Contact lens management of keratoconus

Abstract

Contact lenses are the primary form of visual correction for patients with keratoconus. Contemporary advances in contact lens designs and materials have significantly expanded the available fitting options for patients with corneal ectasia. Furthermore, imaging technology, such as corneal topography and anterior segment optical coherence tomography, can be applied to both gain insight into corneal microstructural changes and to guide contact lens fitting. This paper provides a comprehensive review of the range of contact lens modalities, including soft lenses, hybrid designs, rigid lenses, piggyback configurations, corneo‐scleral, mini‐scleral and scleral lenses that are currently available for the optical management of keratoconus. The review also discusses the importance of monitoring for disease progression in patients with keratoconus, in particular children, who tend to undergo more rapid progressive changes, so as to facilitate appropriate modification to contact lens fitting and/or potential referral for corneal collagen cross‐linking treatment, as appropriate.

Key words:

• corneal ectasia
• corneal topography
• contact lens
• hybrid
• keratoconus
• mini‐scleral
• optical coherence tomography
• piggyback
• rigid lens
• scleral

Acknowledgements

Dr Laura Downie is an investigator for industry‐sponsored dry eye clinical trials (Allergan Pty Ltd), a recipient of an unrestricted research grant (CooperVision Pty Ltd) and has received research laboratory infrastructure support (Medmont Pty Ltd).

Notes

1. With regard to rigid lenses, for the purpose of this paper, the authors will adopt the convention proposed by Efron,2010 in that ‘rigid lenses’ will refer to all lenses made from rigid gas‐permeable materials. The term ‘rigid gas‐permeable’ (RGP) will not be used because the adjective ‘gas‐permeable’ is effectively redundant, as virtually all rigid lenses today are manufactured from gas‐permeable materials.