film. In addition, because of the liquid reservoir between the back surface of the scleral lens and the front surface of the cornea, the cornea is always in a moist environment. One other factor to be considered by those suffering from dry eyes: Many corneas are not spherical or smooth but may be very irregular. The blinking action of the eyelids over an irregular corneal surface can create additional comfort issues for patients suffering from a dry eye. Scleral lenses have smooth surfaces. The blinking action of the eyelids over a scleral lens will not add to any corneal irritation already there. To the contrary, the scleral lenses will actually protect the dry cornea from the environment and the blinking action of the eyelids.

My eyes are always dry even at night. Can I wear scleral lenses while sleeping?

Scleral lenses have a therapeutic effect on a dry eye. Remember, scleral lenses do not touch your cornea but come to rest on the white portion of your eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved sterile saline solution. In other words your corneas are always in a dry environment and your corneas are also protected from the blinking action of your eyelids. I prefer that my patients not sleep with their lenses overnight. However, if you wish to take a short nap with the lenses for about an hour, that will be OK to do.

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FAQ for Radial Keratotomy and Scleral Lenses

Dr. Boshnick; I had Radial Keratotomy surgery in the 1908’s follow by LASIK surgery about 10 years ago. I am having terrible problems with blurred, distorted vision especially at night. My ophthalmologist suggested that I have “Replacement Lens Surgery” to restore my vision. Do you think that this will help me?

Absolutely not. The reason you are not seeing clearly is because your corneas are distorted. We see this all the time in patients with surgical histories similar to yours. Placing an intra-ocular lens into the eye behind the cornea will not improve your vision. On the contrary, there are real risks of cataract formation and other ocular conditions such as infections, glaucoma and retinal tears and detachments. Think of it like this: If you are driving your car with a windshield that is distorted or warped, changing your eyeglasses or your eyeglasses prescription will not allow you to see clearly. If, however, you placed a new windshield over the distorted windshield with a liquid reservoir in between, you would have clear vision with the 2 windshields in place. This may not seem logical to you but optically speaking what I am writing here is true. In the same way, placing a gas permeable scleral lens over your distorted corneas will provide you with clear, comfortable vision once again. This is because the scleral lens vaults over the compromised cornea and replaces it as an optical surface. A liquid interface (.9% sterile saline solution) exists between the back surface of the lens and the front surface of the cornea. Just know that there are no surgeries (PRK, CK, LASIK, LASEK, SMILE, etc.) that will restore the vision you have lost due to your previous refractive eye surgeries. The only technology that will allow you to see clearly and comfortably once again is a well fit scleral lens such as the GVR Scleral lens.

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FAQ for Keratoconus and Scleral Lenses

I Have Keratoconus And Wear Soft Lenses To Correct My Vision. My Vision Is Blurred With Soft Lenses But My Doctor Feels That It Is The Best Vision He Can Give Me. Why Will A Scleral Lens Provide Me With Clearer Vision?

Your comments are all too common. There are several issues that must be considered when treating an eye with keratoconus or suffering the effects of refractive eye surgery such as LASIK:

  • 1. Almost all of these corneas/eyes are very dry. A soft lens will act as a sponge and “suck” moisture from the dry cornea. For this reason, keratoconus patients wearing a soft lens may experience clear vision for a short period of time, but as the lens dries out, the lens will rotate and the vision will deteriorate relatively rapidly.
  • 2. All of the corneas with keratoconus have irregular surfaces and curveatures. A soft lens lies on top of the cornea and assumes the same curevature as the cornea. In other words, the visual error of the distorted cornea is passed on through the soft lens.

I have an advanced case of Keratoconus. What instrumentation can help me understand how my lenses fit?

This is an OCT image of the gas permeable scleral lens over a keratoconic cornea. The two curved lines represent the
front and back surfaces of the scleral lens. The structure below the lens is the cornea. The space between the back surface of the lens and the cornea is filled with unpreserved saline. The lens is not touching the cornea and the compromised corneal tissue
is free to heal.

My keratoconus is very advanced. I see well with my contact lenses but they are not comfortable and pop out 6 or more times a day. I can only wear them for a few hours at a time because they hurt. My doctor says that this is the best fit that I can get. Can scleral lenses help me?

Your doctor’s response is not unusual. Many doctors associate scleral lenses with the poorly tolerated scleral lenses that were used 50 or 60 years ago. The gas permeable scleral lenses used today are made of a highly oxygen permeablematerial that provide excellent vision and comfort. In fact, patients with a number of corneal diseases actually undergo a healing effect after scleral lens wear. The liquid reservoir that exists between the back surface of the lens and the front surface of the cornea bathes the corneal surface while the lenses are worn. This reduces the pain and light sensitivity that can be debilitating to patients with corneal diseases such as keratoconus, Stevens-Johnson Syndrome, post-LASIK and post-R-K surgical complications, corneal transplant surgery complications, chronic dry eye and so on.

I Have An Advanced Case Of Keratoconus. Why Can’t I Get Eyeglasses That I Can See With?

Patients with keratoconus have distorted corneas. Your cornea acts in much the same way like the windshield of your car. If the
windshield of your car is distorted or misshapen, your view of the world beyond the windshield will be distorted, regardless of what kind of eyeglasses you are wearing. Patients with advanced keratoconus or other forms of irregular corneas should think of eyeglasses solely for the purpose of maneuvering about their home or for emergencies. What is really unique about the GVR Scleral lens is that the irregular, distorted cornea is replaced by a smooth, regular optical surface. No matter how distorted or irregular the cornea is, assuming that the interior structures of the eye are healthy, the blurred, distorted vision will be corrected. Almost all of our patients with advanced keratoconus who are legally blind (20/200 or less vision) with their old contact lenses or eyeglasses have 20/20 vision with the GVR Scleral lenses.

