Most experienced contact lens fitters try to maintain symmetry with similar lenses in both eyes. This usually simplifies lens care and can avoid a few other potential issues. However, keratoconus fitting can be challenging making two different lenses essential to obtain an ideal fit. I wouldn’t worry about having different lenses brands or even types in each eye, but if it concerns you, just ask your contact lens specialist to explain why they chose that approach.

As many of you know stem cell research and efforts to develop a replacement cornea have both been ongoing for many years. While progress has been made, we are still a few years away from any practical applications.

First, discontinue the drops. Eye drops for redness usually contain vasoconstrictors (medicine that makes the blood vessels smaller). Over time, the vasoconstrictors become irritating which causes more redness. This sets up a vicious cycle causing some patients to become virtually addicted to these drops.  Using preservative free artificial tears can help make the eyes feel more comfortable and do not contain these vasoconstrictor medicines. 

That said, redness in a GP lens wearer is often a sign of a lens fitting problem or drying of the ocular surface related to the lens fit. Fitting issues can easily be identified by your contact lens specialist. Sometimes a minor change in fit, polishing the lens surface, a new material or a new lens care solution may solve the problem. Occasionally, eliminating redness can be challenging. Other issues should be explored for a persistent red eye in a lens wearer. These include underlying dry eye and allergy. All in all, it is best to discuss this with your contact lens fitter who can find the cause and help solve the problem. 

Keratoconus has a genetic basis. Having a parent who has the disorder may increase your risk of developing keratoconus or of developing corneal thinning post-LASIK. You may also have subclinical evidence of keratoconus that has concerned your doctor. You should ask if his recommendation is based solely on your family history or if there are other factors like abnormal corneal topography. Ultimately, you have to decide if the risk is justified. Sometimes a second opinion is helpful. My advice is when it comes to your sight; it is better to err on the side of caution.

Keratoconus has a genetic basis. Having a parent who has the disorder may increase your risk of developing keratoconus or of developing corneal thinning post-LASIK. You may also have subclinical evidence of keratoconus that has concerned your doctor. You should ask if his recommendation is based solely on your family history or if there are other factors like abnormal corneal topography. Ultimately, you have to decide if the risk is justified. Sometimes a second opinion is helpful. My advice is when it comes to your sight; it is better to err on the side of caution.

Keratoconus is a highly variable and unpredictable disease. Many patients have a mild form and do not progress significantly. However, there is no way to predict this for an individual.

You are not alone. Many keratoconus patients complain of discomfort or outright pain. Since pain may also be a sign of other problems you should bring this to your doctor’s attention as soon as possible.

First of all, if you have just been diagnosed, the likelihood is that your vision is not too bad at the moment. It is important to realise that most people who contribute to forums are those who have the worst problems. Those who are getting on fine simply just get on with their lives! Keratoconus is a progressive condition but the active stage often lasts about 10 years and many people stabilise before that. If you cannot get good vision with glasses, then most often you can with contact lenses, which enable you to get on with life normally. Most patients with keratoconus fall into this category.

Keratoconus is generally more advanced in one eye than the other and many people only develop symptoms in one eye. It won’t “spread” like an infection, but as the condition is linked to weaker collagen fibres in the cornea, it is likely that both eyes could be affected to some extent.

Research is increasingly showing that keratoconus has some genetic components. Twins often have keratoconus and it does run in families. On the other hand, you may be the only person in many generations that has it. However, to offset this, it is possible that one of your ancestors may have had keratoconus but it was not diagnosed – it is more commonly recognised nowadays than in the past. So yes, it is possible but there is no current test to check if you can pass it on.

Generally, as long as you can reach the legal requirements of your country for vision whilst driving, you are fine. If you can only attain this when wearing contact lenses, you are advised to inform the relevant authority who will simply note that you have to be wearing contact lenses in order to drive. Some people have trouble, even with their contact lenses, driving at night as still they suffer from haloes and ghosting – especially facing oncoming traffic on unlit roads. If this is the case then it is better not to drive at night.

No. In keratoconus, the cornea becomes thinner and weaker. As laser treatment also thins the cornea (as you are lasering “away” part of the cornea), this simply makes the situation worse. In fact, if you have sub-clinical keratoconus, laser treatment will most likely accelerate the condition, so is not recommended. 

Grafting is reserved for when there is vision loss due to scarring, distortion that cannot be corrected with contact lenses or the cornea becomes extremely thin. Usually all other treatment methods are explored before resorting to surgery and a graft. Many people still have to wear contact lenses after a graft in any case, as the front of the eye is still irregular.

Other surgical techniques include intracorneal rings and CXL (cross-linking; C3R) but both of these also may require you to wear contact lenses afterwards.

Many people can wear normal soft lenses in the early stages. Once keratoconus progresses, then these do not work because they simply mould to the irregular shape of the cornea. At this point, you can move onto specialist soft lenses such as the KeraSoft IC or RGPs (Rigid Gas Permeables). RGPs can give good vision – but often the best vision is obtained when the lens is fitted flat against the eye, which can lead to scarring if not corrected. RGPs are often uncomfortable as keratoconics tend to have more sensitive eyes than usual. If soft lenses do not give good vision, then piggy-backing an RGP on a soft lens may work. There are also hybrid lenses (centre RGP, surround soft) and sclerals (cover the whole eye). You are best advised by your eye care professional.

