Keratoconus Patient Sees 20/20 Far and Near

Achieving clear vision at both distance and near can be a challenge for anyone with keratoconus, especially as presbyopia begins to affect reading vision in the 40s and beyond. At Insight Vision Optometry, Las Vegas, our specialty contact lens team works with patients to find customized solutions that address both conditions at once. This case illustrates how a combination of scleral and soft contact lenses with a monovision approach restored full 20/20 vision at all distances.

What Is Monovision and How Does It Work?

Monovision is a contact lens strategy in which one eye is corrected for distance vision and the other is corrected for near vision. Your brain learns to rely on the appropriate eye depending on the task, whether you are driving, reading, or working on a computer. This approach can reduce or eliminate the need for reading glasses.

Monovision is not ideal for everyone, and it typically requires a short adjustment period. Some patients notice mild visual imbalance or slight difficulty with depth perception during the first few days. Most people adapt within one to two weeks. A trial fitting in the office helps determine whether monovision is a comfortable option before committing to a full prescription.

How Keratoconus Complicates Lens Fitting

Keratoconus causes the cornea to thin and steepen into an irregular shape, making standard glasses and soft contact lenses less effective at providing sharp vision. For patients with keratoconus in one eye and relatively normal vision in the other, a combination approach is often the best strategy. The eye with keratoconus benefits from a scleral lens, which vaults over the irregular cornea and creates a smooth optical surface. The other eye can often be fit with a standard soft contact lens.

In this case, the patient had mild to moderate keratoconus in her left eye, which had previously undergone corneal cross-linking to stabilize the condition. Her right eye was only mildly suspicious for keratoconus. The team fit a scleral lens on the left eye and a soft contact lens on the right eye to address each eye’s unique needs.

Combining Scleral Lenses With Monovision for Reading and Distance

Because the patient was interested in reducing her dependence on reading glasses, our doctors introduced a monovision correction. Her right eye, which was her dominant eye, was set for distance vision with a soft contact lens. Her left eye, wearing a scleral lens, was adjusted for near vision. After testing different near-vision powers in the office, the patient was most comfortable with a moderate near addition.

At her follow-up appointment two weeks after lens dispensing, she reported a brief adjustment period during the first few days but adapted quickly. Her results were excellent: 20/20 distance vision and 20/20 near vision with both eyes open. She did note some glare while driving at night, which is a common experience with monovision. A pair of prescription driving glasses was provided to correct her left eye for distance during nighttime driving when needed.

What to Expect if You Are Considering Monovision With Scleral Lenses

If you have keratoconus and are also experiencing difficulty with near vision, here are some practical points to discuss with your doctor:

• Monovision requires a trial fitting to determine whether your brain adapts comfortably to the approach
• A short adjustment period of several days to two weeks is normal
• Night driving may require a supplemental pair of glasses for optimal distance vision in both eyes
• Scleral lenses provide stable, clear vision for the keratoconic eye while also offering all-day comfort
• Not every patient is a candidate for monovision, and your doctor will help determine the best option for your visual needs

Schedule a Specialty Lens Fitting

Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS specialize in fitting scleral lenses and customized contact lens solutions for keratoconus and other irregular corneal conditions. To learn whether a scleral lens with monovision could work for you, contact Insight Vision Optometry, Las Vegas at 702-747-4070 to book a consultation.