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keratoconus

Contact Lenses for the “Hard-to-Fit” Patient

Utilizing cutting edge technologies and techniques our eye doctors in North York, Toronto, design and fit Scleral Contact Lenses and other specialty contact lenses for hard to fit patients.

It is not uncommon for patients to have difficulty wearing contact lenses for a number of reasons. Due to the individual eye shape, certain conditions or impairments or the aftermath of surgery, some patients are considered to be “hard to fit” as contact lens wearers.

For hard to fit patients that prefer to wear contact lenses however, there are options available that can provide comfortable and effective contact lens wear. This will require a specialized fitting with an eye doctor that is an expert that knows your condition and the various products available to find the right match for your specific condition.  You may be considered a hard to fit contact lens candidate if you have one of the following conditions:

Dry Eyes

Astigmatism

Giant Papillary Conjunctivitis (GPC)

Keratoconus

Pellucid Marginal Degeneration

Complications from post-refractive surgeries including LASIK, PRK, RK, ALK, and CK and Intacs

Presbyopia (reduced near vision common in individuals aged 40 and over).

Corneal Scarring

Steven Johnson's Syndrome

Severe Dry Eye

Dry Eyes and Contact Lenses

Dry Eye Syndrome causes your eyes to feel dry, gritty, burning, red, and irritated.  Dry Eye Syndrome can also cause blurred vision. Often these symptoms can sometimes worsen by the use of contacts. In fact, many people who do not normally suffer from chronic dry eyes, will experience some of these symptoms as a result of contact lens wear.

First of all, if you have chronic dry eyes, you should see your eye doctor for treatment and relief before you think about contact lenses. Once your dry eyes are treated, it is safe to try contacts and there are a number of options that can be considered.

Many brands of soft contacts and products such as disinfectant and cleansing solutions are made with ingredients that are designed to be more comfortable for individuals with dry eyes. Your eye doctor will be able to recommend some of these brands and products to you. Alternatively, gas permeable (GP) or rigid gas permeable (RGP) lenses are made with a hard material that in some cases does not dry out like soft lenses and they are able to hold a certain amount of moisture beneath the lens to keep the eye from drying out. Gas permeable lenses are a very good option and can be quite comfortable for individuals with dry eyes.

Additionally, your doctor might recommend a specific wearing schedule such as limiting the time you wear your contacts throughout the day or replacing your contacts on a more frequent basis.

Toric Lenses for Astigmatism

Astigmatism is a condition that causes blurred vision (in some cases double vision) because rather than being round, the front of the eye (the cornea) has two curves instead of one, therefore, having two focal points instead of one. This makes it hard for traditional contact lenses to fit and therefore requires specialized contact lenses such as toric lenses or rigid gas permeable lenses (RGPs).

Toric contact lenses are designed to correct astigmatism and custom made to fit the eye of the patient. Most are made of soft material designed to stay in place on the eye, however in some cases, when the rotation of the lens (due to blinking and eye movement) can’t be stopped, gas permeable lenses might be tried. Due to the customization and more complicated fitting process required for these lenses, they are more expensive and take more time for the contact lens laboratory to make than traditional lenses.

Giant Papillary Conjunctivitis (GPC) and Contact Lenses

GPC is a type of conjunctivitis in which the inner surface of the eyelid becomes swollen.  The condition can be caused or worsened by a buildup of protein deposits on contact lenses.  Your eye doctor may either recommend daily disposable lenses or RGP lenses (which are not water-based) and therefore do not have a tendency for protein buildup.  Your doctor may also prescribe medicated eye drops and require you to stop the use of contact lenses until the symptoms improve.

Rigid Gas Permeable (RGP) or Gas Permeable (GP) Lenses

 

Rigid Gas Permeable (RGP) also known as Gas Permeable (GP) lenses are effective for many hard to fit patients.  The hard, oxygen permeable material lets the eye breathe and significantly reduces the chance of infection due to protein deposits which tend to harbor bacteria on soft lenses.  RGPs also hold moisture under the lens to keep eyes from drying out.