No. Solutions used for RGPs are too “strong” to use with soft lenses, which absorb any liquid they are put into. You have to use the appropriate solution for the lens you are wearing. Always check with your eye care professional if you are not sure.

It was once thought that contact lenses halted the progression of keratoconus – but this is not true. Rigid lenses may reshape and remould the eye but it will always ‘unmould’ if you leave the lenses out. Intracorneal rings reshape the cornea in order to reduce the effects of aberrations and distortion, but do not stop the condition from progressing. CXL is the only surgical technique so far that appears to slow down the progression of keratoconus.

NO! Many patients with keratoconus also suffer from allergic conditions and have dry eyes. This all leads to discomfort which makes you want to rub. However, rubbing your eyes will lead to further damage – in fact some people think that excessive rubbing may even be part of the cause of the keratoconus. So do NOT rub. Use cold compresses or just firmly press the eye, without actual rubbing.

Many patients with keratoconus cannot wear RGPs for this reason. One way is to wear RGPs on top of a soft lens – piggy-backing. Another is to wear a specialist soft lens like KeraSoft IC, a hybrid lens or a scleral. In quite advanced keratoconus, you may not get as good vision in a soft as an RGP, but it may be worth the lower visual acuity to get the length of wear time. Hybrids can sometimes cause problems with oxygen transmission (though hopefully newer designs are better from this point of view). Sclerals are sometimes the only option – they cover the entire eye so do not cause surface irritation. However, if you have bad allergies the likelihood is that you will produce excess protein in your tears which can adhere to the lenses surfaces (deposits). Therefore, care has to be taken at all times to keep the lenses as clean as possible.

Many people with keratoconus have one eye that is much better than the other. It may have been like this for some time, so that the brain simply cannot work the two eyes together to produce a 3-dimensional image. In this situation, you do not have depth perception, so that tripping and general clumsiness is to be expected. Someone who only has the use of one eye from being very young adapts to it. If you lose your binocular vision as an adult, then it is much harder to adapt. If you actually then regain good vision in your two eyes later on, through contact lenses or surgery, the brain then often has a hard time readjusting to using the two eyes together again! If your two eyes are “fighting” each other, this can sometimes cause headaches and fatigue.

Many countries have disability legislation that covers the workplace. This includes advice about dealing with employees who may have problems with vision. Keratoconics can be a challenge because if they are OK with contact lenses, then they are ‘normal’ but if they have problems where they cannot wear their contacts, they suddenly become partially sighted for a period of time. Employers often find this hard to understand. The keratoconic self-help groups can often be a rich source of information and support in this respect.

It is extremely rare for someone with keratoconus to go blind. Modern management both with contact lenses and/or surgery means the vast majority of keratoconus patients will lead a normal life. However, it is extremely important that the patient plays their part in looking after their eyes. This means keeping contact lenses in good condition, attending regular appointments and following the advice of their eye care professional.

Over 95% of people with keratoconus will have the condition in both eyes. Reasonably often (especially in early keratoconus) only one eye will appear to be affected but corneal topography will confirm the condition in both eyes. For this reason, both eyes are always imaged with the corneal topographer at regular intervals.

Probably not. Astigmatism is induced when the front of the eye (cornea) is a different curve vertically versus horizontally, somewhat like a rugby ball. Regular astigmatism is normal and can be easily corrected with spectacles or soft contact lenses. Irregular astigmatism is caused by distortion of the cornea from injury, scarring, infection or conditions such as keratoconus or pellucid marginal degeneration. This irregular astigmatism is the main reason spectacles often don’t work well for keratoconic patients as the astigmatism changes across the surface of the cornea.
“With-the-rule” astigmatism is when the cornea is flattest in the horizontal direction. “Against-the-rule” astigmatism is when the cornea is flattest vertically.

There are many different types of contact lenses used for keratoconus. Generally speaking RGP (hard) lenses are less comfortable when first fitted but give superior vision to soft lenses. Most keratoconus patients will adapt to their hard lenses, however if reasonable comfort is not achieved then there is several different options to improve comfort. If you tried contact lenses some time ago and didn’t succeed, chances are that there are new options that will suit.

No. Contact lenses for keratoconus are designed to provide a good standard of vision while worn. They will not reverse the condition.
As long as the lenses are well fitted and cared for they will not worsen the condition. However, it is extremely important to have regular checks because dirty or ill-fitting lenses do have the potential to cause corneal scarring or infection. 
 

The fitting of contact lenses for keratoconus is a lot more complicated and time consuming than regular contact lenses and the lenses themselves are usually custom made lenses with very complicated shapes. Because of this the cost is usually quite high. 

Sodium fluorescein (NaF) is an orange dye used to assess the fit of RGP lenses on the eye. The dye is made to glow green by using a blue light. The intensity of the glow shows the proximity of the lens to the eye at various points across the cornea. NaF dye is non-toxic and does not cause permanent staining of the eyes or skin.

No. Laser refractive surgery (eg: PRK, LASIK etc) reshapes the cornea by removing (ablating) corneal tissue resulting in a thinner cornea. This corneal thinning carries an extremely high risk of causing the keratoconus to rapidly worsen. Keratoconus is a contra-indication to laser refractive surgery.