Answer:    Soft contact lenses work well in early keratoconus. In more advanced disease they will do no harm but they may not provide adequate visual correction. Some clinicians feel that the comfort and the elimination of scaring with soft lenses may outweigh the visual benefits of rigid lenses.

Q: I am going on 58 and have worn glasses for near-sightedness most of my life, I was diagnosed with keratoconus. My doctor has recommended contact lenses but I've never worn them before and I'm worried that I may not be able to handle them at my age.

A: Give contact lenses a try. Handling lenses is far less difficult than you would imagine and the improvement in your vision is likely to be substantial. Make sure that you find a contact lens specialist who is patient and willing to take the time needed to properly train you to care for your lenses.

Q: I've had transplant surgery and I've been told to expect changes in my vision for many months. How long should it take before my eye to stabilize and is the astigmatism likely to get better or worse as my eye continues to heal? Also, will I need contact lenses after surgery?

A: Healing and refractive results vary tremendously from patient to patient making it difficult to predict results for any one patient. There is also no way to know if a contact lens will be necessary until your eye is stable. In addition to contact lenses and glasses several adjunctive surgical procedures can be performed to reduce post transplant astigmatism if needed.

Q: What is difference between keratoconus and "common" astigmatism and what do the numbers mean ?

A: Astigmatism is a common condition where the curvature of one or more of the optical surfaces of the eye (the cornea and lens surfaces) are more "round" in one direction than the other. In "regular" astigmatism the maximum and minimum powers are aligned at 90 degrees to each other while in "irregular" astigmatism they do not align. An egg is a good example of a surface with "regular astigmatism". Keratoconus is a degenerative condition where the cornea thins in affected areas. This can lead to astigmatism - often regular at first but becoming increasingly irregular as the disease progresses.

In simple terms the diopter (D) represents the reciprocal of the focal distance in meters. Astigmatism between 0.25 and 2.00 D of is not unusual. Between 2.25 and 3.75 is less common but still seen. Much above that in a "normal" person is unusual. Keratoconus and post-transplant patients can have 10 D or even more of astigmatism.

A: Multiple images can be caused by a disparity between the two eyes or from multiple refractive zones within the optical zone of just one eye. If you see double and it disappears when you close either eye it is most likely a binocular problem caused by the two eyes not working together. The causes of this are many and some are potentially serious. Multiple images in one eye occur more frequently in ocular surface diseases or in diseases affecting the lens or iris of the eye. In keratoconus, surface thinning can create multiple optical zones that individually focus the same image to different areas of the retina, thus creating the additional perceived images. Contact lenses will usually eliminate much of this distortion.