Rigid Gas Permeable (RGP) Lenses for Keratoconus

Keratoconus is a condition in which the cornea thins and bulges forward into a cone shape.  Traditional contact lenses may cause some discomfort in these patients and the vision may still be blurry therefore RGPs are often used for treatment for mild, moderate, and some severe cases.  Rigid gas permeable lenses may help to slow down the cone shape from worsening in some cases. Further, RGPs are able to assist in vision correction for keratoconus which is often not possible with soft contacts or even eyeglasses.

Post-LASIK or Vision Correction (Refractive) Surgery

While LASIK surgery has a very high success rate, there are vision complications and symptoms that sometimes remain.  Night vision after LASIK, in particular, can sometimes give you side effects such as glare or halos around lights.  RGPs are often effective in helping with these side effects and restoring clear vision.

Bifocal and Multifocal Contact Lenses for Presbyopia

Presbyopia is a common condition in those people usually over 40 years old iin which the eyes’ ability to focus on close objects is impaired. Many people keep a pair of bifocal or multifocal glasses on hand for times when they have to read menus, newspapers, books, and other objects that require near vision.  For those that prefer contact lenses over eyeglasses, bifocal and multifocal contact lenses are an option.

For some patients that have presbyopia and need correction for distance vision as well, one option is monovision.  Monovision is a contact lens fitting process in which you wear a contact lens in one eye for distance vision and the other contact lens of your other eye for near vision.  Another option is multifocal contact lenses.  In this contact lens fitting process, both eyes are usually fit for distance vision and both eyes are used for near at the same time.  Both contact lens fitting options usually take about one week for the brain and the eyes to adjust.

If you have one of these conditions or find contact lens wear difficult for another reason, speak to your eye doctor. As technology improves there are more and more options for hard to fit contact lens patients to benefit from the comfort and convenience of contact lens use.

 

Scleral Contact Lens

We design and fit scleral contact lenses by incorporating advanced technology such as OCT(Optical Coherence Tomography), Corneal Topography,  and Bio-microscope. When combined with our expertise in fitting specialty contact lenses, these advanced technologies help us to achieve  more accurate and comfortable contact lens fitting outcome. Scleral contact lenses can be the best option for many patients with keratoconus , post LASIK, RK, and other refractive surgery cases. Scleral contact lenses also can be the lens of choice for some other corneal disease such as Pellucid Marginal Degeneration, Irregular cornea, post corneal graft, Dry Eye , Steven Johnson syndrome,  and other ocular surface diseases. If you have failed in contact lenses for keratoconus and other corneal disorders in the past, make an appointment with us to see if scleral lenses can be the right solution for you.

The following conditions can be managed with scleral contact lenses.

  • Astigmatism - Some patients with irregular astigmatism benefit more clear vision correction from scleral lenses.
  • Sjogren's Syndrome- Sjogren's syndrome is an autoimmune disease that causes extreme dryness in many parts of the body, including the eyes. Scleral contact lenses provide relief by creating a reservoir of fluid between the lens and the cornea that keep the cornea moist and reduce dryness and discomfort.
  • Dry eye - Sever dry eye can be worsened by some regular corneal contacts, while scleral lenses provide a tear reservoir comfort and prevent corneal ulceration. They improve better vision,  comfort and quality of life and productivity at work
  • Graft vs. Host disease (GVHD)- Ocular manifestation of post graft complications can cause dry eye and other ocular surface disease , and corneal irregularities. Scleral lenses can be the best option to restore vision and comfort.
  • Corneal Dystrophy-Corneal Dystrophies are a group of inherited eye disorders that affect the cornea and can lead to corneal irregularities, causing patients to experience blurred vision. Scleral lenses offer the perfect solution, as they vault over the cornea, provides comfort and clear vision.
  • Keratoconus - Keratoconus or conical cornea is a progressive degenerative corneal disease. Eyeglasses and regular contacts can't provide a clear vision in Keratoconus.
  • Post- Corneal Surgery - Those who has  LASIK, a corneal transplant, or other corneal surgery, scleral contacts lenses can provide optimal vision correction and reduce the risk of corneal irritation or infection.
  • Steven Johnson's Syndrome 

