San Diego Keratoconus Clinic
Over one hundred eye doctors throughout San Diego, Southern California, and nationwide have referred their keratoconus patients to the Keratoconus Clinic at EyeLux Optometry for specialist treatments and care. That’s why EyeLux Optometry cares for more keratoconus patients in a week than most practices serve in an entire year.
The Keratoconus Clinic at EyeLux Optometry is directed by Brian Chou, O.D., F.A.A.O. Dr. Chou underwent post-graduate fellowship training at UCLA’s Jules Stein Eye Institute, Cornea External Disease Division, at which time he cared for the first two dozen keratoconus patients to have Intacs surgery in the United States. He is also an accomplished author on keratoconus and has presented on keratoconus treatments and innovations to more than 1,000 eye care professionals at national meetings. Dr. Chou is a Fellow of the Scleral Lens Education Society and serves on the editorial board of Review of Cornea & Contact Lenses.
EyeLux Optometry’s keratoconus treatment referral clinic uses state-of-the-art technology including corneal topography and external digital ocular photography. We have an extensive inventory of diagnostic contacts lenses — including scleral contact lenses, corneal gas permeable contact lenses, SynergEyes hybrid lenses, custom keratoconic soft lenses, and piggyback lenses — allowing medically-necessary contact lens prescribing according to what is best for your individual situation. Most of our patients with keratoconus are able to obtain desirable outcomes with non-surgical treatment.
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Audio Keratoconus Presentations
Listen to a 45 minute presentation by Dr. Brian Chou discussing various types of contact lenses for use for keratoconus patients at the 2011 San Diego Vision Symposium sponsored by the Discovery Eye Foundation.
What is keratoconus?
Keratoconus is a disease where the cornea — the clear front of the eye — becomes progressively distorted. A normal cornea is spherical in shape, like a ball. Keratoconus causes the cornea to bulge forward, protruding into a cone shape. This shape distorts the rays of light passing through the cornea. The rays are unable to meet at a clear point of focus on the retina, resulting in blurry vision.
Nearsightedness and astigmatism are common with keratoconus, as are glare and light sensitivity. Keratoconus patients often require prescription changes each time they visit their eyecare practitioner, especially during progression of the disease.
Keratoconus causes: When and in whom does this condition occur?
Often beginning in teens, keratoconus usually progresses into the 20s or 30s before stabilizing on its own. In severe cases, the cornea continues to thin and bulge outward, creating even greater blurred vision. Scarring of the cornea can spontaneously develop.
More than 1 in 1,800 people have keratoconus, according to researchers. In ten percent of cases, patients report a family member who has keratoconus, but keratoconus has no race or gender correlation. Many keratoconus patients also suffer from hayfever, eczema and asthma.
Some researchers feel that eye rubbing may increase the progression of keratoconus. Although it hasn’t been proven that eye rubbing exacerbates keratoconus, it is still a good idea to refrain from rubbing your eyes. Your eye doctor at EyeLux Optometry may prescribe eye drops to minimize eye itching symptoms.
What keratoconus treatments are available?
In mild cases of keratoconus, eyeglasses and soft contact lenses can provide adequate vision. But in more advanced cases, most keratoconus patients will require custom-made gas permeable (GP) contact lenses. It’s essential to have properly prescribed custom contact lenses. This is critical not only for optimal vision, comfort, and eye health; but poorly-prescribed lenses can increase the risk of corneal abrasions, scarring, and infection.
Keratoconus surgery may be necessary in severe and advanced cases; published reports say that 10-20% of keratoconus patients get corneal transplants. If our examination reveals that you have significant scarring of the cornea, your doctor may recommend a corneal transplant. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. Although most corneal transplants are successful, the majority of patients afterwards still need glasses, soft contacts, or GP lenses for adequate vision.
What kind of contact lenses can help someone with keratoconus?
