Patience in Keratoconus

I had a patient referred to me for contact lens fitting. This 20 year old patient was just diagnosed with keratoconus. His parents came with him. They waited for me to see them. After doing a thorough check, I pointed to the parents the scar that formed on the patient's cornea. The parents were very sorry that they had not noticed it. I fitted the patient with scleral contact lenses. After which I taught him the insertion and removal technique. As I do the training myself, we had to block off my schedule to prioritise this case. It took us more than a visit for him to be able to insert the lenses as his lids kept on closing. The parents were very supportive and stayed with us throughout this ordeal. For most families in the Philippines, optometrist visits are a family event. Family support is truly an important part of a successful contact lens wear, as no one can motivate more than patient's own family. After showing how much vision improvement we were able to attain with the scleral lenses, the parents were very happy. And patient said now he can already look for work. That's the thing about fitting specialty contact lenses, we can really change lives.

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How to Know If Your Keratoconus is Progressing?

Keratoconus typically starts at puberty and progresses until the third or fourth decade of life. At initial diagnosis, younger patients with the steepest corneal curvature (Kmax) of over 55 D have a significantly greater risk of progression. Keratoconus seen at this age is more aggressive, leading to more severe cases. Without any management, the corneal curvature becomes more conical in shape, which can cause worsening of vision, thinning and scarring of the cornea, and possible development of hydrops. However, it tends to stabilize after 20 years from the first diagnosis. To detect keratoconus progression, some corneal parameters need to be evaluated. WHAT THE EYE DOCTOR IS LOOKING FOR? -Increase maximum corneal refractive power (Kmax) by more than 1 Diopter within one year. -An increase in (corneal) myopia by more than 3 Diopter or astigmatism by more than 1.5 Diopter within one year. -An average corneal refractive power increase by more than 1.5 Diopter within one ...

Can I Drink Alcoholic Beverages While Wearing Scleral Lenses?

Scleral lenses are fitted to patients with complicated prescriptions and irregular corneas. A common question I encountered is "Doc, is it safe to drink alcoholic beverages while I am wearing my scleral lenses?" . Looking into the different papers on the effects of alcoholic beverages on the eye, alcohol, similar to coffee and smoking, can induce some ocular dryness. Studies noted the presence of ethanol in tears of patients within 6 to 12 hours after drinking alcoholic beverages. The presence of ethanol in tears may cause increased evaporation rate, increased corneal staining, and decreased tear volume, leading to dry eyes. Unlike in soft contact lenses, the material of scleral lenses does not undergo dehydration. However, scleral lens wearers may still feel some symptoms of dryness. It is essential, though, to be sure to be still able to remove your lenses when you get home, clean and store them properly. We have one patient who was ...

Can You Do Weight Lifting If You Have Keratoconus?

Many patients are asking if they can still do weight lifting since they have keratoconus. During weight lifting, in order to carry tons of weight, a powerlifter may utilise a breathing pattern which involves Valsalva manoeuvre. According to wikipedia, t he V alsalva manoeuvre is performed by moderately forceful attempted exhalation against closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon. Other situations where Valsava manoeuvre is done are during diving, hyperbaric oxygen therapy, air travel and sometimes even going to the restroom doing your number 1. According to Findley, Keating and Toscano (2003), the Valsalva manoeuvre is commonly used in powerlifting to stabilise the trunk during activities such as squat, deadlift, and bench press. So what happens to the cornea when Valsalva manoeuvre i...

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