Surgery may be necessary to correct a vision problem caused by keratoconus or some other cornea disorder. Around 1.3 million people in the US over age 40 are legally blind, and keratoconus can lead to legal blindness. If your vision has significantly worsened since adolescence and you have been diagnosed with keratoconus, cornea surgery may be recommended. Since both rigid gas permeable (RPG) and scleral contact lenses are often regularly-worn by people with keratoconus, understanding the capacity to resume your customary contact lens use following cornea surgery is important.
Described below is a common minimally-invasive cornea surgery performed in people with keratoconus, and the impact of this type of surgery on RPG or scleral contact lens utilization. The professionals at the Precision Keratoconus Center can enable you to understand whether your preferred type of contact lens can be worn before or following cornea surgery.
Corneal Cross-Linking – Statistics and Considerations
The thinning of the cornea that occurs in keratoconus negatively impacts eyesight. While wearing “hard” (RPG) contact lenses or scleral lenses can address the myopia and astigmatism that is typically experienced by keratoconus-afflicted people, it cannot correct changes to the cornea. By administering eye drops containing Riboflavin (Vitamin B2) in conjunction with a laser beam of UV-A light, the collagen fiber bonding in the cornea is strengthened in corneal cross-linking surgery.
Published findings in 2017 of a systematic review of the literature in BioMed Research International concluded that most studies revealed corneal cross-linking surgery as halting the progression of keratoconus for at least one year.
Your Cross-Linking Surgery Options
Corneal cross-linking is categorized as either “epithelium-on” or “epithelium-off” surgery, and can be combined with another minimally-invasive cornea surgery (such as the implantation of rings).
According to an article in 2018 in Contact Lens Spectrum – if “epithelium-on” cross-linking was performed – contact lens wear can resume as early as one month following the surgical procedure. However, this article reports that corneal ectasia progression is higher in keratoconus patients who experienced “epithelium-on” surgery as compared to those who experienced “epithelium-off” surgery.
The use of scleral contact lenses following cross-linking is particularly recommended in this article (as scleral lenses do not place stress on the cornea, so can be utilized sooner following cross-linking than other contact lenses).
If you do not need corneal cross-linking, scleral contact lenses are less likely to increase eye pain experienced as a result of keratoconus than other types of contact lenses.
Comparing Post-Surgery Satisfaction with Scleral Lenses to Other Contact Lenses
Corneal cross-linking with “epithelium-off” requires a longer recuperation period, and can preclude the comfortable wearing of contact lenses other than scleral lenses. According to an article in 2016 in the Review of Cornea and Contact Lenses, the following are three advantages of choosing to wear scleral contact lenses after undergoing cross-linking surgery:
- Minimal mechanical interaction with the treated zone;
- Helps promote ocular healing;
- Other optical benefits
Why Post-Surgical Cornea Healing is Crucial to Safe Contact Lens Wear
The Kellogg Eye Center of Michigan Medicine notes the following as risks associated with “epithelium-off” cross-linking surgery:
- Corneal epithelium (epithelial surface cell) defect;
- Epithelial haze;
- Delayed epithelial healing;
- Ulcerative keratitis
In order not to interfere with the post-surgery healing of the cornea, it is critical not to resume wearing any type of contact lens until permitted by your ophthalmologist. Indeed, full surgical healing is imperative before wearing contact lenses, so that your surgically-involved eye will not be adversely affected by a foreign object (contact lens) placed in it.
Following cornea surgery, consider a consultation with a professional at the Precision Keratoconus Center to determine whether wearing traditional RPG or scleral lenses can improve your vision.