Keratoconus and contact lenses
Keratoconus is an eye condition in which the cornea, the clear dome at the front of the eye, gradually thins and bulges forward into a cone shape. The irregular surface distorts vision in a way that glasses often cannot fully correct. For most people with keratoconus, specialist contact lenses give the clearest vision.
The cornea thins and bulges into a cone. Specialist contact lenses usually give the clearest vision.
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Specialist fitting at our Middleton practice, 36 Long Street. Ask at any of our five practices and we book you in.
A thinning of the cornea that changes its shape.
The cornea is normally a smooth, evenly curved dome. In keratoconus it becomes thinner and weaker, and the pressure inside the eye pushes it forward into a cone. It is not an infection and not caused by inflammation.
Who it affects
It usually starts in the teens or early twenties and can progress into the thirties before it slows down. It almost always affects both eyes, often one more than the other.
Why it happens
The exact cause is not known. It is linked to eye rubbing, allergic eye disease, asthma and eczema. About 1 in 10 people with keratoconus has a close relative with it, and it is more common in some ethnic groups, including people of South Asian heritage.
How it is found
An optometrist may notice a prescription that keeps changing or astigmatism that is hard to correct. Corneal topography confirms it by mapping the steepening, often before vision is badly affected.
What it does to your sight. The cone creates irregular astigmatism and increasing short sight. Vision becomes blurred and distorted, letters can have shadows or double edges, lights glare and halo at night, and glasses need changing more often. In more advanced keratoconus the cornea can scar.
Two separate goals. Treatment has two jobs. The first is to stop the cornea changing: corneal cross-linking, done at the hospital, strengthens the cornea. The second is to see clearly: glasses in the early stages, then specialist contact lenses. Only a small number of people ever need a corneal transplant. Our clinic does the second job, and works alongside your hospital for the first.
The type and stage of the cone decide the lens.
| Cone | What it looks like on the map | What usually works |
|---|---|---|
| Nipple cone | Small and steep, near the centre | Often a corneal RGP lens; a mini scleral if comfort is poor |
| Oval cone | Larger, sitting lower on the cornea | Larger RGP designs or a mini scleral, which stays steady |
| Globus cone | Covers most of the cornea | Usually a scleral or mini scleral lens that vaults the whole cornea |
| Stage | Typical vision | Typical lens |
|---|---|---|
| Early | Glasses still work reasonably well | Glasses, or a specialist soft toric lens |
| Moderate | Glasses no longer give clear vision | Corneal RGP or mini scleral |
| Advanced, or after a graft | Strongly irregular cornea | Scleral or mini scleral, sometimes a hybrid lens |
These are starting points, not rules. Your map, your comfort and what you need to see decide the final lens.
Lenses give the vision. They don’t stop the cone.
One question: what is the best vision your eye can have?
Every specialist fitting starts with a map of your cornea from our SBM Sistemi corneal topographer: the shape of the front of the eye, point by point. The lens is designed from that map, then checked on the eye at the slit lamp.
Find your best vision
We measure what you see now, then what you see through a trial lens. The difference tells us what is possible.
Choose the lens family
Soft, corneal RGP, mini scleral, scleral or hybrid, chosen from the map and your history, not by habit.
Check the eye is healthy
Corneal thickness, scarring and the surface of the eye, so the lens is safe to wear all day.
You leave knowing which lens we recommend, why, how many visits it should take, and the total cost. Nothing is ordered until you agree.
From first visit to all-day wear.
- Tell us your story
What you struggle to see, what you have tried, hospital letters and old lenses if you have them.
- Map the cornea
SBM Sistemi topography, the cone’s type and position, and a slit-lamp check of corneal health.
- Trial lenses
Lenses chosen from the map are tried on the eye; we check the fit, the clearance and your vision.
- Order your lens
Made to measure for your eye, once you have agreed the design and the price.
- Collection and teaching
Putting it in, taking it out, cleaning, and filling it if it is a scleral lens.
- Refine
Small changes to the design until vision and comfort are right. Complex fits often take three to five visits.
- Review and re-map
Regular reviews with a new corneal map, so any change in the cone is caught early.
From simplest to most specialist.
