Dr. Edward Boshnick - Corneal Ectasia and Scleral Lenses

Understanding Corneal Ectasia

The cornea, the clear, outermost layer of the eye, plays a pivotal role in vision by refracting, or bending, light to focus it on the retina. This focused light is then converted into signals that are transmitted to the brain for visual interpretation. Any disruption to the cornea’s structure, therefore, can lead to significant vision problems. One such disruption is Corneal Ectasia, a condition that we’ll explore in-depth in this article.

What is Corneal Ectasia?

Corneal Ectasia, also known as post-LASIK ectasia, is a rare but significant complication resulting from LASIK (Laser-Assisted In-Situ Keratomileusis) surgery. LASIK is a widely used procedure to correct common vision problems, including myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

In Corneal Ectasia, the cornea, post-LASIK surgery, undergoes abnormal thinning and bulging, which in turn affects its ability to refract light accurately. The precise causes behind Corneal Ectasia aren’t entirely understood, but it’s often linked to an undiagnosed or mild form of a corneal disorder known as keratoconus. Furthermore, it can manifest itself immediately following the LASIK surgery or months to years later.

Symptoms of Corneal Ectasia

The impact of Corneal Ectasia on a person’s vision can range from subtle changes to severe vision loss. Notably, the symptoms are progressive, meaning they worsen over time. Individuals with this condition may experience:

Frequent changes in their eyeglasses or contact lens prescription, reflective of the unstable nature of their vision.
Progressive myopia (nearsightedness) and levels of astigmatism, leading to blurred or distorted vision.
A decrease in the best corrected visual acuity, which is the sharpest vision attainable using corrective lenses.
Visual disturbances such as halos, glare, shadows, and ghost images, particularly around light sources or in bright conditions.
Dry and/or red eyes, indicative of ocular surface inflammation or dry eye syndrome, a common co-occurring condition.
Ocular pain and headaches, arising from eye strain or corneal swelling.
Emotional distress or depression, secondary to the persistent vision problems and their impact on daily activities.

Treatment Approaches for Corneal Ectasia

The approach to treating Corneal Ectasia largely depends on the severity of the condition. Corneal surgeons may attempt procedures such as Collagen Cross Linking, which aims to strengthen the corneal tissue, or the implantation of intra-stromal plastic rings, known as Intacs, to regularize the corneal surface.

However, it’s been noted that non-invasive treatments can offer significant benefits, especially in cases of LASIK-induced corneal ectasia. Among these, the use of scleral lenses stands out as a particularly effective strategy.

Dr. Boshnick's Approach: Scleral Lenses for Corneal Ectasia

In the management of corneal ectasia, Dr. Boshnick emphasizes the therapeutic potential of scleral lenses. These are large, gas permeable contact lenses designed to vault over the cornea, resting instead on the sclera, or the white part of the eye.

In treating Corneal Ectasia, scleral lenses play a crucial role by replacing the compromised cornea as an optical surface, effectively providing the eye with a new, smooth refractive surface. This lens creates a gap between itself and the cornea, which is filled with a sterile, unpreserved saline solution. This keeps the front surface of the eye in a continuously moist environment, potentially aiding in the relief of symptoms such as dryness and discomfort.

Through his vast experience, Dr. Boshnick has observed that a well-designed and properly fitted scleral lens can restore quality vision and ocular comfort to patients suffering from LASIK-induced corneal ectasia. The benefits of this approach underline the importance of individualized, patient-centric care in managing complex conditions such as Corneal Ectasia.

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Frequently Asked Questions

What is Corneal Ectasia?

Corneal Ectasia is a complication resulting from LASIK surgery, characterized by thinning and bulging of the cornea. This condition can lead to an increase in a patient’s myopia (nearsightedness) and astigmatism.

What are the symptoms of Corneal Ectasia?

The symptoms of Corneal Ectasia can include frequent changes in the eyeglasses or contact lens prescription, progressive myopia and astigmatism, a decrease in best corrected visual acuity, visual disturbances such as halos, glare, shadows and ghost images, dry and/or red eyes, ocular pain, headaches, and even depression.

Can Corneal Ectasia occur immediately after LASIK surgery?

Yes, Corneal Ectasia can occur immediately following LASIK surgery, but it can also develop months to years later.

How does Dr. Boshnick treat Corneal Ectasia?

Dr. Boshnick recommends a non-invasive treatment using scleral lenses to restore quality vision and ocular comfort in patients suffering from LASIK-induced Corneal Ectasia. Scleral lenses replace the cornea as an optical surface, essentially providing a new, smooth refractive surface.

What are scleral lenses and how do they work?

Scleral lenses are large, gas permeable contact lenses designed to vault over the cornea, resting instead on the sclera or the white part of the eye. They create a gap between the lens and the cornea filled with sterile, unpreserved saline solution, keeping the front surface of the eye in a continuously moist environment.

How can scleral lenses help with Corneal Ectasia?

Scleral lenses can provide significant relief from the symptoms of Corneal Ectasia by creating a new, smooth refractive surface for the eye, restoring quality vision and providing ocular comfort. They also maintain a continuously moist environment for the cornea, aiding in symptom relief.

Can scleral lenses improve my best corrected visual acuity if I have Corneal Ectasia?

Yes, scleral lenses can improve best corrected visual acuity in patients with Corneal Ectasia. They work by replacing the distorted cornea as an optical surface with a smooth, regular lens, allowing for improved focus and sharper vision.