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San Diego Keratoconus Clinic

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Eye doctors throughout San Diego and Southern California refer their keratoconus patients to the Keratoconus Clinic at EyeLux Optometry for specialist care. That’s why EyeLux Optometry serves as many keratoconus patients in a week as the typical practice serves in a year.

The Keratoconus Clinic at EyeLux Optometry is pleased to have the services of Dr. Brian Chou as Clinic Director. Dr. Chou is a nationally known for his treatment of keratoconus patients. He was fellowship trained at UCLA’s Jules Stein Eye Institute, Cornea External Disease Division, at which time he cared for the first two dozen keratoconus patients to have surgery with Intacs corneal rings in the United States. He is also an accomplished author and lecturer on keratoconus within the professional eye care community, having presented to more than 1,000 eye care professionals at national meetings.

EyeLux Optometry's keratoconus referral clinic uses state-of-the-art technology including corneal topography and external digital ocular photography. We have an extensive inventory of diagnostic contacts lenses allowing our doctors to prescribe whatever best matches your individual needs. Our clinic can successfully manage keratoconus without surgery in most cases.

Video and Audio Keratoconus Presentations

Please read the information below to learn more about keratoconus.

What is keratoconus?

Keratoconus is a disease where the cornea — the clear front of the eye — becomes progressively distorted. A normal cornea is spherical in shape, like a ball. Keratoconus causes the cornea to bulge forward, protruding into a cone shape. This shape distorts the rays of light passing through the cornea. The rays are unable to meet at a clear point of focus on the retina, resulting in blurry vision.

Nearsightedness and astigmatism are common with keratoconus, as are glare and light sensitivity. Keratoconus patients often require prescription changes each time they visit their eyecare practitioner, especially during progression of the disease.

When and in whom does keratoconus occur?

Often beginning in teens, keratoconus usually progresses into the 20s or 30s before stabilizing, although in severe cases it can continue to worsen. In these cases, the cornea continues to thin and bulge outward, creating even greater blurred vision. Scarring of the cornea can spontaneously develop.

More than 1 in 1,800 people have keratoconus, according to researchers. In ten percent of cases, patients report a family member who has keratoconus, but keratoconus has no race or gender correlation. Many keratoconus patients also suffer from hayfever, eczema and asthma.

Some researchers feel that eye rubbing may increase the progression of keratoconus. Although it hasn't been proven that eye rubbing exacerbates keratoconus, it is still a good idea to refrain from rubbing your eyes. Your eye doctor at EyeLux Optometry may prescribe eye drops to minimize eye itching symptoms.

What treatments are available for keratoconus?

In mild cases of keratoconus, eyeglasses and soft contact lenses can provide adequate vision. But in more advanced cases, most keratoconus patients will require custom-made GP contact lenses. It's essential to properly prescribe your custom contact lenses. This is critical not only for optimal vision, comfort, and eye health; but poor fitting lenses can increase the risk of corneal abrasions, scarring, and infection.

Surgery may be necessary in severe and advanced cases; published reports say that 10-20% of keratoconus patients get corneal transplants. If an examination reveals that you have significant scarring of the cornea, your doctor may recommend a corneal transplant. In this procedure, the scarred tissue is replaced with a section of donated cornea that is clear. Although most transplants are successful, most patients afterwards still need glasses, soft contacts, or GP lenses for adequate vision.

What kind of contact lenses can help someone with keratoconus?

Rigid gas permeable (GP) contact lenses are most commonly prescribed. They provide a smooth, artificial surface to mask the "peaks and valleys" of the keratoconic cornea, in turn providing the best vision. The keratoconus clinic at EyeLux Optometry uses a variety of lens designs, and the best contact lens for you will be determined following a complete evaluation.

Do I need a referral in order to visit the EyeLux Optometry keratoconus clinic?

No. Doctors from around the state of California refer keratoconus patients to the keratoconus clinic at EyeLux Optometry, but you may contact us directly. Your first step will be a complete eye examination and evaluation. Please tell our staff that you are a keratoconus patient when scheduling your first appointment.

Can I get LASIK if I have keratoconus?

LASIK and other laser eye surgeries are not appropriate for keratoconus patients due to an unacceptable risk of a poor outcome. The LASIK procedures removals corneal tissue, and because in keratoconus patients the cornea is already thin and weak, LASIK can irreversibly destabilize the cornea and accelerate its distortion.

What's new in keratoconus treatment?

The ClearKone hybrid contact lens, introduced by SynergEyes, Inc., in 2009, is one of the most significant new contact lens design for keratoconus. EyeLux Optometry's Dr. Chou was the first practitioner in San Diego to commercially prescribe ClearKone. ClearKone can demonstrably improve visual acuity and lens-wearing comfort for select keratoconus patients.  In 2013, a higher oxygen permeable version of this lens, SynergEyes UltraHealth, was introduced.  UltraHealth uses a soft skirt material called a silicone-hydrogel which permits greater oxygen supply to the eye.  EyeLux Optometry is one of the first practices in the U.S. to offer this lens treatment for selected cases of keratoconus.

