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Pellucid Marginal Degeneration

7 Tips for Using Scleral Contact Lenses

Scleral contact lenses are larger diameter Rigid Gas Permeable (RGP) lenses. The larger size of scleral contact lenses fits vaults over the cornea of the eye.

They are often a good option for patients with corneal diseases like keratoconus and pellucid degeneration.

Scleral contact lenses can be customized for each individual patient providing a more comfortable fit. Other benefits of scleral contact lenses are clear vision and improved dryness. 

Be patient as you learn to adjust to wearing scleral contact lenses. It will take a bit of practice. 

1. Not the Same as Other Lenses

Scleral Contact Lenses are inserted and removed differently than regular contact lenses. This can take some time to adjust to. This video provides some tips on inserting and removing scleral contact lenses as well as caring for them, we also have a video here. You may need to try several insertion and removal methods before finding the one that works well for you.

2. Cleaning Regularly

Like any contact lens wearers, regular cleaning is essential. Make sure you’re washing your hands thoroughly before inserting scleral lenses and for lens removal.

Use only recommended products to keep lenses and your eyes in the best condition. Follow instructions from your eye doctor on proper lens care and cleaning methods.

Regularly clean your contact lens case as well.

Good hygiene will prevent eye infections.

3. Removing Scleral Contact Lenses

A drop or two of preservative-free artificial tears or saline into the eye before removing and a gentle massage can help to loosen the lens. For most wearers, it is best to remove their lenses about one hour before going to bed. 

4. UV Protection

We recommend wearing sunglasses with your custom scleral contact lenses to protect your eyes from UV rays. 

5. When Wearing Makeup

For those that would like to wear makeup while wearing scleral lenses, there are a few minor adjustments.

Put your custom scleral contact lenses in before applying your makeup. Choose cream rather than powders and eye-friendly, hypoallergenic products. Don’t use eyeliner on the inside rims of the eyes.

Remove lenses before cleaning off makeup. 

6. Facial Moisturizer

Avoid oil-based moisturizers on the eyelids.

7. Avoid Wearing Lenses on a Plane

For anyone wearing contact lenses, wear your glasses when flying if you are able to. The air in aircraft cabins is very low causing your eyes to become dry and uncomfortable. Put them in as soon as you land when you are able to do so. 

There are many benefits to custom scleral contact lenses for patients. With a bit of time and practice, scleral contact lenses will become part of your routine. A scleral lens fitting may take more time but patients often find them more comfortable.

They will help to keep the cornea healthy and with their wider diameter are often more comfortable for better patient vision and comfort. Fitting scleral lenses properly can also help with dry eyes as the scleral lens design is to vault over the eye, protecting the cornea underneath. Follow all of the recommendations provided to you by our optometrists

Contact our Albuquerque office if you are having any issues or to book an appointment for a custom scleral contact lenses consultation and fitting.

Photo by Nataliya Vaitkevich from Pexels

Differences between Keratoconus and Pellucid Marginal Degeneration

Keratoconus and Pellucid Marginal Degeneration (PMD) are both considered to be cornea ectatic disorders or corneal thinning disorders. While they may have similar topographic features, they have slightly different cornea abnormalities. They can often be misdiagnosed. It is possible for a person to have both eye conditions but this is quite rare.

There is some discussion of whether PMD is a form of keratoconus or its own eye disease entirely. Treating and managing these eye disorders is different so it is important to have a keratoconus or PMD specialist working with you to get the proper diagnosis.

Cornea Abnormalities

PMD shows severe inferior crescent-shaped thinning of the cornea. This shows as the thinning of the corneal band with the cornea protruding above the thinning. It is sometimes referred to as a “beer belly” configuration when you view it from the side. The cornea of a patient with keratoconus is cone-shaped rather than the dome shape of a healthy eye.

In PMD, cornea thinning extends 1–2 mm away from the inferior limbus while in keratoconus, the thinning usually occurs in the paracentral region. If the cone shape is away from the cornea, a patient with keratoconus can often be confused to have PMD.

Hereditary

There is no known hereditary link for those with PMD. It is a bit more complicated with Keratoconus. There is often no hereditary link, but if you have a first-degree relative with keratoconus, you are at higher risk than the general population of developing this eye disease.

Keratoconus is quite a rare disorder and PMD is an even more rare eye disorder. About 3% of cases with corneal ectasia resulted in a PMD diagnosis with the other 97% having keratoconus.

Keratoconus is more likely to occur in men. Some studies have found that PMD might be more apparent in women.

Many patients will have had a history of allergies, hayfever, asthma, or eczema, possibly due to excessive rubbing of the eyes.

Age of Diagnosis

Symptoms of Keratoconus are often diagnosed in the teenage years. PMD symptoms will typically start to show after age 30. Keratoconus will start to plateau after around age 40 but PMD will continue to progress.

Patients with keratoconus are often diagnosed sooner as vision starts to deteriorate earlier. The first signs are often a minor blurring of their vision.

Symptoms of Keratoconus and Pellucid Marginal Degeneration

With both diseases, eyesight deterioration progresses. Both may have astigmatism (eyesight problem of blurriness) present with keratoconus patients also sometimes experiencing myopia. Keratoconus causes astigmatism reducing visual acuity.

Neither eye condition usually causes pain. Keratoconus will typically show scarring while with PMD typically there is usually no scarring present.

Treatments for Keratoconus and Pellucid Marginal Degeneration

Corneal Cross-linking

Corneal cross-linking is a treatment that can halt the progression of both keratoconus and PMD. It is a minimally invasive procedure that uses special eyedrops of Riboflavin (Vitamin B12) and a UV light.

Rigid Gas Permeable Contact Lenses and Custom Scleral Contact Lenses

Rigid Gas Permeable (RGP) contact lenses are often used to treat both eye diseases. Custom scleral contact lenses may feel the most comfortable for those with keratoconus as they are wider and a scleral lens can vault over the dome of the eye.

Glasses or Soft Contact Lenses

Often this is the first treatment for mild cases. Lenses can be custom fit so the patient has a more comfortable experience.

Surgery or Cornea Transplant

In a small number of cases, a patient may need to have surgery or a corneal transplant.

How We Can Help

Having an eye doctor near you that understands the differences between diagnosing and treating keratoconus and pellucid marginal corneal degeneration is essential. Visit our comfortable office in Albuquerque to speak with our eye doctors that have experience treating these eye disorders.