Category Archives: Keratoconus Technology

Contact Lens after Corneal Transplant – Trying a Mini-Scleral

Well, after a fair bit of anxiety and dread, I found my visit to Koffler Vision Group* for the fitting of a new mini-scleral RGP contact lens on my grafted eye to be quite uneventful.  We tried several diameters and shapes until one felt, well, like it wasn’t there.  (*My choice for contact fitting in Lexington.  I’m still Dr. Holland’s patient.  I would link to their site but it is not great and crashed my browser twice.  I will link to their Google Place page though)

Turns out the one with most comfort was a mini-scleral.

I hadn’t considered mini-scleral for my grafted eye, but it makes sense.  It forms a “helmet” over the graft and rests well outside my cornea.  It keeps the corneal hydrated and provides good vision.  I think I had put mini-sclerals out of my head after my less-than-stellar experience with them before my graft.  But that was not due to the lens, it was due to the cone and abrasiveness.

Anyway, I have my lens ordered and will post again when I get it in.  As usual, the Koffler staff were terrific.  By the way, Dr. Koffler was my second choice for my graft – but I just clicked better with Dr. Holland’s attitude about DALK options.  I feel confident either would do a great job, especially on a PK or other surgery.  I did apologize for being such a grump during my last visit to them 2 years ago (I was frustrated with trying to find a contact lens with a steep cone.)

Oh yes, they did a new topography.  Said it was “beautiful.”


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New – DALK Transplant Chronology

Quick post to let you know that I just made a new page which covers the chronology from my first Dr. appt to one year after the surgery.  Same posts, but in chronological order.


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Post-DALK Transplant Topography – Graft

This is what my corneal topography looked like after 2 sutures removed, and led to the removal of two more.

Corneal Topography - Graft


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Cornea Day in San Diego – DALK Practice Expansion Recommended

I saw on the web today that Cornea Day in San Diego happened yesterday.  Edward J. Holland, MD and W. Barry Lee, MD did a panel on surgical techniques.  Dr. Holland had told me that he planned to do this, specifically that there was a section about how more corneal surgeons need to master the DALK/Big Bubble technique in order to leverage its advantages.

“Despite the technically challenging aspects of deep anterior lamellar keratoplasty, the big-bubble technique can and should be mastered, a presenter said here.  “Corneal surgeons must add DALK to their surgical scope,” W. Barry Lee, MD, FACS, said during a presentation at Cornea Day, which preceded the American Society of Cataract and Refractive Surgery meeting. “Get familiar with the big-bubble DALK steps.”   Dr. Lee discussed Anwar’s big-bubble DALK technique, stating that the main goal is to place an air injection posteriorly into the stroma to provide contrast between residual stroma and Descemet’s membrane. The surgeon should create a paracentesis to release pressure and inject a small air bubble to confirm the successful placement of the big bubble, according to Dr. Lee.”

I hope to ask Dr. Holland how the event went – and perhaps even get a copy of the transcript.


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Keratoconus Contact Lens Archeology

Check out all the contact lenses I’ve tried in my journey with keratoconus. This is probably 1/3 the actual count.



Thoughts on Semi Scleral Lenses

It’s been a year now since I tried wearing a type of Semi Scleral lens… it’s a 14MM lens, so larger than most soft lenses, but not as large as a full-scale scleral.  It’s like a really large RGP in a way.  I was unable to use hybrid lenses such as Synergeyes – as I could never get a full vault from them and they did not transmit enough oxygen (though it could have just been my incompetent fitter.)  See others’ similar experience.

First:  Do not compromise on who’s doing your fitting. Even if you have to drive a couple of hours, find someone who does a lot of Kerataconus patients. Most lens fitters do a few KC patients a year.  Find someone who does a few per month at least.   Just because they have the fitting kit in the office does not mean they know how to use it!

I keep a plunger at work, car and home.

The lens has the following advantages for those with Advanced Keratoconus:

  • The lens vaults the corneal “point” preventing abrasions and discomfort.
  • It holds a saline/tear layer under the lens, addressing dry eye symptoms for many people.
  • It’s easier to insert than a full scleral.  Just 3-4 drops of saline in the lens, inserted with your face down.  (similar to this video)
  • It stays in place – it’s really held on the eye.
  • Wear time of 8-10 hours on a good day.
  • Better vision than you’ll get with a soft KC lens or glasses.

The disadvantages as I see them

  • A learning curve to insert properly… bubbles must be avoided.  It takes 1-2 weeks.
  • If your KC is really steep, the lens must be also, so the “rim” of the lens will be bearing the load, as well as the “push” that your eyelid places on it each time you blink.   This doesn’t hurt as it happens, but over the course of the day it can get uncomfortable.  You may see blanching – or redness – just at the scleral-iris boundary.
  • Removal must be done carefully to avoid pain.  You must use a suction plunger to remove them.
  • Very expensive.  $300-400 each.
  • A little lit-mirror can be wonderful for this

    Insurance will not cover them … says they are “cosmetic”

  • Breakable… do not drop them on a tile floor – spread a towel out on the counter.
  • Cleaning is tricky… you want to be really careful.  I use a q-tip to clean the “inside bowl” of the lens.  Take your time.
  • Never let anything under them – rinse the heck out of ’em.

Some other thoughts about these lenses:

  • You must not wear them too long, or you’ll pay the price the next day.
  • When removing them, make sure your eye is well lubricated.  Let the lubricant sit in your eye for 30-45 seconds before attempting removal.
  • Preservative-free saline works best under the lens.  Even if you’ve never had any problem with preservative – this is a new situation.  This saline will be under the lens in a small volume – and any thing that irritates your eye will be concentrated under there.   I use Unisol 4 in the 4-oz bottles because you must discard the solution after 30 days.
  • I use Refresh No-Rub for nightly storage – hoping it will help disinfect the lens.
  • I take a Zyrtec every day to avoid eye itch.
  • Invest in a nice little LED-lit mirror to carry around.  I have one at work, one in my car.
  • Buy a few extra plungers – I keep one at work, one in my car, and one at home.

It takes some time to get used to them, but they can work really well.

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Posted by on February 14, 2011 in Keratoconus Technology

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