CONTACT LENS FOR

KERATOCONUS

Norehan binti Abdul Rani

OPTOMETRIST, HBM
17/6/2022
 CONTENT

• INTRODUCTION TO CONTACT LENS

• WHAT IS KERATOCONUS
• MANAGEMENT FOR KERATOCONUS
• TYPE OF CONTACT LENS FOR KERATOCONUS
• CONTACT LENS FITTING
INTRODUCTION TO CONTACT
LENS
 KERATOCONUS
CORRECT
REFRACTIVE BANDAGE
ERROR

INDICATION FOR CONTACT LENS

MYOPIA CONTROL
POST SURGERY
(ORTHOKERATOLOGY)
COSMESIS
CORRECT REFRACTIVE ERROR

• MYOPIA
• HYPEROPIA
• ASTIGMATISM
• PRESBYOPIA
• APHAKIA
CL FOR APHAKIC CHILDREN
 KERATOCONUS

• To achieve optimum VA
& vision quality
• Help correct the
distortion caused by the
corneal irregularities
 BANDAGE CL

• Provides relieve from pain

• To protect and reduce pain of a cornea with surface disorder
eg. bullous keratopathy, keratitis, recurrent erosion syndrome
• Promote healing of the cornea
• Mechanical protection and support
• Stabilizing wounds, cuts and holes
• Bandage contact lenses are beneficial
for corneal protection in this case of
corneal perforation. 

• maintaining epithelial integrity following

penetrating keratoplasty. 
 COSMESIS

• Prosthetic CL – to cover the poor appearance of the cornea

• Colour CL- cosmetic/beauty purpose
 POST SURGERY

• Corneal surgery such as pk cause irregularity of the cornea

-> poor vision
• Scleral lens used to achieve optimum VA

 Scleral lenses over post–radial keratotomy eyes.

 ORTHOKERATOLOGY

• As a myopia control options

• Wear during sleeping
• Reshape the cornea
TYPE OF CONTACT LENS
 2 BASIC TYPE OF CL (MATERIAL)

SOFT CONTACT LENS HARD LENS

• Hydrogel • Hard lens (PMMA)

• Silicon hydrogel • Semi-hard @ rigid gas
permeable (RGP) lens
 SOFT CONTACT LENS

• Made of SOFT and flexible material that allow O2 to pass

through the cornea
• More comfortable than RGP
• Easier to fit
• Modality;
• Daily
• Biweekly
• Monthly
• 3 monthly
• Conventional
 HARD LENS / RGP LENS

• More durable and resistant to deposit buildup

• Less comfortable compared to soft CL
• Longer adaptation period needed
• Longer time for fitting assessment
• Hard lens – made from PMMA
• RGP – rigid gas permeable
KERATOCONUS
 WHAT IS KERATOCONUS

• Non-inflammatory ectatic thinning disorder of the cornea

that results in poor vision because of irregular astigmatism
• The cornea becomes more distorted, and steeper in
curvature, usually beginning in adolescence.
• Thinning & steepening of the central and/or para-central
cornea
 CLINICAL SIGNS

• Munson sign
• Rizzuti phenomenon
• Retinoscopy- dull and scissors reflex
• Keratometry- mire distortion
• Vogt striae (VT line)
• Fleischer ring
• Corneal thinning
• Hydrops
• Scarring near to the cone apex
• Increase visibility of nerve fibres (HZ line)
Figures 1: 1(a) Munson's sign (1b) Rizutti's sign Figures 2: (2a) Vogt's striae

Figures 4: (4a) Thinning in Mild Keratoconus (4b) Thinning in Severe

Keratoconus
Figures 5: (5a) Apical corneal scarring (5b) Acute Hydrops

Figures 6: (6a) Prominent corneal nerves (6b) Bowmans rupture

 WHAT DOES THE PATIENT SEE?

• Monocular polyopia - the appearance of many

different imaginary images
• Pt may see "halo" effects-rays around the light
sources at night.
CORNEAL TOPOGRAPHY
(a) displays central keratoconus, also known as "nipple cones," present within or near to the pupil
(b) demonstrates oval keratoconus, larger in size than central cones and typically presents inferior to the
corneal apex. It is also the most common cone presentation.
(c) globic keratoconus involves the largest surface area of the cornea compared with central or over cones,
while
(d) pellucid marginal degeneration presents as thinning nearer to the peripheral cornea and can appear as
"kissing doves" or "butterfly wings" on the axial map.
 KERATOCONUS CLASSIFICATION:
CORNEAL CURVATURE

GRADE CORNEAL CORNEAL

RADIUS (MM) DIOPTRIC (D)
NORMAL 7.00 – 8.00 42 – 48

EARLY 6.50 – 6.90 49 – 52

MODERATE 6.00 – 6.40 53 - 56

ADVANCED <6.00 >56

 KERATOCONUS CLASSIFICATION:
CONE SHAPE

Grade Shape & Cone Position

Nipple Small cone diameter (5mm)
Cone lies @ lower nasal quadrant within a few mm
of the visual axis.
Oval Larger cone (>5mm)
Lies more commonly in the infero-temporal
quadrant.
Globus Largest diameter (>6mm)
75% of cornea is effected
 MANAGEMENT OF KERATOCONUS

• Spectacle for early keratoconus

• Contact lens
• Corneal Cross linking
• INTACS – intra corneal ring
• Corneal transplant
CONTACT LENS FOR
KERATOCONUS
 CONTACT LENS FOR KERATOCONUS