Rigid gas permeable (GP) contact lenses are commonly prescribed, with the large-diameter scleral lenses accommodating a large number of keratoconus patients. Rigid surface contact lenses provide a smooth, artificial surface to mask the “peaks and valleys” of the keratoconic cornea, in turn providing the best vision. The keratoconus clinic at EyeLux Optometry uses a variety of lens designs, and the best contact lens for you will be determined following a complete evaluation.
Do I need a referral in order to visit the EyeLux Optometry keratoconus clinic?
No. Doctors from around the state of California refer keratoconus patients to the keratoconus clinic at EyeLux Optometry, but you may contact us directly. Your first step will be a complete eye examination and evaluation. Please tell our staff that you have keratoconus when scheduling your first appointment.
Can I get LASIK if I have keratoconus?
LASIK and other laser eye surgeries are not appropriate for keratoconus patients due to an unacceptable risk of a poor outcome. The LASIK procedures remove corneal tissue, and because in keratoconus patients the cornea is already thin and weak, LASIK can irreversibly destabilize the cornea and accelerate its distortion.
What’s new in keratoconus treatment?
Scleral lenses are arguably the most significant technological advancement in keratoconus treatments. Scleral lenses are large-diameter rigid contact lenses, typically the size of a nickel to quarter. These specialty lenses rest on the white part of the eye, or sclera, and trap a fluid cushion between the cornea and contact lens, providing a smooth, artificial front surface to bend light. When prescribed properly, these lenses are surprisingly comfortable because they rest on the relatively insensitive white part of the eye rather than the cornea, yet the provide exceptional rigid-quality vision. Most eye doctors do not routinely prescribe scleral lenses but refer their patients that benefit from them to clinics like ours. While scleral lenses have existed for a while, only more recent technological advances have made these designs available through clinics like EyeLux Optometry. We are routinely able to help keratoconus patients avoid risky eye surgery by prescribing scleral contact lenses.
In addition to scleral lenses, others with keratoconus benefit from the new-generation of hybrid contact lenses which have a rigid center but soft outer skirt. The SynergEyes ClearKone hybrid contact lens, was introduced in 2009. EyeLux Optometry’s Dr. Chou was the first practitioner in San Diego to commercially prescribe ClearKone. ClearKone can demonstrably improve visual acuity and lens-wearing comfort for select keratoconus patients. In 2013, a higher oxygen permeable version of this lens, SynergEyes UltraHealth, was introduced. UltraHealth uses a soft skirt material called a silicone-hydrogel which permits greater oxygen supply to the eye. EyeLux Optometry is one of the first practices in the U.S. to offer this lens for selected cases of keratoconus treatements.
EyeLux Optometry also prescribes special soft contact lenses for various keratoconus treatments including KeraSoft IC and NovaKone. These lenses are thicker-than-normal lenses which help minimize the irregular eye surface of keratoconus.
Specialty contact lenses are the first-line treatment of choice for keratoconus, but for some patients keratoconus surgery may be needed. A small number of keratoconus patients get corneal transplants, but this is a last resort. An alternative to transplants is Intacs® prescription inserts, also known as intrastromal corneal ring segment implantation. Intacs are generally an option when a wearer cannot tolerate GP lenses, but the keratoconus has not progressed to the point of needing a transplant. Glasses or contacts may still be needed after such a procedure; but soft contact lenses might provide acceptable vision in these circumstances, avoiding GP contact lenses. Dr. Chou has cared for the first dozen keratoconus patients that underwent Intacs® surgery in the United States during his fellowship at Jules Stein Eye Institute.
Corneal cross-linking is another new surgical procedure for slowing or halting progressive keratoconus. In this procedure, riboflavin and ultraviolet irradiation are used to strengthen the cornea. Since keratoconus arrests on its own by the third to fourth decade of life, the greatest value of corneal cross-linking may be for those under age 30. It is important to understand that while corneal cross-linking can reduce some corneal distortion, the vast majority still require special contact lenses afterwards to achieve the best vision.
We can advise you if any of these keratoconus treatments are appropriate for your individual circumstances. Because there is tremendous variability in the severity of keratoconus from one person to another, and even from one eye to another, there is no single treatment which is appropriate for every patient with keratoconus.
