Do you have vision problems due to a Corneal Dystrophy?

Scleral Lenses can answer those problems.

Scleral Lenses rest on the sclera, the white part of the eye, and don't come in contact with the cornea.  They are like a dome that vaults over the cornea and they create a smooth and clear surface so that light bends better and focuses on the retina, the back of the eye.  Scleral Lenses also create a space between the back part of the lens and the front of the eye. This “reservoir” often keeps the eye more hydrated (wet) and that solves the symptom of dry eye.

Scleral lenses are about the same size as soft contact lenses, but soft lenses have a large amount of water.  As the water evaporates during the day, the soft lens makes a dry eye feel even dryer. 

Corneal dystrophies are a group of genetic eye disorders that cause changes in the cornea, the clear front surface of the eye. These disorders often affect both eyes and typically progress slowly over time. They are usually inherited and can cause vision problems.

These changes can be in the epithelium, the topmost part of the cornea,  in the stroma, the inner part of cornea, or in the endothelium, the bottommost part of the cornea. 

Common Types of Corneal Dystrophies

1. Epithelial Dystrophies

• Map-Dot-Fingerprint Dystrophy (EBMD) Also known as Cogan's dystrophy or anterior basement membrane dystrophy.
  • Symptoms: Blurred vision, recurrent corneal erosions (painful episodes where the outermost layer of the cornea becomes loose), sensitivity to light, and irritation.

1. Stromal Dystrophies

• Granular Corneal Dystrophy
  • Symptoms: Glare, blurred vision, and sometimes pain if the deposits are close to the surface.

• Lattice Corneal Dystrophy
  • Characterized by deposits that cause lattice-like lines.
  • Symptoms: Progressive vision loss, discomfort, and recurrent corneal erosions.

• Macular Corneal Dystrophy
  • Causes grayish-white, ill-defined opacities in the cornea, usually starting in childhood or adolescence.
  • Symptoms: Gradual vision loss, clouding of the cornea, and potential discomfort.

1. Endothelial Dystrophies

• Fuchs' Endothelial Dystrophy
  • Affects the innermost layer of the cornea (endothelium), leading to fluid buildup and corneal swelling (edema).
  • Symptoms: Blurred or cloudy vision, particularly in the morning, glare, and halos around lights.

• Posterior Polymorphous Corneal Dystrophy (PPCD)
  • Symptoms: Often asymptomatic but can lead to blurred vision, glare, and, in rare cases, increased eye pressure or glaucoma.

Treatment and Management

• Lubricating Eye Drops and Ointments are often the first line of defense and may relieve discomfort and manage mild cases.  It can be annoying and costly to have to keep inserting lubricating eye drops.
• Scleral Lenses offer the best prognosis because they create a new surface that refracts (bends) light onto the retina (the back of the eye), and at the same time, create a tear ‘reservoir’ between the cornea and the back surface of the lens. That keeps the eye hydrated (wet).  This also eliminates the need for surgery in most cases.
• Bandage Contact Lenses: This can protect the cornea and reduce pain associated with recurrent erosions.
• Phototherapeutic Keratectomy (PTK): A laser procedure that can remove abnormal deposits or smooth the corneal surface.
• Corneal Transplantation: In severe cases where vision is significantly impaired, corneal transplantation (penetrating keratoplasty, DSEK, or DMEK) may be necessary.
• Regular Monitoring: Patients with corneal dystrophies should have regular eye exams to monitor for changes and manage symptoms promptly.

Prognosis

The prognosis for corneal dystrophies varies depending on the type and severity. Some dystrophies cause only minor symptoms and have only a minor impact on vision.  Others may lead to significant visual impairment.  The appropriate management can help maintain vision and improve quality of life for those affected by corneal dystrophies.