Contact Lens Services
Ordering Contacts
San Diego Keratoconus Clinic
Corneal Refractive Therapy
Keratoconus Treatment in San Diego
Since 1979
The keratoconus clinic at Carmel Mountain Vision Care is specifically equipped to provide keratoconus services with state-of-the-art technology including a Humphrey ATLAS topographer, ultrasound pachymetry, and wavefront aberrometry. Because specialty contact lenses are often deemed medically necessary for restoring functional vision in keratoconus, we have an extensive inventory of diagnostic contacts lenses allowing our doctors to prescribe solutions matching your individual needs. Consequently, are able to successfully manage keratoconus without surgery in most cases.
While the average eye care practice will see just a few keratoconus patients each year, our clinic serves that many in an average week. In fact, eye doctors throughout San Diego and Southern California refer their keratoconus patients to Carmel Mountain Vision Care due to our experience and expertise.
Frequently Asked Questions
What is keratoconus?
Who gets keratoconus?
How is keratoconus treated?
Do I need a referral by another eye care practitioner to have services in the keratoconus clinic at Carmel
Mountain Vision Care?
What types of contact lenses are prescribed for keratoconus?
Are there new treatments for keratoconus?
What precautions should I take if I have keratoconus?
Keratoconus is an eye disease where the cornea or the clear front of the eye becomes progressively
distorted. A normal cornea is round or spherical in shape, but with keratoconus the cornea bulges forward,
protruding into a cone shape. As light enters the cone-shaped cornea it is it is bent and distorted and unable
to come to a point of clear focus on the light-sensitive retina.
Keratoconus affects both eyes but the two eyes often are asymmetrically affected. This disease typically
begins during teenage years. In most patients, it progresses for several years before stabilizing by the third
to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to
thin and bulge outward further blurring vision. Scarring of the cornea can spontaneously develop.
Nearsightedness and astigmatism are common to this disease. Many patients also experience glare and light
sensitivity. Keratoconus patients often require prescription changes each time they visit their eyecare
practitioner, especially during progression of the disease.
Researchers believe that more than 1 in 1,800 people have keratoconus, or approximately 3 million people worldwide have keratoconus. It affects males and females in equal numbers and has no known racial predisposition. Genetics are a possible cause with approximately 1 in 10 patients reporting a family member who has keratoconus. Researchers still do not understand the genetic transmission completely, however studies are underway. A disproportionately large number of keratoconus patients also have “atopic” diseases, such as hayfever, eczema, asthma, compared to the general population.
Rigid gas permeable (GP) contact lenses are the primary treatment. In mild cases, glasses and soft contacts are effective, but in more advanced cases, glasses and soft contacts no longer work well. To counteract the distortion of the cornea, most keratoconus patients require special GP lenses to provide a smooth surface to focus light in place of their own cornea’s distorted surface. Because the pattern of corneal distortion in keratoconus is as unique as a fingerprint, the GP lenses are custom prescribed and manufactured. Proper contact lens prescribing is crucial to ensure optimal vision, comfort, and eye health. Poor fitting lenses can increase the risk of corneal abrasions, scarring, and infection.
Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. If your doctor determines you have significant scarring of the cornea, he or she may recommend corneal transplant surgery. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. About 10 to 20% of keratoconus patients undergo corneal transplantation, according to the existing literature. Although corneal transplantation is frequently successful, most patients afterwards still need glasses, soft contacts, or GP lenses for adequate vision.
No. Although most of our keratoconus patients are referred in by another health care practitioner, you can schedule yourself without a referral. All keratoconus patients new to our practice must first schedule a comprehensive examination in our clinic, even if a recent examination was performed elsewhere and you were advised to undergo a contact lens fitting with a keratoconus expert. The examination in our practice allows our doctors to independently determine the most appropriate treatment regimen. When making your appointment, please advise our staff that you have keratoconus so that we can best accommodate your needs.
What types of contact lenses are prescribed for keratoconus?
In most cases of keratoconus, a contact lens with rigid optics is required for restoring the best vision. The rigid lens surface provides a smooth, artificial surface to clearly bend light into the eye while masking the "peaks and valleys" of the distorted cornea underneath. The most appropriate contact lens type for you is determined by our doctors following a comprehensive examination and contact lens prescribing. Our doctors prescribe a variety of non-proprietary lens designs to minimize your lens cost and to speed up delivery time. When appropriate, our doctors also prescribe proprietary lens designs including SynergEyes KC, SynergEyes ClearKone, Rose-K, MacroLens, FlexLens Piggyback, Dyna Intralimbal, and WAVE topography-driven contact lenses.
Are there new treatments for keratoconus?
The SynergEyes ClearKone hybrid contact lens, introduced in 2009, is perhaps the most significant new contact lens design introduced for keratoconus. Carmel Mountain Vision Care was the first clinic in San Diego to commercially prescribe ClearKone. For selected patients with keratoconus, ClearKone can markedly improve vision, lens wearing comfort, and overall quality of life.
Although specialty contact lenses are the primary treatment for most individuals with keratoconus, surgical intervention is sometimes appropriate. Corneal transplantation is the end-of-the-line treatment for a small number of keratoconus patients. A possible surgical alternative to corneal transplantation is Intacs® prescription inserts, also known as intrastromal corneal ring segment implantation. Intacs is available to keratoconus patients intolerant of GP lenses but with disease that has not progressed to the point of needing to have a corneal transplant. This surgery involves the placement of tiny plastic segments within the cornea beneath the surface to reduce its distorted shape. Corrective lenses are still required after the procedure to give the best possible vision, although soft contact lenses or glasses may be sufficient instead of GP lenses.
Another surgical procedure, called collagen cross-linking, is under investigation for managing progressive keratoconus. Collagen cross-linking is performed using riboflavin and ultraviolet irradiation to strengthen the integrity of the cornea. The preliminary results appear promising, although additional safety and efficacy data is pending.
During a comprehensive examination, your doctor at Carmel Mountain Vision Care can properly advise if one of these new treatments for keratoconus is appropriate for you.
What precautions should I take if I have keratoconus?
Patients with keratoconus must not have LASIK laser eye surgery due to an unacceptable risk of a poor outcome. The cornea in keratoconus is unusually thin and weak. For patients with keratoconus, LASIK surgery thins and weakens their corneas further. This can irreversibly destabilize the cornea and accelerate its distortion.
Some researchers feel that eye rubbing may increase the progression of keratoconus. Although a causitive link between eye rubbing and keratoconus is not established, it is still a good idea to refrain from eye rubbing. Your eye doctor at Carmel Mountain Vision Care may prescribe eye drops to minimize eye itching symptoms.