What Is The Difference Between Keratoconus And Corneal Ectasia Following LASIK Surgery?

Corneal Ectasia is one of the most devastating complications resulting from LASIK. It has been my experience that this condition develops weeks to years following LASIK surgery. When this develops, patients will notice a rapid onset of blurred, distorted vision which cannot be corrected with eyeglasses or conventional contact lenses. There is no way to determine (with absolute certainty) beforehand whether a patient is at risk for corneal ectasia after LASIK. I have found that the most effective way to treat this LASIK induced complication is with a GVR Scleral lens.

Keratoconus is a protrusion or ectasia of the cornea due to heredity. While the end result of keratoconus, visually may be the same as in post-LASIK corneal ectasia, the treatment may differ. With post-LASIK corneal ectasia, we are usually dealing with a very dry cornea and a LASIK created corneal flap. This type of cornea does not do well with a soft or conventional gas permeable lens. The reason for this is that most of the time these corneas cannot tolerate of support any type of lens (rigid or soft) resting on it’s surface. I prefer to use a GVR Scleral lens because this unique lens will not rest of the post-LASIK cornea but will vault over the compromised corneal tissue. A liquid reservoir exists between the back surface of the lens and the front surface of the cornea. In other words, the traumatized cornea is always in a moist environment. Besides restoring quality vision and comfort, the lens acts as a therapeutic device and promotes healing.

With keratoconus, the cornea, while distorted, may not be as dry as the post-LASIK cornea. In addition, there is no LASIK created corneal flap to contend with. For this reason among others, there are a number of specialty soft and gas permeable lenses that may work well on a keratoconic cornea that will not provide quality vision or comfort or promote health to the post-LASIK traumatized cornea with ectasia.

1. Why should I consider a scleral lens and not just go ahead with a corneal transplant?

There are real risks involved with corneal transplant surgery including infection and rejection of the transplant. In addition, long term studies of patients with corneal transplants have shown the following to be true:

  • 50% of patients who underwent corneal transplant surgery will need some form of rigid contact or scleral lens in order to achieve visual acuity better than 20/50.
  • Stable vision in most cases is not achieved for one year or longer after the surgery.
  • In many cases the life time of the corneal graft is limited. Repeated corneal transplant surgery (due to infection, rejection etc.) is the 2nd commonest indication for a repeated corneal transplant operation.
  • There is a life long risk of rejection. This risk is greater in younger patients.
  • There is a life long risk of wound rupture due to trauma.
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Glossary of Scleral Lens-related Terms

Contact Lens

The contact lens refer to either a soft or gas permeable lens that rests on the front surface of the eye. Many corneas with conditions such as keratoconus, post-refractive surgical complications, chronic dry eye, corneal dystrophies and disease and many other ocular conditions cannot support this type of lens. In other words, a “contact” lens has contact with the front surface of the eye, the cornea.

Cornea

The clear front surface of the eye. The cornea is to the eye what a watch crystal is to your wristwatch.

Corneal Transplant Complications

Like all invasive procedures, corneal transplant surgery does have risks. It may take up to a year for the cornea to “seat” properly. In addition during the first year after the corneal transplant surgery is done, the contour and curvature of the cornea may change. Most patients who undergo a corneal transplant will need to wear a specialty contact or scleral lens for vision and ocular comfort purposes.

Ectasia

Post-LASIK Ectasia is a devastating complication of LASIK. This complication can occur weeks to years after the LASIK surgery is done. LASIK surgery thins out the cornea, which is the front surface of the eye. Because of the thinned out cornea, the pressure within the eye against the weakened corneal “wall” can cause the cornea to “buckle” or protrude. In other words vision will become severely compromised and the cornea will become distorted. There is no surgical or medical cure to restore the cornea to it’s pre-ectasia condition. The only technology that will permit this eye to see clearly once again is a gas permeable scleral lens.

GVR Scleral lens

A GVR Scleral lens does not have contact with the front surface of the eye ( the cornea). Instead, the lens is supported by the white portion of the eye, known as the sclera. There is a space between the back surface of the scleral lens and the front surface of the eye. This space is filled with pure, unpreserved saline solution. In other words, the cornea is always in a liquid environment. We refer to our unique scleral lens as the GVR (Global Vision Rehabilitation Center) Scleral lens. This is because we design our scleral lens using proprietary software and computer imaging technology. We create the design and tell our laboratory exactly how it is to be made.

Gas Permeable Material

This is the material that our scleral lenses are made from. Oxygen from outside of the eye penetrates the scleral lens and enters to cornea. The cornea is the only tissue in our body that has no blood vessels. For this reason it is important that the correct materials are used to fabricate the lens and to design the lens so that no contact is made with the compromised cornea.

Keratoconus

Keratoconus is a protrusion and thinning of the cornea. This can occur in the center or peripheral areas of the cornea. The end result of keratoconus is blurred, distorted vision than is best corrected with a specialty contact or scleral lens. Advanced cases of keratoconus can best be corrected with gas permeable scleral lenses.

Post-Refractive Surgical Complications

This refers to the unexpected loss of vision and ocular comfort that patients who have undergone LASIK, Radial Keratotomy, PRK and other vision altering eye surgeries have experienced. These complications include double vision, glare, halos loss of vision in low light situations, fluctuating vision, vitreous floaters and chronic dry eyes. Many of these conditions can take place years after the surgery was done.

Sclera

The white portion of the eye.

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