Keratoconus Patient With Scar Tissue Achieves 20/40 Vision

At Insight Vision Optometry, Las Vegas, we regularly work with keratoconus patients whose corneal conditions present unique challenges. This case study highlights how scleral lenses can dramatically improve vision even when corneal scarring is present.

How Corneal Scarring Affects Vision in Keratoconus

Keratoconus causes the cornea to thin and bulge into an irregular, cone-like shape. Over time, some patients develop corneal scar tissue as the disease progresses. These scars form on the cornea’s surface and can significantly block or distort light entering the eye, reducing visual clarity even with glasses or standard contact lenses.

The location and density of a scar play a major role in how much vision is affected. A dense scar located centrally on the cornea, directly in the line of sight, tends to cause more significant vision loss than a scar positioned off to the side. Patients with corneal scarring often find that glasses provide very limited improvement, and standard soft contact lenses cannot compensate for the irregular surface.

What Happened During the Scleral Lens Consultation

A patient with longstanding keratoconus was referred to our office for a specialty contact lens consultation. He had developed corneal scars in both eyes over the years. The right eye had a dense, centrally located scar that limited his best correctable vision to 20/150, while the left eye also had some central scar tissue but with more visual potential.

Our doctors evaluated both eyes carefully. Given the severity of the right eye’s scarring and limited vision potential, the team recommended corneal transplant co-management for the right eye and a specialty scleral lens for the left eye.

How Scleral Lenses Improve Vision Over Irregular Corneas

Scleral lenses are large-diameter gas permeable lenses that vault entirely over the cornea and rest on the white of the eye, known as the sclera. The space between the lens and the cornea is filled with preservative-free saline, creating a smooth optical surface that replaces the irregular corneal surface for light refraction. This design allows scleral lenses to correct vision even when the cornea is scarred, thinned, or highly irregular.

During the in-office evaluation, a diagnostic scleral lens was placed on the left eye. With glasses alone, the patient had been seeing 20/80 in that eye. With the diagnostic scleral lens, his vision improved to 20/40, a meaningful improvement that occurred despite the presence of corneal scar tissue.

Designing a Custom Scleral Lens for the Best Fit

Based on the diagnostic fitting results, Dr. Stephanie Woo, OD, FAAO, FSLS, and the specialty lens team designed a custom scleral lens to account for irregularities not only on the cornea but also on the scleral surface. Every eye has a unique scleral shape, and advanced imaging helps our doctors map these contours so the lens fits comfortably and performs well throughout the day.

What Keratoconus Patients Should Know About Scleral Lenses

If you have keratoconus with or without corneal scarring, scleral lenses may be an option worth exploring. Here are a few things to keep in mind:

• Scleral lenses can often improve vision significantly even when glasses or soft contacts cannot
• The fluid reservoir under the lens provides comfort and keeps the cornea hydrated throughout the day
• A proper fit requires specialized expertise and advanced diagnostic equipment
• Scleral lenses do not treat keratoconus itself but provide clear, stable vision while the condition is managed
• If scarring is severe and a corneal transplant is needed, scleral lenses are often used after the transplant to optimize vision

Schedule a Scleral Lens Consultation

Our specialty contact lens team, led by Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS, has extensive experience fitting scleral lenses for keratoconus and other complex corneal conditions. To find out whether scleral lenses could improve your vision, contact Insight Vision Optometry, Las Vegas at 702-747-4070 or visit www.insightvisionlv.com to schedule a consultation.