Contact Lenses for Keratoconus
Understanding Keratoconus and Why You Need Specialized Contact Lenses
In keratoconus, your cornea gradually becomes thinner and weaker over time. Instead of maintaining its normal rounded dome shape, the cornea bulges outward into an irregular cone. This distortion causes light to scatter as it enters your eye rather than focusing properly on your retina.
The result is blurred and distorted vision that cannot be fully corrected with regular eyeglasses. You may notice images appear stretched, multiple ghost images, or increased sensitivity to light and glare.
Regular soft contact lenses are designed to drape over the front surface of your eye. When your cornea has an irregular cone shape, soft lenses simply conform to that abnormal curve. They cannot create the smooth optical surface needed to correct the distortion caused by keratoconus.
While soft lenses may feel comfortable, they typically provide poor vision quality for people with keratoconus. Specialty rigid or hybrid lenses are needed to vault over the irregular cornea and create a new refractive surface.
You may realize you need specialty lenses when your current contacts no longer provide clear vision even with updated prescriptions. Common warning signs include constantly changing prescriptions, difficulty seeing at night, halos around lights, and eyestrain or headaches.
- Your vision fluctuates throughout the day even with contacts in place
- You cannot achieve 20/20 vision with your current lenses or glasses
- Your contact lenses feel unstable or move excessively on your eye
- You experience increased light sensitivity and glare
Specialty contact lenses work by creating a smooth, regular front surface over your irregular cornea. The space between the back of the rigid lens and your cornea fills with tears, which neutralizes the corneal irregularity. The front surface of the lens then properly focuses light onto your retina.
This approach can improve vision that glasses and soft lenses cannot match. Many patients achieve significantly improved clarity and reduced distortion with the right specialty lens design.
Types of Contact Lenses Available for Keratoconus
Rigid gas permeable lenses have been the standard treatment for keratoconus for many years. These small, firm lenses rest on the central cornea and maintain their shape rather than conforming to the irregular surface. They allow oxygen to pass through to your cornea while providing excellent optical quality.
RGP lenses typically provide very sharp vision for keratoconus patients. However, they can take several weeks to adjust to and may feel uncomfortable initially, especially if your keratoconus is advanced with a steep corneal cone. Modern fits aim for apical clearance or appropriate alignment to reduce the risk of scarring from excessive pressure on the corneal apex.
Scleral lenses are larger diameter rigid lenses that vault completely over your cornea and rest on the white part of your eye called the sclera. They create a fluid reservoir between the lens and your cornea, providing high comfort for many wearers and stable vision throughout the day.
- They are less likely to fall out or become displaced during daily activities
- The fluid reservoir keeps your eye surface well hydrated
- Many patients find them comfortable early, though some need a brief adaptation period
- They work well even for advanced keratoconus with very irregular corneas
Common issues include fogging during the day and lens suction if the landing zone is too tight. These are typically resolved by adjusting the lens design or care routine. Modern scleral lenses may include toric or quadrant-specific haptic designs to optimize fit and stability.
Hybrid contact lenses have a rigid gas permeable center surrounded by a soft lens skirt. The rigid center provides the crisp optics needed to correct keratoconus, while the soft outer ring offers better initial comfort than traditional RGP lenses.
These lenses can be a good middle ground for patients who need the vision quality of rigid lenses but struggle with RGP comfort. However, they require careful fitting and may not work as well for very advanced or irregular keratoconus.
In a piggyback system, you wear a soft contact lens as a base layer and then place a rigid gas permeable lens on top of it. The soft lens acts as a cushion between your sensitive cornea and the rigid lens, improving comfort while still providing good vision correction.
We may recommend this approach if you cannot tolerate RGP lenses alone but need their optical benefits. The main drawbacks are the extra steps required for insertion and removal and a slightly higher risk of reduced oxygen reaching your cornea.
Specially designed soft lenses with custom parameters may work for patients with very mild keratoconus or early-stage disease. These are not regular soft contact lenses but rather custom-manufactured lenses with specific designs to address mild corneal irregularity.
If your keratoconus is minimal and relatively stable, custom soft lenses might provide adequate vision correction with maximum comfort. However, as keratoconus progresses, you will likely need to transition to rigid or scleral lenses for better vision quality.
Getting Fitted for Keratoconus Contact Lenses
Your first specialty lens fitting appointment will be longer than a standard contact lens exam, typically lasting one to two hours. We begin by thoroughly examining your eyes and reviewing your vision history. We then discuss which lens types are most appropriate for your specific corneal shape and visual needs.
During the visit, you may try on several diagnostic lenses while we evaluate how they fit on your eyes and how well you can see with them. This hands-on trial helps us determine the best starting point for your custom lens order.