Selected keratoconus patients may be candidates for large-diameter scleral contact lenses.  Scleral lenses are typically the size of a nickel to quarter.  These specialty lenses rest on the white part of the eye, or sclera, and trap a fluid cushion between the cornea and contact lens, providing a smooth, artificial front surface to bend light.  Most eye doctors do not prescribe scleral lenses.  While scleral lenses have existed for a while, only more recent technological advances have made these designs available in clinics that routinely manage irregular corneal conditions such as keratoconus.

EyeLux Optometry also prescribes special soft contact lenses for keratoconus including KeraSoft IC and NovaKone.  These lenses are thicker-than-normal lenses which help minimize the irregular eye surface of keratoconus.

Specialty contact lenses are the first-line treatment of choice for keratoconus, but for some patients surgery may be needed. A small number of keratoconus patients get corneal transplants, but this is a last resort. An alternative to transplants is Intacs® prescription inserts, also known as intrastromal corneal ring segment implantation. Intacs are generally an option when a wearer cannot tolerate GP lenses, but the keratoconus has not progressed to the point of needing a transplant. Glasses or contacts may still be needed after such a procedure; but soft contact lenses might provide acceptable vision in these circumstances, avoiding GP contact lenses.  Dr. Chou cared for the first dozen keratoconus patients that underwent Intacs® surgery in the United States during his fellowship at Jules Stein Eye Institute.

Collagen cross-linking is another new surgical procedure for treating progressive keratoconus. In this procedure, riboflavin and ultraviolet irradiation are used to strengthen the cornea. This is still an investigational procedure, but it's getting a lot of attention in the professional eye care community because of positive results in clinical trials.

We can advise you if any of these treatments are appropriate for your individual circumstances.

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Selected keratoconus publications by Dr. Chou:

  • Chou B. Treating keratoconus with contact lenses helps your patients and generates referrals. Review of Optometric Business. January 17, 2012.
  • Chou B. Keratoconus (Cataract and refractive surgery comanagement, Chapter 22). In: Ocular therapeutics handbook: A clinical manual, 3rd edition. Eds. Onofrey B, Skorin L, Holdeman N. Philadelphia: Wolters Kluwer Health, 2011:653-656.
  • Chou B., Weissman, B. Making Sense of the Irregular Cornea (cover article). Rev Cornea Contact Lenses. April, 2010: 14-21.
  • Chou B. Corneal irregularity and success with SynergEyes hybrid contact lenses (advertorial). Contact Lens Spectrum, September 2008: 36-37.
  • Chou B. Rigid optics with soft lens comfort: a look at how the technology behind SynergEyes lenses benefits both patients and practitioners. Contact Lens Spectrum, July 2006: 48-53.
  • Chou B. Does unilateral keratoconus exist? Rev Optom, March 2006: 65-66.
  • Chou B. Wavefront aberrometry for keratoconus. Rev Contact Lenses. September, 2005:28-29.
  • Chou B. Has keratoconus met its match? Rev Contact Lenses, February 2001:28-29.
  • Chou B, Boxer Wachler B. Intacs for keratoconus: a promising new option? Rev Optom, April 2000;137(4):97-98.

Selected keratoconus lectures by Dr. Chou

  • Contact Lenses for Keratoconus, San Diego Vision Symposium (National Keratoconus Foundation & The Discovery Eye Foundation), San Diego State University, San Diego, San Diego, CA, May 14, 2011.
  • Fitting Irregular Corneas with ClearKone, the Reverse Geometry Hybrid Contact Lens (1.5 hr workshop), San Diego Specialty Contact Lens Symposium, San Diego, CA Feb 12, 2011.
  • Soft Contact Lenses for Keratoconus (1 hr CE), San Diego Specialty Contact Lens Symposium, San Diego, CA, February 11, 2011. COPE ID #29945-CL.
  • Caring for the Gas Permeable Intolerant Kerataconus Patient (1 hr CE), ClearView Eye & Laser Medical Center, San Diego, CA, March 18, 2009. COPE ID #24507-AS.
  • Use of Intacs and Contact Lenses in the Management of Keratoconus (2 hr CE), Flowers & Suder Vision Institute, San Diego, CA, April 4, 2006.
  • Caring for the Gas Permeable Intolerant Keratoconus Patient (1 hr CE), Annual Meeting of the American Academy of Optometry, San Diego, CA, December 11, 2005. COPE ID #14667-CL.
  • Keratoconus – Current Diagnosis & Treatment (2 hrs CE), Arizona Optometric Association Annual Spring Congress, April 29, 2004. COPE ID # 9210-AS.
  • Intracorneal Rings for Keratoconus (1 hr CE), East West Eye Conference, Cleveland, Ohio, October 25, 2003. COPE ID # 80011-CL.
  • Keratoconus – Current Diagnosis & Treatment (2 hrs CE), San Diego County Optometric Society Meeting, San Diego, CA, August 21, 2003. COPE ID # 9210-AS.
  • Intracorneal Rings for Keratoconus (1 hr CE), Annual Meeting of the American Academy of Optometry, San Diego, CA, December 15, 2002. COPE ID # 80011-CL.

 

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