Keratoconus and other abnormally shaped corneas are very challenging, time,
and material intensive,
as you know. I am enclosing some articles I’ve written on the subject of Keratoconus and Ortho-K in
Conacto July and November 1995, Contact Lens Forum, July 1990, and Contact Lens Spectrum October
1999 on some of these 350 cases I’ve researched thanks to many of your unselfish referrals you’ve
entrusted to me. Many of you who know me know I believe in this non-traditional treatment because
many of these cases have rehabilitated by proof of the before and after topography, corneal changes
on biomicroscope, and improved aided and unaided visual acuity.
This unfortunately involves several changes in aspheric R.G.P. lenses, counseling the patient to focus on balance in their whole body, and extra expense to the patient to cover for the six months of care. Since most of you know I’m not politically correct in established Keratoconus circles, I believe performance and results are the bottom line.
Only 1% of these cases needed a corneal transplant. I would like to share with you why I believe in superior alignment with aspheric R.G.P. to help improve abnormal corneas like Keratoconus. In 1977 I was presented with my first Keratoconus case and fit it applying three point touch with very slight apical clearance. This was one day after I attended my first Bronstein Contact Lens Seminar. I had Dr. Leonard Bronstein check my fit with another well respected contact lens practitioner in Phoenix. The patient and both doctors confirmed it was a good fit. The patient had 20/25 best corrected sight through this spherical hard contact lens with very light and superficial central punctate staining and light 3:00-9:00 staining. It fit exactly like the other lens he was wearing, since he came to me to replace his one cracked hard lens. We could not obtain his records in Ohio so I was on my own.
Four weeks after this refit, Dr.Bronstein challenged me to fit this case with superior intermediate alignment using a Reynolds Corneascope to measure 75% of the corneal surface. My patient agreed to try this unique and controversial fitting technique. It was approximately + 1.75 diopters flatter than central k on our keratometer. When I first saw the lens on his cornea, I got very upset when I saw central bearing, superior alignment on the blink, and inferior clearance that was so dramatic every other blink a bubble of tear escaped through the bottom of the lens.
The patient smiled that day because this aspheric hard lens was very comfortable and his sight was 20/15-3. I had him come back the next day not believing this. His entrance B.V.A. with contacts was now 20/15 and no central corneal staining with 50% improvement in 3:00 to 9:00 staining. We later adjusted these contacts and refit +.50 flatter in B.C. to finish the case. The 3:00 and 9:00 staining had somehow disappeared. This patient is still wearing that lens, in R.G.P. today.
If any of you do not want to handle these cases and wish to refer them, it would be a privilege and a honor to co-manage your patient. All I can promise you is I will give them my experience, time, counseling and compassion.
Hope you have a healthy and prosperous New Year. May you always see the positive big picture.
Dr. Jeff Eger