Our office uses Ocular Surface Tomography and proprietary software designed by Zeiss Optical which allows us to create Scleral Lenses with the proper diameter and curvatures needed for your eye. This technology permits us to determine within microns the necessary clearance required to vault over each individual cornea.
7800 SW 87 Ave Suite B-270 Miami, FL 33173
305-271-8206
Keratoconus case by Dr Edward Boshnick using Scleral lenses
Standing to my left is Kevin, a keratoconus patient who recently visited us from Puerto Rico. Standing on the right is Kevin’s mother, Lili. When Kevin first visited us, his vision was extremely poor. Doctors back home were unable to provide Kevin with functional vision with either contact lenses or eyeglasses. Last week we fit Kevin with scleral lenses which we designed with the aid of computers using proprietary software. With his new scleral lenses Kevin has clear (20/20) comfortable vision with all day lens wear. The smile on Kevin’s face tells the whole story. Our mission is to help patients who have lost quality vision due to corneal disease, ocular trauma, refractive eye surgeries and dry eyes see clearly and comfortably again. Looking forward to seeing Kevin and his mother again next year.
What Is Keratoconus?
DIAGNOSIS FOR KERATOCONUS TREATMENT
To diagnose keratoconus and properly seek Keratoconus Treatment, your eye doctor (ophthalmologist or optometrist) will review your medical and family history and conduct an eye exam. He or she may conduct other tests to determine more details regarding the shape of your cornea. Tests to diagnose and start keratoconus treatment include:
- Eye refraction. In this test your eye doctor uses special equipment that measures your eyes to check for vision problems. He or she may ask you to look through a device that contains wheels of different lenses (phoropter) to help judge which combination gives you the sharpest vision. Some doctors may use a hand-held instrument (retinoscope) to evaluate your eyes.
- Slit-lamp examination. In this test your doctor directs a vertical beam of light on the surface of your eye and uses a low-powered microscope to view your eye. He or she evaluates the shape of your cornea and looks for other potential problems in your eye.
- Keratometry. In this test your eye doctor focuses a circle of light on your cornea and measures the reflection to determine the basic shape of your cornea.
- Computerized corneal mapping. Special photographic tests, such as optical coherence tomography and corneal topography, record images of your cornea to create a detailed shape map of your cornea’s surface. The tests can also measure the thickness of your cornea.
KERATOCONUS TREATMENT
Your keratoconus treatment depends on the severity of your condition and how quickly the condition is progressing.
There is keratoconus treatment from mild to moderate that can be treated with eyeglasses or contact lenses. For many people, the cornea will become stable after a few years. If you have this type, you likely won’t experience severe vision problems or require further treatment.
In some people with keratoconus, the cornea becomes scarred or wearing contact lenses becomes difficult. In these cases, surgery might be necessary.
Lenses
- Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
- Hard contact lenses. Hard (rigid, gas permeable) contact lenses are often the next step in progressing keratoconus treatment. Hard lenses may feel uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. This type of lens can be made to fit your corneas.
- Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend “piggybacking” a hard contact lens on top of a soft one.
- Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can’t tolerate hard contact lenses may prefer hybrid lenses.
- Scleral lenses. These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of resting on the cornea like traditional contact lenses do, scleral lenses sit on the white part of the eye (sclera) and vault over the cornea without touching it.
If you’re using rigid or scleral contact lenses, make sure to have them fitted by an eye doctor with experience in keratoconus treatment. You’ll also need to have regular checkups to determine whether the fitting remains satisfactory. An ill-fitting lens can damage your cornea.
KERATOCONUS TREATMENT
- Corneal cross-linking. In this keratoconus treatment, the cornea is saturated with riboflavin drops and treated with ultraviolet light. Corneal cross-linking may help to reduce the risk of progressive vision loss by stabilizing the cornea early in the disease.
Surgery
You may need surgery as keratoconus treatment if you have corneal scarring, extreme thinning of your cornea, poor vision with the strongest prescription lenses or an inability to wear any type of contact lenses. Several surgeries are available, depending on the location of the bulging cone and the severity of your condition.
Surgical options include:
- Corneal inserts. During this surgery, your doctor places tiny, clear, crescent-shaped plastic inserts (intracorneal ring segments) into your cornea to flatten the cone, support the cornea’s shape and improve vision.
Corneal inserts can restore a more normal corneal shape, slow progress of keratoconus and reduce the need for a cornea transplant. This surgery may also make it easier to fit and tolerate contact lenses. The corneal inserts can be removed, so the procedure can be considered a temporary measure.
Cornea transplant.
If you have corneal scarring or extreme thinning, you’ll likely need a cornea transplant (keratoplasty).
Penetrating keratoplasty is a full-cornea transplant. In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue.
A deep anterior lamellar keratoplasty (DALK) preserves the inside lining of the cornea (endothelium). It helps avoid the rejection of this critical inside lining that can occur with a full-thickness transplant.
Cornea transplant for keratoconus generally is very successful, but possible complications include graft rejection, poor vision, astigmatism, inability to wear contact lenses and infection.
