Akeratoconus (KC) patient who is successfully fit with a scleral lens (SL) may experience improved visual acuity, contrast sensitivity, and quality of life (Picot et al, 2015). Most importantly, SLs may delay the need for corneal transplantation by enabling functional vision (Ozek et al, 2018). Patients who have advanced corneal irregularity and have failed in small-diameter GP or hybrid lenses are constantly referred to our office for SLs before heading to the operating table.

After the initial fitting process, troubleshooting minor changes for an established SL wearer can be relatively straightforward. Slight distance blur? A small power adjustment will clear that up. Apical clearance getting a little too low for comfort? Let’s steepen the base curve radius a touch. We often walk out of the exam room pleased that a patient’s chief complaint has been resolved, but are we truly addressing the root cause of the symptoms?

Treat the Underlying Disease

Sometimes we can forget that these patients have a condition that, with disease advancement, may result in debilitating vision loss. So, other therapeutic interventions must be considered in addition to SL wear. Furthermore, not every patient will follow the classic presentation of KC; as many as 1 in 3 KC patients over the age of 30 experience progression (Gokul et al, 2017).

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