Soft Lenses - For Keratoconus - Kerasoft and Soflex

[jayuk]

Answering Carols question, relating to Soft Lenses, in particular Kerasoft....I thought Id just comment a bit on this from my experience

I have found one thing in common when talking about soft lenses and KC. There are not many Opticians that evaluate them!....Additionally I have found that its "Practice" or "Eye Unit" specific.

If you mention soft lenses for KC at MEH you kinda of get a knockback and a "they dont work" kind of response. However, here and now, with the two lenses mentioned below, this cannot be further from the truth! THEY DO WORK. Its all dependent on the severity of the KC.....

We now have Soft Lens options for mild / Moderate KC which give the SAME if not better vision and clearly outperforms on comfort levels against a hard lens!

The two lenses that I have had experience with are

Soflex - Made by an Israeli Firm and distributed in the UK via Cantor and Nissel..

Soflex Lens Information - http://www.soflexcontacts.com/eng/index.php#

Cantor and Nissell - http://www.cantor-nissel.co.uk/

Kerasoft - Durawave
http://www.ultravision.co.uk/bfora/syst ... ail.xsl/43

The Kerasoft Durawave is quite an interesting soft lens and is made for mild/moderate and also Post Graft corneas.....its just been released by Ultravision .....

The Soflex has a better oxygen transfer rate due to its design (small holes made in the lens to allow for increased tear and oxygen uptake, and above all its material)

In due course, I shall be giving both of these a try in my grafted eye, probably more so the Kerasoft Durawave due to the technology and its purpose and how it would suit a Post Graft eye.

There worth pursuing; and if you cant get them through the usual route, get hold of a Optician (who is "aware" of KC and fitting) and get them to order a trial set from Cantor or Ultravsion. Its a small cost in trying them; but in all honesty that cost is nothing compared against the comfort and potentially equal vision obtained from the lenses.....

Hope that helps

If Ali or anyone would/could give an insight into there real world experience on these lenses that would be fantastic!....Clearly I understand you cant push a lens, but maybe comment on your general experience with Softlenses?....

I personally think that this is an option many could benefit from and the reason why its not explored is because of old ways and people not evaluating other lenses..kinda like...."well this works so I dont see why I should change it" approach..whilst not appreciating the day to day discomforts we as Patients go through....

[Sweet]

Hey you! Have been wondering how the lens situation was with your grafted eye!

I think that it would be a good idea to try as many lenses as you can to find one that suits you. Everyone is different, and what suits one person may not suit someone else. I don't think we can be accused of pushing lenses here if we have KC and talk about them from experience. If it wasn't for reading about piggy backing lenses i wouldn't have tried it, so posts from others and their experiences really helps!

I can't talk about soft lenses on their own, as i use a plain one with my RGP on top, but i can say that it is a very easy lens to put in and out, and that it is very comfortable to wear. It would be nice if i could wear one alone though, but it's not hard to wear two. In fact i think the soft lens keeps the RGP in place better. They do get a little blurry at times, and i need to take the RGP out and rinse it, but i think a lot of people do that with their lenses anyway, so it isn't a problem.

Let us know how you get on with a lens as am very interested now i've got to three months!! Best of luck!

Sweet X x X

[Carol Vines]

thanks jayuk for this information and the links, found it very interesting, i know my optician i have at the moment will only fit rgp's; he's very good but i still have the normal KC discomfort, my right eye at the moment is very sore and i'm trying not to blink, so other options always worth trying.

as sweet says using this forum to put our personal experiences with different lenses on here is a way of sharing with each other

[Sallyuk]

Hi all!

I have soft lenses - not sure exactly which variety though . Although I say lenses I actually mean one right one! (The left one I only got last week and it does not fit comfortably so it will have to go back). I have had the right one for about a month and it does make vision so much better, although there is still some ghosting. It is sooooo comfortable in comparison with the hard lenses. Putting it in and taking it out are easy. There are only a couple of problems I have come across: - firstly because it has been bevelled at the edge to suit my eye it is very thin and this causes a problem if it inadvertently gets turned inside out - it is then almost impossible to work out which is the correct side! Secondly with the cold spell everyone has their heating on and this seems to dry the lens out very quickly which resulted, the other day, in the lens just popping out - I was unaware they could do that and so was unprepared! Thirdly driving at night I am getting even more glaring from lights mainly dragging to the left, is this normal?
On the whole I feel that they are a good solution and hopefully soon I will have a pair that give me reasonable vision.

Hope this is useful to someone out there.

Sally

[Lisa Nixon]

Kerasoft lenses have served me well for several years now - it was like going from wearing a tight pair of stilletto shoes to a pair of comfy slippers. You may get more clarity with a hard lens, but exchanging a line on the chart for comfort was well worth it. Unfotunately my KC has got to the graft stage, but kerasoft have given me a good 4 years of manageable wear - wear time 10+ hours per day. Hope this helps. tubs

[GarethB]

I am not on the soft lenses for KC, but for me tinted RGP corneals stop the glare problem unless light is at such an angle it gets the edge of the lens. Non-tinted lenses make this far worse.

Are the Kerasoft lenses tinted at all?

