Scleral contact lens or Corneal transplant for advanced keratoconus?

Corneal transplant is a very successful treatment for advanced keratoconus and Scleral contact lens provide good visual outcome if there is no central corneal scar. So which treatment option is suitable for advanced keratoconus? Sometimes patient confused between two of them.

PK (Penetrating Keratoplasty) or DALK (Deep Anterior Lamellar Keratoplasty) are traditional corneal transplant surgery for advanced keratoconus. But it performed when the cornea is very thin or corneal scarring at the center of cornea. If there is a scar at central cornea then vision will not be improve 100 percent even with the rigid lenses also. PK is full thickness corneal transplant and DALK is partial thickness corneal transplant. Both surgeries are very successful in most of the cases.

Scleral contact lenses are large diameter gas permeable contact lenses which specially designed to vault over entire corneal surface and the lens is rest on sclera.  That means this will not touch your cornea and lens will touch only scleral part of the eye. Till now this is the best lens for advanced Keratoconus and other corneal irregularities. The diameter of sclera lenses vary between 14.5 mm to 24 mm. The lenses less than 18 mm called as Mini sclera lens.

Also Read Scleral Contact lenses are use for
  • Advanced Keratoconus
  • Keratoglobus
  • PMCD- Pellucid marginal corneal degeneration
  • Corneal transplant
  • Traumatic eye injury
  • Sjogren’s syndrome related dry eye
  • Graft versus-host disease (GVHD)
  • Stevens Jonson syndrome
  • Refractive surgery
  • Protect cornea from scratches in case of trichiasis
Disadvantages of Scleral lenses are
  • Not available worldwide
  • Fitting centre not available all places
  • Cost factor
  • Sometimes eyes are look larger
  • Need more practice for wearing and removal at initial stage
Patient point of view about Optical PK and Scleral lenses:-

Both having some advantages and disadvantages.

Though the cost of corneal transplant vary hospital to hospital (10-25k each eye) but the cost of surgery is much less than Scleral lenses (Boston) (50-70k each eye). Scleral lenses are advised for the patients those who are not suitable for rigid lenses.Scleral contact lens

Scleral lenses (Boston Scleral) are more expensive than PK surgery. Country like India, scleral contact lens not covered by the insurance. All can’t afford the sclera lenses and fitting centres also very less in numbers. Like other contact lenses, these lenses need proper care and maintain. Also few patients don’t want to wear and remove the lenses daily. They need permanent solution.

Also Read

Whereas the surgical cost PK is cheaper than larger diameter sclera lenses. Remember if there are any kinds of central scar then your vision will not be improve 100 percent with scleral contact lens.

Corneal transplant is very successful but it may take one year for recovery after surgery. PK in keratoconus has very good outcome and average 73-91 % of eyes achieving 20/40 or better vision with spectacle. The possible complications of PK or DALK are corneal graft rejection, poor vision, high astigmatism, infections. You also need to use eye drops regularly and may need wear rigid contact lenses for clear vision. Sometimes it does take several years to improve 100 percent vision. Also time to time need to remove corneal sutures and for surgery need good donor corneal tissue.

If there is a central corneal scar then must think for corneal transplant. But in other hand financial condition and patient hygiene both factors are important for scleral contact lens dispensing. So before advice of scleral contact lenses, patient financial condition should be considered.

Krishnendu Mandal
Optometrist, Blogger, Blogging since Jan 2016

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2 thoughts on “Scleral contact lens or Corneal transplant for advanced keratoconus?”

  1. Pingback: Keratoconus surgery: Corneal collagen cross-linking recovery time

  2. Pingback: Financial burden for the treatment of keratoconus in India

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