Back in 2019, a patient stepped through our doors, seeking a second opinion. She had keratoconus—a condition where the cornea, the clear front surface of the eye, thins and bulges into a cone-like shape. Her specific case was especially challenging. The right eye displayed a Kmax greater than 150 D (radius 2.15 mm), and a corneal thickness of just about 160 microns. In other words, the patient had very advanced stage of keratoconus: a very steep cone, and a very thin cornea. In many clinics, a doctor would see this cornea, and immediately start planning a corneal transplant – with all of the risks and challenges that this surgery entails.
But here’s where the power of comprehensive patient care and exploring all avenues comes into play. At ELZA, rather than directly advising surgery, an alternative route was suggested: using a scleral lens.
For those unfamiliar, scleral lenses are a type of contact lens that vaults over the cornea and rests on the white part of the eye (the sclera). The lens is filled with sterile BSS solution, which fills the space between the cornea and the lens. This makes scleral lenses particularly beneficial for those with irregular corneas, such as our patient with keratoconus, as the multitude of small irregularities on the surface of the cornea that cause the visual disturbances and higher order aberrations become filled with the fluid, and as a side benefit, is extremely good at treating severe dry eye too. At ELZA, our Senior Optometrist, Léonard Kollros, is a highly experienced, expert scleral lens fitter, and the case we report here is one of his.
Fast forward four years after the scleral lens fitting, and this same patient now enjoys a visual acuity of 0.63, all thanks to the scleral lens. An impressive result, to say the least.
Stories like this underline the significance of exploring every possible option before resorting to surgical interventions. It’s not just about treating a condition, but about optimizing a patient’s quality of life with the least invasive measures possible.
The journey from diagnosis to treatment can sometimes be overwhelming, and the importance of a second opinion cannot be overstated. And in cases like this, the results not only bring clear vision but also hope and reassurance.
Whether it’s keratoconus, a thin cornea, or any other eye condition, there’s always value in exploring every possible avenue, and the ELZA Institute stands ready to guide patients through these choices, on a journey toward the best possible outcomes.