UK Keratoconus Self-Help and Support Association

Dear all
I am 35 years old; I am about to get my doctor degree in engineering.
I had been diagnosed with KC since three years by now. But I am still using glasses my vision is getting worst and worst and that worry me a lot since my eyes is my main tool for work. At the moment my right eye is 5/10 while my left eye is 8/10 (with glasses). I went to an eye doctor he recommend to use hard contact lens for better vision. I can see 9/10 on my right eye now, but my left eye is not improved much by the contact lens (still 8/10). is that normal?
Frankly speaking I do not like the method in which my doctor selects a suitable contact lens for me. Because, he just try a number of lenses he already had in stock one by one until he finds the one which fits me best. Is that the right way to do it? What about the exact shape of my cornea?
I asked him to fit me with the best lens available, but I am not sure if he is using Rose K lens or not.

I hope some body help me to answer these open questions.
By the way I am living in Germany and can not speak a single word in German, so it is very difficult to find a good doctor form me here.
Yours
A. farag

Hello AO Farag

congratulations on the completion of your PhD. Academic success apart, this is a hard time for you, but be assured the future is not as bleak as you may fear.

In my case there were two stages to the fitting of lenses. The first was the measurement of the cones on my eyes (I have had more severe KC in my right eye, but both eyes were fairly bad).

The measurement seemed only to give the optometrist a "ball park" in which to work. From there it was down to trial and error. In answer to your question, yes I think this is probably fairly normal when fitting coned eyes.

With your vision registering 9/10 and 8/10 you seem to be enjoying fairly good correction with RGP lenses. In time, if this changes, you may be considered for different sorts of lens, lots of which are used by people who visit this site.

Many, perhaps most KC patients seem to live their lives with relatively little trouble, their condition comfortably corrected by contact lenses of one sort or another. For the minority there is the option of surgery, sometimes seen as a last recourse, sometimes considered far earlier. I am not sure what are the clinical indicators for early as opposed to late grafting, but I am certain that somebody else here will know.

As to your problem with the German language; I sympathise. I studied in Salzburg and while I did have some German when I went, I discovered that German as spoken in Salzburg is quite unlike the language as spoken anywhere else in the world!

Every good wish

Andrew MacLean

Hi Andrew MacLean

I want to thank you very much for your replay, I really
appreciate that.

I wish you the best
yours
A. Farag

I am 35 years old; I am about to get my doctor degree in engineering.

Well done on getting your degree. And good luck grappling with the German.

I went to an eye doctor he recommend to use hard contact lens for better vision. I can see 9/10 on my right eye now, but my left eye is not improved much by the contact lens (still 8/10). is that normal?

Unfortunately, yes. It is not always possible to correct the vision up to "full vision". For some people, the best vision that can be achieved is well short of 20/20.

Frankly speaking I do not like the method in which my doctor selects a suitable contact lens for me. Because, he just try a number of lenses he already had in stock one by one until he finds the one which fits me best. Is that the right way to do it? What about the exact shape of my cornea?

There are two reasons for doing this. Mine are fitted from a standard fitting set - the lens fitter looks at my eyes, and judges that it is "approximately size 7" (for example). So
he'll try a 7, and then maybe either a 6 or an 8 to see if those feel/look better. Sometimes, the exact shape of one's eye might suggest "size 7" but in fact a size 6 feels better to the wearer, or gives better vision. It's a balance between "theory" and what actually feels best to the person. And unfortunately,
biology tends to be less "exact" than engineering!

The other reason is the nature of the materials. When I first started wearing contact lenses, they were made out of a plastic called PMMA (this is the abbreviation for its chemical name; the same plastic was sold under the marque "Perspex"). And I had my eyeballs moulded - yes, really!! The fitting person put a thing like a contact lens with airholes and a long stalk from the centre (like a little funnel) in my eye, pumped a moulding
substance down the stalk, waited two minutes, then removed it all just like a big lens, and there was a mould of my eyeball. I
have to say, I was glad this did not have to be done often!

The contact lenses were made form this mould. But - that was fine in those days, because PMMA moulds well, and also it is
smooth (at a microscopic level) so could be fitted quite close to the surface of the eye, so moulding worked well. The disadvantage was that PMMA was airtight - so to get air to the
surface of the eye so it could breathe, the lenses needed air holes - or slits - or "channels" - to get air in and tears out.

These days, most lenses are made of a gas permeable polymer, which, as you'll have guessed, is porous enough to let the air
in to the eyeball without the holes, slits, etc. Many people find lenses made of this substance more comfortable. However,
it does not mould well - hence the use of sets of "standard sizes" to find the nearest, as making moulds of the eyeballs and trying to mould lenses from these doesn't work so well. But also - the fit has to be slightly different. Because it is microporous, the gas permeable polymer has a "rough" surface (at a microscopic level) so it is better if it fits slightly further from the surface of the eye, with a thicker layer of tears between the lens and the eyeball. Which means moulding a lens
that perfectly matches the shape of your eye isn't what you want anyway, or it would fit too "tight" and probably be less
comfortable. So the aim is to find the best shape that is close to the shape of your eye but leaves space for a layer of tears.

At least, that's the way my lenses are fitted now. (Of course, I don't *know* exactly what your doctor is doing and why.)

I hope this makes sense and that you can get some lenses that work well for you.

Rosemary

Dear Rosemary F. Johnson

thank you very much for your very useful information

yours sincerely
A. O. Farag