Regards

Gareth

[Lynn White]

Soft lenses for KC.. well this tends to be a bit of a controversial subject!

The reason why it is thought they cannot work as well as a rigid lens is for the simple reason they tend to mould to the eye's shape whereas a rigid gas permaeable holds its own shape, as does a scleral. So if the lens moulds to the keratoconic shape.. how can it work?

For a start, KC soft lenses are thicker than "normal" softs - it is perfectly true that a standard disposable will just follow the contours of the cornea, but the thicker designs of KC softs do tend to hold their shapes better.

However, this thicker design can often be a problem because not as much oxygen is transmitted through them as thinner softs and this CAN be a real difficulty. Also, RGP's tend on the whole to give better acuity merely because they do not conform to the corneal shape. So why use softs at all..??

Well, as can be seen on these boards... comfort is a massive issue. Many people simply cannot tolerate an RGP because a KC eye is more sensitive than a "normal" eye - which is a really frustrating factor in KC! Softs also have another advantage is that they mould the cornea more gently than RGP's, so in early cases, it is easier to swap between contacts and specs.

I have extensive experience fitting with soft lenses of varying manufacturors and some have been spectacularly successful while other cases just have not worked at all. Like anything else, it depends on the individual eye.

At the moment I would say that soft lenses have not got quite there yet... you need a high oxygen tranmissable material that is stiffer than normal soft materials and has good reproducability and gives good crisp vision. All of the lenses Jay mentioned have some of those attributes but not one lens has all of them at the moment.

Now having said ALL of that, I still think softs are under used in KC. They are very useful in early KC, useful for piggy-backing (for those that don't know what that means.. you place your rgp on top of a simple soft lens - makes it more comfortable) and can be used to great effect even in advanced KC and post graft. They are certainly worth a go!

Lynn

[Sweet]

Lynn nice to see you posting again, have missed your replies!

Just wanted to say that i find piggy backing SO much better than wearing my RGP on it's own. I suffered for years with a painful red eye from wearing a lens despite having it refitted many times. After reading about using a soft lens underneath from members here i asked at my appointment in Moorfields if i could give it a try, and am pleased to say that things are much better.

As with most who have tried this, the wearing time is longer and much more comfortable, so i would say to those who have run out of ideas and are still in pain, to give it a go! Your hard lens actually sits really well on a soft one, and it is easy to take it out without disturbing the soft lens underneath. You really don't need to worry about having them sticking together or affecting each other, which i did wonder about, as they work really well together. The only problem i sometimes get is it being cloudy at times, and i need to take the RGP out and rinse it, but then i had to do that before when i didn't wear a soft lens underneath, so it is no real issue.

If you have never seen a soft lens before, it is not so difficult to get used to, although nothing like a hard lens. Hehe, reminds me of the jellied centre of a jaffa cake!! But hey, i might just have chocolate on the brain!!

Take care ... Sweet X x X

[jayuk]

Lynn

I am glad you posted as I am aware that yourself and also Ali have experience in fitting Soft Lenses with success; and kind of prove that the old way of thinking "soft lenses dont work" is not so true anymore

It would be amazing to see how many people with Mild/Moderate could be fitted with these lenses and gain equaly good vision and increase comfort 10 fold!

J

[Ali Akay]

Jay
As Lynn says soft lenses and KC is a controversial subject.All I can say is that I've been using soft lenses of various designs routinely for a number of years at all stages of KC except the very extreme. If they didnt work I wouldnt waste my time on them! I can honestly say I've had several patients who were able to postpone corneal grafts by virtue of these lenses (one just a day before surgery!).

I agree with everything Lynn said on the subject and would like to add that, in my opinion, their relatively low usage in UK is due to the following factors:
1.As you said practitioners feel more comfortable using the "tried and tested" products rather than experimenting with new products. As conventional wisdom dictates that soft lenses shouldnt work in KC the incentive to try them is not very high.
2.Unlike fitting conventional soft lenses which is largely deskilled nowadays, soft keratoconus fitting can be very time consuming as the fit is often very critical. In a busy hospital clinic it probably is much easier to pop in some good old RGPs than spending a lot of chair time trying to get soft lenses work. It's also possible that some practitioners give it a try and find that they cant get a good result straightaway and give up. There is definitely a learning curve.
3. Soft lens fitting is often more costly as the trial lenses can not be reused.
4.Not all soft lenses are the same! I've been fortunate to work closely with one of the labs involved in soft KC lenses and can say that it has been an evolution. The lenses we use now are better than the ones we had last year which were in turn a lot better than the ones 3-4 years ago.As Lynn says the challenge is designing a material stiff enough and with sufficient oxygen transmission.This brings us to the problem that a practitioner might have tried the lenses 3-4 years ago, not impressed with the result and not realising that things have moved on. Due to the constant evolution the manufacturers have been reluctant to market the product aggresively before they were happy with the end result and we were in a way using the "beta" versions which was still better than the other options on the market. They tell me that they think they've got it now and will start marketing their lenses more aggresively. Obviously I am not going to mention any names, but most hospital eye departments will apparently be receiving mailshots in the near future, so perhaps people interested could talk to their practitioners.
5.They dont work for every patient but this is also true for other lens types