This is an excellent article written by Dr. Donna Weiss that I wanted to share. The article was published in the National Keratoconus Foundation’s November 2015 Newsletter.
If you are reading this, you most likely have or know someone who has keratoconus. And assuming this, I must also assume that you know keratoconus is a disease that requires unique solutions to generate optimized vision though either glasses, contact lenses, surgery or a combination of all three treatments. So, let’s dive into why these unique solutions should not and often cannot be generated through online purchases.
Let’s begin with the obvious. Surgery will never be available online unless we are watching a futuristic movie since the skill and time of a trained physician is involved. So, let’s discuss those treatments that can be purchased online.
The most common treatment for keratoconus is a custom contact lens that combines two surfaces to optimize vision. The first surface is the front of the lens, which focuses incoming light rays. The second surface is the back of the lens, which aligns on the surface of the eye to promote health and comfort for all-day wear.
If you or someone you know has very mild keratoconus, it is possible that you may order your contact lenses online because the distortions you have in a standard soft lens are minimal compared to individuals with moderate and advanced levels of keratoconus. If this is you, congratulations! Ordering standard soft lenses online that were prescribed by your eye doctor will likely not jeopardize your vision or eye health if your doctor evaluates the product upon arrival to confirm a proper fit. However, it is important to remember that keratoconus can change and eyes will age, so maintaining annual eye exams to evaluate the cornea’s health and shape are critical.
What if you or someone you know has moderate or advanced levels of keratoconus? These cases require custom contact lenses to optimize vision and comfort since the cornea shape is far more irregular and will need a unique back surface. As eye doctors, my colleagues and I make careful assessments of how this customized back surface aligns on your eye like a tailor would custom fit a suit or a wedding dress.
One major difference is that we assess this alignment when you blink, move your eyes, look straight ahead and look down to read. Imagine if a tailor assessed how your clothes fit when you danced, sat and leaned over to pick something up so that your clothes were customized to fit well in all positions! Thorough assessments of keratoconus eyes in various positions requires multiple fittings and adjustments to customize contact lenses, so an optimize alignment is achieved to allow nutrients and oxygen to reach the cornea while the lens is properly balanced on the cornea. The answer to why these custom contact lenses can’t be ordered online is simple: the required customizations for keratoconus contact lenses to properly fit unique corneal surfaces are not “stock items”. If we think about ordering a wedding dress or suit online, you or I would likely receive a product that was too big, too small, too tight or just not right for our body type because the clothing was not customized to our unique body shapes. The difference between the wedding dress analogy and a customized keratoconus contact lens is that a wedding dress off the shelf may fit poorly but would not likely hurt my body. However, an online contact lens that is not fit properly and worn frequently may cause scarring, inflammation and blood vessel growth into the cornea. These adverse effects result in permanently decreased vision, significant light sensitivity and permanently increased the risk for future corneal surgeries. Ordering customized contact lenses online cannot incorporate the subtle design adjustments that an experienced fitter will make to the shape, size, plastics, and thickness.
Let’s move onto a less conventional treatment for keratoconus, glasses. Glasses will often improve the vision of a keratoconus patient but will often not optimize the vision like custom contact lenses. However, everyone who wears contact lenses should have a current pair of glasses to avoid over-wearing their contact lenses.
Spectacles for keratoconus patients often enhance the vision when using polarization, anti-reflective glare, and lens-thinning technologies. Furthermore, keratoconus is often more advanced in one eye of an individual and may require the lens over the more affected eye to be thicker. Working with an experienced optometrist will allow the keratoconus patient to select different plastics for each eye based on the prescription to balance the lens thickness. Also, an experienced optometrist obtains real-time measurements for proper frame selection and lens positioning to reduce the weight and center the lenses over the eyes. So, can a keratoconus patient order their glasses online? The answer is yes. However, if your spectacle prescription is far outside normal ranges in either one eye or both, my advice is to think twice about ordering online. Manufactured glasses with high amounts of astigmatism and myopia result in the best outcomes when designed by an experienced optician.
Keratoconus is a tough disease. Period. Dealing with insurances are often not easy. Many friends and family members do not understand what it takes for a keratoconus patient to see well and maintain comfort all day long. Yet, when you consider the cost of what we pay for our cell phones, vacations or even the upcoming holidays, I ask you to think twice about how you treat the only two eyes you have. When purchasing contact lenses and glasses for your very unique situation, the best gift you can give yourself every holiday season is to work with experienced professionals and leave that online cart for books and gadgets.
Dr. Weiss started her specialty contact lens practice in New York City with Drs. Farkas, Kassalow, Resnick and Associates and in 2007, relocated to Los Angeles to join the Boxer Wachler Vision Institute as the Director of The Irregular Cornea Contact Lens Department. Dr. Weiss has served as a clinical instructor at the Western University of Health Sciences College of Optometry, held an Assistant Professor position at the Southern California College of Optometry and lead the University Eye Center of Los Angeles as the Chief of Contact Lens Services. She completed her Master in Public Health at the Johns Hopkins Bloomberg School of Public Health in 2014 to begin efforts in blindness prevention.
Dr. Weiss enjoys lecturing on custom contact lens designs and focuses her clinical work on designing custom contact lenses and managing ocular pathologies. Her research includes contact lens innovations and surgical treatments for refractive errors.