Keratoconus

Using cutting edge technology instruments, our eye doctors in North York, Toronto can diagnose Keratoconus in its early stage to start the treatment as soon as possible to prevent it from worsening and vision loss. Progression of keratoconus usually is faster in younger adults therefore early diagnosis is vital for early treatment and better outcome.

Keratoconus is a degenerative eye disease that affects the cornea, which is the clear, transparent layer at the front of the eye. The cornea is responsible for focusing the light that comes into your eye onto the retina for clear, sharp vision. Keratoconus causes the corneal tissue to thin out and bulge into a cone-like shape which deflects the light entering the eye and distorts vision.

We also incorporate advanced technology such as topography, Optical Coherence Tomography (OCT) and Bio-Microscope to fit specialty contact lenses such as Scleral, Rose K, Hybrid contact lenses, etc. to restore the vision in in those with Keratoconus. These costume made lenses provide dramatic improvements in vision , comfort and quality of life to patients with keratoconus and other corneal disorder such as pellucid marginal degeneration, post LASIK or other refractive surgery complications.

As part of ongoing treatment of Keratoconus, we also teamed up with top corneal specialists in Greater Toronto Area, to provide the most advanced and best possible surgical treatments when needed.

Causes of Keratoconus

The exact cause of keratoconus is not known. The disease usually starts to appear in the late teens or twenties and can affect one or both eyes, usually progressing at a slow pace and slowing or stabilizing after around 10-20 years. It is believed that there is a genetic component as often it runs in families.

New research suggests that there may be a link between keratoconus and oxidative damage which weakens the cornea. There is also an association with overexposure to ultraviolet (UV) radiation from the sun and chronic eye irritation.

Symptoms of Keratoconus

With the gradual change in the shape of the cornea, vision becomes progressively worse. The patient may experience nearsightedness, astigmatism, distorted vision (straight lines look wavy), blurry vision, light sensitivity and glare, and eye redness or swelling. Typically, patient’s eyeglass prescription will change often as the vision becomes worse and contact lenses will be difficult to wear due to discomfort and improper fit.

When keratoconus becomes more severe (which usually takes a long time however on occasion can happen rather quickly), the cornea can begin to swell and form scar tissue. This scar tissue can result in even further visual distortion and blurred vision.

Treatment for Keratoconus

In the early stages of the disease, standard eyeglasses and soft contact lenses will usually correct the nearsightedness and astigmatism experienced by the patient. As the disease progresses however, glasses and soft contact lenses may no longer correct vision and soft lenses may become uncomfortable. This is when other forms of vision correction will be recommended.

Gas Permeable and Scleral Contact Lenses
At the more advanced stage of keratoconus rigid gas permeable (RGP) contact lenses, scleral or semi-scleral lenses may be used for increased comfort and visual acuity. Since they are more rigid, RGP and scleral lenses are able to create a smooth, round shape around the cornea, creating a smoother surface for better vision.  Many patients find these more comfortable than regular RGPs and find that they move around less when the eyes move. The main disadvantage of these rigid lenses is that for some, they are somewhat less comfortable than soft lenses and they must be continually refitted as the shape of the eye changes.

Scleral contact lenses

Topography and OCT guided scleral contact lens design is the treatment of choice for Keratoconus and variety of other complicated corneal diseases, at Empress Eye Clinic in North York, Toronto. If you have failed in contact lenses for keratoconus in the past, ask us about other advanced treatments that may be the solution for you.

Scleral or semi-scleral lenses have a larger diameter which covers the entire cornea and reaches over into the white part of the eye, which is known as the sclera (the white part of eyeball).