Specialist soft lenses
For early keratoconus where a soft toric design still gives good vision.
Corneal RGP
Small rigid lenses with very sharp optics. Often the first choice for nipple cones.
Mini scleral and scleral
Large lenses that vault over the cornea on a layer of saline. Steady and comfortable on oval and globus cones, and after a graft.
We start with the simplest lens that can give you clear, comfortable vision, and only move up if it can’t.
Three patients, shared with their permission.
Ortho-K beyond the usual range
The problem. He was short-sighted at about -9.00 and had been told Ortho-K could not correct him, because his prescription was beyond the range it is normally used for.
What we did. We mapped his corneas and designed a two-stage plan. A first custom Ortho-K lens reduced his prescription from about -9.00 to -5.00. Once that was stable, a second design took him from -5.00 to plano.
The result. His eyes took about three weeks to adapt. He now sees clearly all day without glasses or daytime lenses, and he is very happy with the result.
A larger pupil after an injury
The problem. An injury to one eye had left that pupil much larger than the other. The difference was noticeable, and they found us online looking for a hand-painted lens.
What we did. We designed a custom hand-painted soft lens, replaced once a year. The painted iris is matched to the colour of their own eye, with a pupil the same size as the other side.
The result. The pupils now look the same size and the eye looks natural. Nobody can tell they are wearing a lens.
Matching eyes for a wedding day
The problem. A medical condition had changed the colour of one iris, and she was getting married.
What we did. We designed a custom hand-painted mini scleral lens, matched to the colour of her other eye. It was made for appearance rather than to correct her sight.
The result. Her eyes matched again, on her wedding day and since.
The fitting and the lens, kept separate.
| Specialist assessment and fitting (keratoconus, irregular cornea, scleral, mini scleral, RGP) | £200 |
| Scleral and mini scleral lenses | From £1,800 a pair |
| Corneal RGP and other custom lenses | Quoted for your lens design |
| Spreading the cost of scleral lenses | Flexible Direct Debit available; we explain the exact terms before you go ahead |
| Follow-up and aftercare | Part of the service; we confirm what is included before you go ahead |
The £200 is the clinical service. The lens cost is separate and depends on the design your eye needs. We explain the likely total before any custom lens is ordered, and you are never asked to choose an expensive lens before we know it is the right one. The aim is the least complicated lens that genuinely solves the problem.
Specialist fitting at Middleton. Ask at any practice.
Specialist keratoconus, scleral and complex contact lens fitting is done at our Middleton practice, 36 Long Street, Middleton M24 6UQ (Monday to Friday 9:00am to 5:30pm). Ring Middleton on 0161 653 0771, or ask at any of our practices and we book you in there.
Also: all contact lenses · Ortho-K · dry eye clinic
Keratoconus questions
What causes keratoconus?
The exact cause isn’t known. It runs in some families and is linked to eye rubbing and allergy. It usually starts in the teens or twenties.
Will contact lenses stop it getting worse?
No. Lenses correct the vision. Corneal cross-linking at the hospital is what stops progression. We map your cornea at each review and refer you if it is changing.
Which lens is best for keratoconus?
It depends on the type and stage of the cone. Small central cones often suit a corneal RGP; larger or lower cones and grafts often suit a mini scleral or scleral lens.
What happens at the first fitting?
We map your cornea with our SBM Sistemi topographer, check corneal health, try lenses on the eye and tell you which lens we recommend, why, how many visits and the total cost.
I couldn’t get on with RGP lenses. Can you still help?
Often, yes. A mini scleral lens doesn’t touch the cornea and many people who found RGP lenses uncomfortable wear one all day.
How much does it cost?
The specialist assessment and fitting is £200. Scleral and mini scleral lenses are from £1,800 a pair, with flexible Direct Debit. RGP lenses are quoted for the design.
Do I need a referral?
No. Ring our Middleton practice directly. Bring any hospital letters you have.
Do I still need hospital checks?
Yes, if your hospital wants to see you. Good vision through a lens doesn’t tell you the cone is stable.
Ready to see what your eye can do?
Ring our Middleton practice to book the specialist assessment. Bring your glasses, any old lenses and hospital letters.