Bilateral Corneal Transplants and Glaucoma Patient Success With Scleral Contacts

Patients who have undergone corneal transplant surgery often face ongoing vision challenges, even after a successful graft. When additional conditions like glaucoma are present, finding the right vision correction becomes even more complex. At Insight Vision Optometry in Las Vegas, our specialty contact lens team has extensive experience fitting scleral lenses for patients with corneal transplants and other coexisting eye conditions.

Why Is Vision Often Poor After a Corneal Transplant?

Corneal transplant surgery replaces a damaged or diseased cornea with healthy donor tissue. While the procedure has a high success rate, the new cornea often heals with an irregular shape, leading to significant astigmatism and other refractive errors that glasses alone cannot fully correct. The healing process can take a year or more, and the resulting corneal irregularities may be too complex for standard contact lenses to address effectively.

When a patient has bilateral corneal transplants, meaning both eyes have received donor tissue, these challenges are compounded. Each eye may have a different degree of irregularity, requiring individualized solutions.

How Do Glaucoma and Other Conditions Complicate the Fitting?

Patients with corneal transplants may also have other eye conditions that affect how a contact lens can be fitted. Glaucoma, for example, is sometimes treated with a drainage tube (called a glaucoma shunt) that is surgically placed in the eye to lower eye pressure. The presence of a glaucoma tube changes the surface anatomy of the eye and must be carefully accounted for during the scleral lens design process.

Other complicating factors can include a decentered pupil, irregular scleral shape, or thinning of the corneal graft. Each of these factors requires the lens to be designed with precision to ensure safe clearance over the transplant, proper centration on the eye, and stable, comfortable wear.

How Custom Scleral Lenses Solve Complex Cases

Custom scleral lenses are designed using advanced imaging technology that captures the detailed contours of both the cornea and the surrounding sclera. For patients with corneal transplants and additional complications, this level of customization is essential. The laboratory team works closely with the prescribing doctor to design a lens that safely vaults the transplant, avoids contact with surgical hardware such as glaucoma tubes, and centers properly on the eye despite any anatomical irregularities.

The result is a lens that provides clear, stable vision while protecting the delicate transplanted corneal tissue.

A Remarkable Patient Outcome

One of our patients with bilateral corneal transplants and glaucoma had been unable to see well with glasses for years. His right eye presented additional challenges, including a decentered pupil and a glaucoma drainage tube. His left eye required especially careful lens design due to the advanced complexity of his transplant.

With custom scleral lenses, he achieved 20/30 vision in the right eye and 20/15 in the left eye. At the dispensing appointment, the patient was visibly moved by his results. He shared that he had not seen this clearly in over five years.

What Should Corneal Transplant Patients Know About Scleral Lenses?

• Scleral lenses are one of the most effective vision correction options after corneal transplant surgery, especially when glasses or standard lenses fall short.
• Patients with glaucoma tubes, decentered pupils, or other complications can still be successfully fitted with custom-designed scleral lenses.
• The fitting process requires specialized imaging and expertise, and may involve close collaboration between your scleral lens doctor and your corneal or glaucoma surgeon.
• Regular follow-up visits are essential to monitor the health of the transplant and the fit of the lens over time.
• If you experience sudden vision changes, increased eye pain, or new redness around a transplant eye, contact your eye doctor right away, as these may be signs of graft rejection or other urgent conditions.

Schedule Your Scleral Lens Consultation at Insight Vision

If you have had a corneal transplant and are not seeing well with glasses, scleral lenses may be the solution. Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS have the expertise to design custom scleral lenses for even the most complex cases at Insight Vision Optometry, Las Vegas. Call 702-747-4070 or visit www.insightvisionlv.com to schedule your consultation.