Bullous Keratopathy in Keratoconus Treated with GVR Scleral Lens

The patient standing next to me was diagnosed with keratoconus many years ago. Standing next to her is her husband. When she first visited our office we immediately saw that she had an advanced case of keratoconus. The year before we met her she underwent cataract surgery in both eyes and also Collagen Cross Linking therapy in both eyes. The keratoconus in her left eye was so advanced that the outer cellular layer of her left cornea (the epithelium) was separating from the underlying corneal tissue, a condition known as bullous keratopathy. Over the years this patient was fit with a variety of gas permeable lenses which caused her significant discomfort and often pain. In addition her lenses would often pop out of her eyes at the most inconvenient times. When this patient first visited our office her visual acuity was 20/150 with her corrective lenses. In 2012, we fit both eyes with GVR Scleral lenses which are allowing her to 20/25 with all day comfort. Since we first met this very nice lady, her vision and her corneas have remained stable. I expect her to be able to wear her lenses comfortably and with clear vision for many years to come. In the lower photograph is a profile photo of her left cornea. Both corneas have similar topographies. The center of gravity of this cornea is so far out that any small gas permeable lens placed on its surface will be unstable, uncomfortable and likely pop out. The scleral lenses that we fit her with do not touch her corneas but rather vault over her corneas and rest on the white portion (the sclera) of her eyes. The space between the back surface of the lenses and the front surface of her corneas is filled with unpreserved sterile saline solution so that her dry, irritated corneas will always be in a wet environment.