GVR® SCLERAL LENSES
For over 30 years my practice has been devoted to the non-surgical treatment of patients who have suffered loss of vision and ocular comfort due to the following conditions:
- Keratoconus and Pellucid Marginal Degeneration
- Post-Refractive Surgical Complications such as Corneal Ectasia, Dry Eye and
- Reduction in Quality Vision
- Irregular and Compromised Transplanted Corneas
- Stevens-Johnson Syndrome
- Corneal Dystrophies
- Compromised Corneas Due to Ocular Trauma
Over these many years, I have developed one of the largest specialty scleral lens practices in North America. Very often this unique technology is the only non-surgical treatment that will restore quality vision and comfort to these patients. If you have patients who you feel could benefit from my services and these materials, please consider my office as a referral source. Please know that all patients will be sent back to your office with a detailed report including anterior segment photos. In addition, please feel free to contact me if you need assistance with a patient suffering from any of the above conditions.
Below are ocular photos of some of my patients’ eyes with conditions which I have written about. All of these patients now have functional vision and comfort for the first time in many years. These patients are wearing gas permeable scleral lenses which I designed.
Doctor Boshnick designs Scleral Lenses to be unique for each individual patient and eye because no two eyes are the same and no two patients have exactly the same vision and ocular issues. our goals with these unique lenses are:
- To eliminate blurred and distorted vision resulting in restored ocular comfort once again.
- To promote and restore healing to the compromised irregular cornea and adjacent ocular tissues.
- To protect the compromised cornea from the environment and the eyelids.
Stevens-Johnson Syndrome
Troy Thomas was blinded from Stevens-Johnson Syndrome from 1990 until August 2004. Troy is shown standing next to his beautiful bride Shay while holding up his Florida driver’s license and standing next to his new car. His corrected visual acuity with his scleral lens is 20/20.
Stevens-Johnson patient Tiffany with her new scleral lens. Tiffany now has functional vision for the first time in 6 years.
Scleral lenses are a unique type of lens designed to treat a variety of eye conditions which do not respond to any other type of therapy. The new generation of scleral lenses being used today are made from a highly oxygen permeable polymer and are unique in that they are fit onto and supported by the sclera (the white portion of the eye).
Because these lenses vault over the compromised cornea and fit under the eyelids, they are extremely comfortable and are almost never dislodged accidentally.
The space between the front of the cornea and the back surface of the scleral lens is filled with artificial tears. This liquid reservoir fills in the surface irregularities of the cornea allowing vision to be restored in a comfortable manner. The lens and the fluid liquid bandage beneath it protect the cornea from exposure to air and the rubbing effects of blinking. This cushion of fluid beneath the lens also provides oxygen to the cornea allowing the eye to heal. The effect is to create a smooth optical surface over the diseased cornea that replaces the distorted surface to improve vision often dramatically.
Our unique proprietary scleral lenses can replace the need for corneal transplant surgery which has a potential for serious complications, long healing period and uncertain visual outcome. When corneal transplant surgery fails, our lens designs can enable patients to recover lost vision. In other words, these unique lenses provide a non-surgical means of restoring lost vision and act in a therapeutic manner.
Over the years, many patients have come to our office seeking relief from the following devastating vision and ocular disorders: keratoconus, corneal ectasia resulting from lasik, post refractive surgical complications, distorted corneal transplants, Stevens-Johnson Syndrome, Sjogren’s Syndrome, corneal degenerations and dystrophies, eyelid abnormalities, chemical and burn injuries to the eye, aniridia, and pellucid degeneration. Scleral lenses have been the therapy of choice in treating all of these conditions with an extremely high rate of success.
The Scleral Lens is, in fact, a medical and therapeutic device that can be fitted to virtually any eye shape and for any degree of visual error while allowing the diseased/injured eye to heal. It is important to understand that Scleral Lenses are custom made for each patient. Therefore, the ability of the doctor to fit these lenses demands greater experience and more time than fitting conventional soft or rigid gas permeable lenses. Computerized Topographical Maps of the entire corneal surface are generated to facilitate the lens size and fitting. In addition, several diagnostic Scleral Lenses of varying curvatures and diameters may be applied to the eye during the fitting process.
Depending on the complexity of the eye and the condition of the ocular surface, adjustments of the lens parameters may be needed. This will require additional lenses to be made and exchanged. The entire scleral lens fitting process can take several visits to determine the optimal lens for each eye.
The following are photos of some of my patients with various eye conditions who have benefited from scleral lenses:
“This instrument is an Anterior Segment Ocular Coherence Tomographer (OCT) made by Zeiss Optical. We utilize this instrument to determine and measure the entire shape and thickness of the cornea and to evaluate the relationship of our scleral lenses with reference to the underlying cornea. With this instrument we can determine within 4 microns the clearance between the back surface of a scleral lens and the front surface of the cornea.”
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Welcome to Global Vision Rehabilitation Center
Dr. Edward Boshnick maintains a cutting edge practice devoted to the restoration of vision and comfort lost as a result of refractive eye surgery (including LASIK and Radial Keratotomy), keratoconus, corneal transplant surgery, pellucid marginal degeneration, extreme dry eye, corneal dystrophies, corneal trauma, lasik damage and Stevens-Johnson Syndrome.
A few words about Dr. Edward Boshnick and his eye care practice:
Dr. Edward Boshnick maintains a cutting edge optometric practice covering all types of vision care including non-surgical vision improvement, contact and scleral lens care, children’s vision and vision rehabilitation for the partially sighted. Dr. Boshnick received his B.A. degree from the University of Miami and his Doctorate degree was awarded in Optometry from Southern College of Optometry.
