Managing keratoconus with reverse-geometry and dual-geometry contact lenses: a case report

To present a case of keratoconus successfully managed with various rigid gas-permeable contact lenses with reverse-geometry and dual-geometry designs.

Case report.

The steepest topographic keratometric readings of a 30-year-old woman with keratoconus were 62.18 diopters in the right eye and 54.70 diopters in the left eye. A conventional reverse-geometry lens worked well in the left eye. The more distorted right eye was fitted with a series of different reverse-geometry and dual-geometry lenses. Her visual acuity was 20/20 in each eye when she wore contact lenses during the day. Unaided vision was as good as 20/25+ in the right eye and 20/20 in the left eye for several hours after lens removal. No significant complication occurred during 42 months of follow-up.

Keratoconus is a corneal disease characterized by progressive stromal thinning and ectasia, typically in the inferior cornea. Rigid gas-permeable contact lenses are the most common management option to improve vision. Corneal surgery, such as keratoplasty, is the next choice when contact lenses are ineffective or intolerable. The large overall diameter and contact area of reverse-geometry and dual-geometry lenses can assist in stabilizing the lenses on distorted corneas. These contact lenses may provide viable alternatives for management before corneal surgery.