We use advanced imaging technology called corneal topography to create a detailed map of your cornea's shape and curvature. This color-coded map shows us exactly where your cornea is steepest, flattest, and most irregular. The measurements are essential for designing lenses that match your unique eye shape. We may also perform corneal tomography with Scheimpflug or OCT imaging to evaluate the back surface of the cornea and detect early ectatic changes.
- Corneal topography captures thousands of measurement points across your cornea
- We measure corneal thickness to assess keratoconus severity and monitor progression
- We evaluate your tear film quality to ensure adequate lubrication for lens wear
- We assess your overall eye health to rule out other conditions
- We may ask you to leave your contact lenses out for a period before imaging to reduce lens-induced corneal warpage and improve measurement accuracy
Choosing the optimal lens involves considering many factors including the severity and location of your corneal cone, your comfort tolerance, your lifestyle needs, and your manual dexterity for lens handling. We also consider whether your keratoconus is stable or still progressing.
For example, we might recommend scleral lenses if you have advanced keratoconus with a very steep cone, or hybrid lenses if your keratoconus is moderate and you prioritize initial comfort. Our goal is to find the lens that provides the best balance of vision, comfort, and eye health for your individual situation.
After we order your custom lenses, you will return for a dispensing visit where we teach you how to insert, remove, and care for your new lenses. You will then wear the lenses for a trial period, usually one to two weeks, so we can evaluate their performance in real-world conditions.
We schedule follow-up visits to check how the lenses are fitting and whether any adjustments are needed. It is common to modify lens parameters such as diameter, curvature, or power several times before achieving the optimal fit. This fine-tuning process ensures both excellent vision and healthy long-term lens wear.
Caring for Your Keratoconus Contact Lenses
We will teach you proper insertion and removal techniques during your dispensing visit. For scleral lenses, you typically fill the lens bowl with sterile saline and apply the lens using a small plunger. For RGP lenses, you place them directly on your eye using your fingertip or a specialized inserter.
- Always wash and dry your hands thoroughly before handling your lenses
- Use only recommended solutions and never use tap water on your lenses
- Work over a clean towel or soft surface to prevent lens damage if dropped
- Check that each lens is clean, moist, and free of cracks before inserting it
- For scleral lenses, fill the lens bowl with preservative-free sterile saline from single-use vials and avoid creating bubbles
- Do not use multipurpose solution or tap water to fill the bowl of a scleral lens
- Clean your inserter and remover plungers daily with approved solution, rinse with preservative-free saline, and air-dry. Replace plungers regularly
- To remove a scleral lens, gently break suction by allowing air under the lens edge before lifting the lens off the eye
Use only an approved GP or peroxide-based disinfecting system; saline does not disinfect. Each evening when you remove your lenses, you must clean them properly to remove protein, lipids, and debris. Place a few drops of your prescribed cleaner on each lens, gently rub both sides with your fingertip for 20 seconds, then rinse thoroughly with the recommended solution.
If using a hydrogen peroxide system, ensure full neutralization before lens insertion. Never put unneutralized peroxide directly in your eye.
After cleaning, store your lenses in fresh disinfecting solution in their designated case overnight. Never reuse old solution or top off your case. Replace your lens case every one to three months to prevent bacterial contamination. Do not rinse lenses or cases with tap water; clean the case with approved solution and allow it to air-dry face down.
- Rinse lenses with preservative-free sterile saline after disinfection and before insertion, especially for scleral lenses
- If your lenses have a surface coating, use only compatible cleaners and avoid alcohol-based or abrasive products
- Do not store lenses in saline; always store in fresh disinfecting solution
Most specialty contact lenses for keratoconus are designed for daily wear only, meaning you should remove them each night before sleeping. Typical wearing time ranges from 10 to 14 hours per day, though your individual tolerance may vary. Increase wearing time gradually during your first week as directed to avoid overuse.
Remove your lenses immediately if you experience pain, excessive redness, sudden vision changes, or unusual discharge. Also take them out during activities where they could be dislodged or contaminated, such as swimming or showering, unless we specifically advise otherwise. For scleral lens fogging, remove the lens, rinse, and refill with fresh preservative-free saline before reinserting.
Store your lenses in their case filled with fresh solution whenever they are not on your eyes. Keep your lens case clean and dry between uses and store it in a cool, dry location away from bathroom humidity. Do not rinse or store your case with tap water.
Rigid gas permeable and scleral lenses typically last one to two years with proper care, though this varies based on lens material and how well they are maintained. Plan for replacement roughly every 12 to 24 months or sooner if you notice scratches, warpage, reduced wettability, or if your corneal shape changes. We will let you know when your lenses need replacement based on their condition and any changes in your prescription or corneal shape.