Whether it is glasses or contact lenses being used to correct vision, patients will likely have to undergo many tests and prescription changes as their vision change.

Intacs
Intacs are small, surgically implanted plastic inserts which are placed on the cornea to flatten it back to shape. Usually, they are able to restore clear vision, with the continued use of glasses. Intacs are often recommended when contact lenses and eyeglasses are no longer able to correct vision adequately. Intacs take about 10 minutes to insert and can delay the need for a corneal transplant.

Corneal Crosslinking (CXL)

 

In corneal crosslinking, a UV light and eye drops are used to strengthen and stiffen the cornea which helps to reduce bulging and restore the cornea to its natural shape.

Corneal Transplant
When corneal scarring occurs and eyeglasses and contact lenses no longer help, doctors may suggest a corneal transplant to replace the corneal with healthy donor tissue to restore vision. Most patients will still require eyeglasses or contact lenses for clear vision following the transplant.

Keratoconus is a condition that requires ongoing treatment by a qualified eye doctor. If you or a loved one suffers from this disease make sure that you find an eye doctor that you like and trust to accompany you on this journey.

Dr. Javad Heshmati, Optometrist

Dr. Heshmati is a Doctor of Optometry. He is certified in controlled substances, diagnostic, topical and oral therapeutics to medically treat eye diseases.

Dr. Heshmati received his optometry degree in 1991 from Shahid Beheshti University of Medical Sciences. After moving to Ontario in 1997, he continued studying Optometry and Ophthalmic Dispensing, and he received his certificates in ophthalmic dispensing in 1999. He received his certification from the Canadian Examiners in Optometry and became a member of the College of Optometrists of Ontario in 2004. He then started his practice as an Eye Doctor in Ontario.

Dr. Heshmati established the Empress Eye Clinic in 2007 to provide the highest quality eye care to his patients.

Dr. Heshmati backed his academic knowledge with extensive Optometry experience in ocular health, geriatric, pediatric, myopia control, primary care optometry, and contact lens. He co-manages cataract, corneal cross-linking and laser refractive surgery with top ophthalmic surgeons in Toronto.

Dr. Heshmati also prescribes and fits a wide range of advanced and specialty soft and gas permeable contact lenses (Toric for astigmatism, multi-focal for presbyopia, scleral for keratoconus and dry eye, therapeutic, bandage and prosthetic contact lenses for damaged cornea, and Orthokeratology ( Ortho K)also known as Corneal Reshaping for myopia control in kids.

Throughout more than 25 years of practice, Dr. Heshmati has demonstrated excellence in clinical practice by dedicating himself to the highest level of patient care. He continually strives to learn the latest knowledge and treatment techniques to incorporate them into his routine practice.

Dr. Heshmati strongly believes in preventative eye care. He incorporates advanced technologies and techniques in his practice, enabling him to diagnose, prevent, and treat eye diseases in the early stages to prevent vision loss.

Providing the most thorough eye care available and educating and helping patients understand all aspects of their vision and eye health, Dr. Heshmati prides himself that his patients are the primary referral source to his practice.

Treatment of Eye Diseases

 

 
Utilizing cutting edge technology  Drs. Heshmati  ,and Habib  diagnose and manage, with greater precision, diseases like Glaucoma, Macular Degeneration, Keratoconus, Retinal diseases, Cataracts ,Iritis, Uveitis, and Ocular surface diseases . The sooner the condition is diagnosed and treated,  the better the outcome. We are taking an aggressive approach to diseases that previously had few treatment options. Great advances have been made in the treatment of these diseases.

Empress Eye Clinic makes it an imperative that all staff members are up-to-date on the latest technology and techniques to make your visit to our clinic as comfortable and effective as possible. As ophthalmic and optometric technology changes, it is critical that our eye doctors have all the right eye care qualifications and follows the latest developments in eye care.

 
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