Selected keratoconus publications by Dr. Chou
- Chou B. Solving Scleral Contact Lens Induced Pingueculitis. Rev Cornea Contact Lenses. November, 2016: 24-28.
- Chou B. Treating keratoconus with contact lenses helps your patients and generates referrals. Review of Optometric Business. January 17, 2012.
- Chou B. Keratoconus (Cataract and refractive surgery comanagement, Chapter 22). In: Ocular therapeutics handbook: A clinical manual, 3rd edition. Eds. Onofrey B, Skorin L, Holdeman N. Philadelphia: Wolters Kluwer Health, 2011:653-656.
- Chou B., Weissman, B. Making Sense of the Irregular Cornea (cover article). Rev Cornea Contact Lenses. April, 2010: 14-21.
- Chou B. Corneal irregularity and success with SynergEyes hybrid contact lenses (advertorial). Contact Lens Spectrum, September 2008: 36-37.
- Chou B. Rigid optics with soft lens comfort: a look at how the technology behind SynergEyes lenses benefits both patients and practitioners. Contact Lens Spectrum, July 2006: 48-53.
- Chou B. Does unilateral keratoconus exist? Rev Optom, March 2006: 65-66.
- Chou B. Wavefront aberrometry for keratoconus. Rev Contact Lenses. September, 2005:28-29.
- Chou B. Has keratoconus met its match? Rev Contact Lenses, February 2001:28-29.
- Chou B, Boxer Wachler B. Intacs for keratoconus: a promising new option? Rev Optom, April 2000;137(4):97-98.
Selected keratoconus lectures by Dr. Chou
- 7 Badass Contact Lens Hacks to Tame Keratoconus (1 hr CE), San Diego County Optometric Society Specialty Contact Lens Symposium & Workshop, San Diego, CA, May 20, 2016.
- An Insider’s Look in UltraHealth: the newest hybrid contact lens (1 hr CE). San Diego County Optometric Society, San Diego, CA, May 18, 2014.
- Contact Lenses for Keratoconus, San Diego Vision Symposium (National Keratoconus Foundation & The Discovery Eye Foundation), San Diego State University, San Diego, CA, May 14, 2011.
- Fitting Irregular Corneas with ClearKone, the Reverse Geometry Hybrid Contact Lens (1.5 hr workshop), San Diego Specialty Contact Lens Symposium, San Diego, CA Feb 12, 2011.
- Soft Contact Lenses for Keratoconus (1 hr CE), San Diego Specialty Contact Lens Symposium, San Diego, CA, February 11, 2011. COPE ID #29945-CL.
- Caring for the Gas Permeable Intolerant Kerataconus Patient (1 hr CE), ClearView Eye & Laser Medical Center, San Diego, CA, March 18, 2009. COPE ID #24507-AS.
- Use of Intacs and Contact Lenses in the Management of Keratoconus (2 hr CE), Flowers & Suder Vision Institute, San Diego, CA, April 4, 2006.
- Caring for the Gas Permeable Intolerant Keratoconus Patient (1 hr CE), Annual Meeting of the American Academy of Optometry, San Diego, CA, December 11, 2005. COPE ID #14667-CL.
- Keratoconus – Current Diagnosis & Treatment (2 hrs CE), Arizona Optometric Association Annual Spring Congress, April 29, 2004. COPE ID # 9210-AS.
- Intracorneal Rings for Keratoconus (1 hr CE), East West Eye Conference, Cleveland, Ohio, October 25, 2003. COPE ID # 80011-CL.
- Keratoconus – Current Diagnosis & Treatment (2 hrs CE), San Diego County Optometric Society Meeting, San Diego, CA, August 21, 2003. COPE ID # 9210-AS.
- Intracorneal Rings for Keratoconus (1 hr CE), Annual Meeting of the American Academy of Optometry, San Diego, CA, December 15, 2002. COPE ID # 80011-CL.