• Spectacles are useful in the early stages of keratoconus when the

astigmatism is mild. But in more advanced keratoconus, spectacles
won’t help and contact lenses become necessary for improving the
vision and play a major role.
• CL required for the visual improvement in patients with keratoconus. 
• The main goal of fitting contact lenses is to improve visual acuity with
comfort without compromising the health of the cornea. 
• Various options for contact lenses are available and one can use any
one of these as a starting lens, depending on the severity of the cone
and associated conditions
• To fit contact lenses is a challenge in patients with keratoconus;
 TYPES OF CL FOR KERATOCONUS

• Lens material – RGP, SOFT, SOFT TORIC, HYBRID CL,

PIGGYBACK LENS
• Lens design/size - CORNEAL LENS, SEMI SCLERAL,
MINI SCLERAL, SCLERAL LENS
 LENS MATERIAL

SOFT

• Spherical/toric SCL
• Or specifically design for KC, eg Kerasoft

RGP

• Spherical/toric RGP
• Or Keratoconus CL

HYBRID

• Combination of soft & RGP material

KERASOFT CL

• Soft contact lens specially design for

keratoconus
• indicated for RGP intolerance
• Mild to moderate KC
• difficult to fit Kerasoft lenses in advanced
or severe keratoconus
 LENS DESIGN/SIZES

Corneal lens 8 mm – 12.5mm All lens bearing on the

cornea
Semi 12.5 mm – 14.9 mm Lenses share bearing on the
scleral / cornea & sclera
corneo
scleral lens
Mini scleral 15 mm -17.9 mm All lens bearing on the
sclera
Full scleral 18 mm -25 mm All lens bearing on the
sclera
 KERATOCONUS CL

• Corneal lens: Corneal RGP lens is the first lens of

choice for visual improvement.
 KERATOCONUS LENS

ROSE K2 IGEL EE CONUS

• Invented by Dr Paul Rose OD • Custom made RGP lens

• An optometrist from New • Yearly contact lens
Zealand • Use gas permeable material
• Began development from 1989
 SUB TYPES OF ROSE K2
Sub Types of Rose K2
Rose K2 (corneal lens)
Rose K2 NC (corneal lens)
Rose K2 IC (corneal lens)
Rose K2 Post Graft (corneal
lens)
Rose K2 XL (semi scleral
lens)
Indications
Oval Keratoconus
Nipple Keratoconus
Early PMD
Nipple Keratoconus
Keratoglobus, PMD, Lasik Induced Ectasia,
Post graft, Oval Keratoconus
Pt that had undergone penetrating keratoplasty,
Oval Keratoconus, Nipple Keratoconus and
Lasik
Keratoconus, PMD, Post Graft, Post Surgery
 SEMI SCLERAL LENS – ROSE K2 XL

• Indication: when any irregular cornea condition that cannot

be successfully fitted within the limbus, corneal RGP
intolerance
• Keratoconus, PMD, Post Graft & Post Surgery
• Eg. Rose K2 XL
• Std diameter 14.6 mm (13.60 mm – 16.00mm)
SEMI-SCLERAL LENS
 FULL SCLERAL LENS

• 18MM – 25MM
 HYBRID LENS

• Combine hard and soft lenses in their device

• Their central part is a RGP lens, and the material for the
periphery area (which is called the "skirt") is a soft hydrogel
polymer.
• Compared to hard and soft lenses, the use of hybrid lenses
provides combination of comfort for the patient and visual
acuity. 
HYBRID LENS
 PIGGYBACK LENS: COMBINATION OF
HARD AND SOFT CONTACT LENS

• soft lens is placed on the

patient's eye, and RGP-lens
on top of the soft lens.
• this achieves a combination
of soft contact lens comfort
with the efficiency of vision
improvement inherent in
hard lenses.
 CONTRAINDICATION OF CL IN
KERATOCONUS PATIENT

• Corneal hydrops
• Corneal scarring -can fit with CL but make sure not touching
the scarring
• Poor hygiene
• Mental incompetence
• Poor compliant or unmotivated patient
 KC CONTACT LENS FITTING

• 3 important parameters : diameter of the contact lens, the base

curve and the power.
• The diameter is based on the location of the cone, its size, and
steepness.
• Good to start with a lens of small diameter such as 8.7 mm.
• Early nipple cone has a small diameter, making the fitting of
contact lens easier.
• The oval or sagging cone is located inferotemporally and needs
larger diameter lenses and it is difficult to fit these patients.
 CL FITTING STEPS

1. Central fit
2. Peripheral fit
3. Overall diameter
4. Location
5. Lens movement
6. Power
CL FITTING ASSESSMENT
 CL DELIVERY

• Reassess the CL fitting

received
• Teach patient how to put and
remove the CL
• Do’s & don’t in CL wear
CL AFTER CARE
 SUMMARY

•Fitting contact lens in keratoconus can improve the

vision and delay the need for keratoplasty.
•Scleral lenses are used when all other options fail to
fit or the patient has associated ocular disease such as
vernal keratoconjunctivitis.
•The lens of choice is RGP lens and if the patient
develops discomfort or intolerance, then one can go
in for customized soft toric lenses or piggy back CL
and later on, if required, hybrid lenses can be
considered.
 KC CL TRIAL SET AVAILABLE IN HBM

• ROSE K2 DIAMETER 8.7MM

• ROSE K2 DIAMETER 9.6MM
• IGEL CONUS
• ROSE K2 XL (NEW)
ROSE K2 8.7 ROSE K2 9.6
THANK YOU