Ongoing Care and When to Contact Our Office
Once your lenses are properly fitted, we will schedule periodic exams to monitor both your lens fit and your overall eye health. Initially, you may need visits every three to six months. If your keratoconus is stable and your lenses are performing well, we may extend visits to once per year.
During these appointments, we evaluate whether your lenses are still fitting correctly, check for any signs of corneal stress or complications, and assess whether your keratoconus is progressing. We also verify that your vision remains optimal and update your lens prescription if needed. We also look for signs of conjunctival blanching, corneal edema, or epithelial disruption that can occur with an ill-fitting lens.
Contact our office if your vision becomes blurry or unstable even when your lenses are properly cleaned and inserted. This may indicate that your lens prescription has changed or that your corneal shape has progressed. We can determine whether you need new lenses or just parameter adjustments.
- Your lenses feel less comfortable than they used to
- You notice excessive movement or poor lens centration on your eye
- Your lenses develop scratches, deposits, or warping
- You need to use rewetting drops much more frequently than before
- You experience persistent midday fogging that requires frequent removal and refill
- You notice ring impressions on the white of your eye after lens removal or visible vessel blanching while the lens is on
Seek immediate care if you develop sudden severe eye pain, significant vision loss, intense light sensitivity, or heavy discharge. These symptoms could indicate a serious infection or corneal abrasion that requires prompt treatment.
Also contact us urgently if your eye becomes very red and remains that way after removing your lenses, or if you see any white or colored spots on your cornea. Early intervention for these issues can prevent serious complications and protect your vision.
- A painful red eye after sleeping in your lenses
- Accidental exposure of your eye to unneutralized hydrogen peroxide solution
If your keratoconus continues to worsen despite wearing specialty lenses, we may discuss additional treatment options. Corneal cross-linking is a procedure that can strengthen your cornea and slow or stop keratoconus progression, and as of 2025, it remains an important intervention for progressive disease. Corneal cross-linking aims to halt or slow progression; it does not typically improve vision, so most people still need glasses or contact lenses afterward. Avoid eye rubbing and manage allergies aggressively, as these behaviors can worsen keratoconus.
In cases where contact lenses no longer provide adequate vision or become intolerable, surgical options such as specialized corneal transplant procedures may be considered. Intracorneal ring segments may improve lens tolerance or reduce irregularity but are not a substitute for cross-linking when progression is documented. We will work with you to explore all available options and refer you to a corneal specialist if needed.
Frequently Asked Questions
Adaptation time varies depending on the lens type and your individual sensitivity. Scleral lenses often feel comfortable within a few days, while rigid gas permeable lenses may take two to four weeks for full adaptation. Your brain also needs time to adjust to the improved but different visual quality, which can take several weeks even after the lenses feel physically comfortable.
Many vision and medical insurance plans provide at least partial coverage for medically necessary contact lenses for keratoconus, since this is a disease condition rather than simple refractive error. Coverage varies widely by plan, so we recommend checking your specific benefits. Our office can provide documentation and billing codes to help you maximize your insurance benefits.
We generally do not recommend alternating between specialty lenses and regular soft contacts. Doing so can cause inconsistent vision and may affect how your specialty lenses fit. If you have very mild keratoconus and custom soft lenses work adequately, you might wear those regularly, but switching back and forth between different lens types is usually not advisable.
If we cannot achieve functional vision with contact lenses alone, we explore other options based on your specific situation. Sometimes combining lenses with glasses worn over them can provide additional correction. In more advanced cases, we may discuss surgical interventions such as intracorneal ring segments or corneal transplantation with a specialist.
Yes, you should always have backup glasses available. You will need them for times when you cannot wear your contact lenses, such as during eye infections, when your eyes need a rest, or first thing in the morning and before bed. While your glasses may not provide vision as sharp as your specialty lenses provide, they serve as an important backup option.
No. These lenses are prescribed for daily wear only. Sleeping in lenses increases the risk of infection and complications.
Fill the lens with preservative-free sterile saline from single-use vials. Use only the disinfecting solutions we recommend for cleaning and soaking. Do not use saline for disinfection and do not use tap water at any step.
With proper care, most rigid and scleral lenses last 12 to 24 months. Replace sooner if you notice scratches, warpage, poor wetting, or if your prescription or corneal shape changes.
Getting Help for Contact Lenses for Keratoconus
If you have been diagnosed with keratoconus or suspect your corneas are changing shape, we can evaluate your eyes and determine whether specialty contact lenses are right for you. Our eye doctor has experience fitting complex lenses and will work with you to find the best solution for your vision needs and lifestyle.