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Keratoconus. Contact lens or keratoplasty?
W E Smiddy1, T R Hamburg, G P Kracher
1Contact Lens Service, Wilmer Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Ophthalmology
|April 1, 1988
Summary
Contact lenses, particularly specialized bispheric designs, can successfully fit most keratoconus patients, potentially delaying or preventing the need for corneal transplant surgery. Many post-keratoplasty eyes also benefit from contact lens wear.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Optometry
Background:
- Keratoconus is a progressive corneal ectasia leading to visual impairment.
- Contact lens intolerance is common in keratoconus, often preceding referral for keratoplasty.
- Management strategies aim to improve vision and delay surgical intervention.
Purpose of the Study:
- To evaluate the success rate of contact lens fitting in keratoconus patients.
- To determine the rate of progression to keratoplasty despite contact lens wear.
- To assess the role of specialized contact lenses in managing keratoconus.
Main Methods:
- Retrospective analysis of 115 consecutive keratoconus patients.
- Evaluation of contact lens fitting success rates for both nonoperated and postkeratoplasty eyes.
- Tracking of progression to keratoplasty and visual outcomes with contact lens wear.
Main Results:
- 87% of nonoperated eyes were successfully fit with contact lenses.
- 31% of successfully fit eyes ultimately required keratoplasty after an average of 38.4 months.
- 69% of eyes did not require keratoplasty with an average follow-up of 63 months.
- Specialized bispheric lenses were necessary for 76% of successful fittings.
- 60% of postkeratoplasty eyes achieved best vision with contact lenses.
Conclusions:
- Contact lens fitting is successful in a high percentage of keratoconus patients.
- Specialized contact lenses can delay or avoid keratoplasty in many cases.
- Contact lenses are frequently required for optimal vision after keratoplasty.