Customised Lens Design for Complex Corneas
If your vision is becoming increasingly blurred, distorted or sensitive to light (or your glasses prescription keeps changing) keratoconus may be the cause.
Westmead Eyes provides detailed keratoconus assessment, progression monitoring and specialised contact-lens fitting. We also coordinate care with corneal surgeons when corneal cross-linking or another ophthalmic assessment is required.
Patients travel to Westmead Eyes from across New South Wales, interstate and overseas for complex keratoconus assessment and customised contact-lens design.
Located within Westmead Public Hospital, we provide keratoconus care for patients from Parramatta, Western Sydney, regional Australia and overseas
We’ve partnered with experienced corneal surgeons who offer bulk-billed corneal cross-linking (CXL) for eligible patients. This may allow suitable patients to access treatment without a private surgical fee and without waiting through the public hospital system.
Keratoconus Assessment and Contact Lens Consultation
Your first appointment is a detailed assessment designed to evaluate your corneal shape, vision, risk of progression and suitability for specialised contact lenses.
What We Assess
- Whether keratoconus is present
- Whether the condition appears stable or progressive
- How well your vision can be corrected
- Whether specialised contact lenses may help
- Whether referral for corneal cross-linking should be considered
Your Assessment May Include
- Comprehensive eye examination
- Vision and prescription assessment
- Corneal topography and tomography
- Corneal thickness assessment
- Review of previous scans and prescriptions
- Assessment for signs of progression
- Specialised contact-lens suitability assessment
- Discussion of monitoring and vision-correction options
- Discussion of CXL referral where appropriate
Before Your Appointment
Please bring any previous corneal scans, prescriptions, specialist reports or contact-lens details that may assist with your assessment.
Patients wearing rigid gas-permeable, hybrid or scleral lenses may need to discontinue lens wear before corneal imaging. Contact us before your appointment for individual instructions.
What is Keratoconus?
Keratoconus is a condition in which the cornea – the clear front surface of the eye – becomes thinner, steeper and more irregular.
The cornea normally has a smooth, regular curve that helps focus light inside the eye. With keratoconus, its shape becomes distorted, producing irregular astigmatism and reduced visual quality.
Keratoconus commonly affects both eyes, although one eye may be more affected than the other.
Symptoms of keratoconus may include
- Blurred or distorted vision
- Frequent changes in glasses prescription
- Increasing astigmatism
- Ghosting or multiple images
- Glare and halos around lights
- Difficulty driving at night
- Light sensitivity
- Reduced vision despite updated glasses
- Difficulty obtaining consistently clear vision
Keratoconus is often first detected during the teenage years or early adulthood, although it can be diagnosed at other ages.
Family history, allergic eye disease and frequent or forceful eye rubbing are recognised risk factors.
Why Early Detection Matters
Keratoconus can progress over time, particularly in children, teenagers and younger adults.
Corneal topography and tomography allow us to examine the shape, curvature and thickness of the cornea in detail. Comparing scans over time can help determine whether meaningful change has occurred.
Early detection is important because corneal cross-linking may be considered where keratoconus is progressing or there is a significant risk of further progression.
Not everyone diagnosed with keratoconus requires immediate cross-linking. The recommendation depends on the individual patient, scan findings, age, corneal thickness and evidence of change over time.
There is no single universally accepted measurement that determines progression in every patient, so the complete clinical picture must be considered.
Two Different Goals of Keratoconus Care
Corneal cross-linking and specialised contact lenses have different purposes. One helps manage progression, while the other helps improve vision.
Managing Progression
Corneal cross-linking is intended to strengthen the cornea and reduce the likelihood of keratoconus continuing to progress.
Its primary purpose is stabilisation. It does not remove keratoconus or guarantee that glasses or contact lenses will no longer be required.
Improving Vision
Glasses and specialised contact lenses are used to improve vision affected by the irregular shape of the cornea.
Contact lenses do not stop keratoconus progression, so the condition must still be monitored separately.
Many patients require both: monitoring or treatment to manage progression, together with glasses or specialised contact lenses to improve vision.
Specialised Contact Lenses for Keratoconus
When glasses no longer provide clear vision, specialised lenses can significantly improve visual quality. When fitting keratoconus contact lenses, our goal is to provide the best possible vision with the least amount of stress on the cornea. There must be as little force on the thinnest point of the cornea as possible, otherwise there is a risk of long term damage.
There are several types of lenses that may be used depending on the severity of keratoconus, including soft lenses (Kerasoft IC), rigid gas permeable (RGP) lenses, hybrid lenses, and scleral lenses.
For moderate to advanced keratoconus, scleral lenses are often the most effective option for achieving clear, stable vision.
Learn more about scleral lens treatment here: Scleral Contact Lenses
We routinely see patients referred to us by other optometrists, eye surgeons and cornea specialists to see if a contact lens is an option for vision correction. Often, the vision of patients with even advanced keratoconus is restored and a corneal transplant can be avoided.
Customised Lens Design for Complex Corneas
Our approach extends beyond simply selecting a lens from a standard fitting set.
Where appropriate, detailed corneal and ocular-surface measurements can be used to customise aspects of the lens, including:
- central and peripheral clearance;
- landing-zone alignment;
- lens diameter;
- edge profile;
- optical correction;
- front-surface toricity;
- higher-order optical correction where appropriate;
- modifications for highly asymmetric or irregular eyes.
We also offer advanced mapped and customised scleral-lens designs for suitable patients.
This may be particularly valuable for patients with:
- highly irregular corneas;
- previous unsuccessful lens fittings;
- unstable vision in conventional lenses;
- poor comfort with corneal RGP lenses;
- corneal grafts;
- significant asymmetry of the eye;
- complex post-surgical corneal shapes.
Patients are referred to Westmead Eyes by optometrists, ophthalmologists and corneal specialists. Some travel from interstate and overseas for our experience in complex lens design and fitting.
No contact lens can guarantee a particular level of vision or comfort. The final outcome depends on the individual cornea, ocular health and response to lens wear.
Can Contact Lenses Help Avoid a Corneal Transplant?
Advanced keratoconus does not automatically mean that a corneal transplant is required.
When reduced vision is the main reason surgery is being considered, a successful specialised contact-lens fit may provide useful vision even when glasses and standard contact lenses have been unsuccessful.
This may mean that corneal surgery is not required solely because glasses cannot provide adequate vision.
However, contact lenses cannot resolve every complication. Patients with significant corneal scarring, hydrops, severe lens intolerance or other advanced changes may still require assessment by a corneal surgeon.
The decision to proceed with surgery is made with the treating ophthalmologist.
Travelling to Westmead for Your Assessment?
Patients regularly travel to Westmead Eyes from regional New South Wales, interstate and overseas for complex keratoconus and scleral-lens care.
Please tell us when booking if you will be travelling a significant distance.
This allows our team to:
- advise how long to discontinue existing contact-lens wear;
- request previous scans, prescriptions and clinical reports;
- arrange the correct appointment type;
- allocate sufficient consultation time;
- discuss the likely fitting and follow-up process;
- consolidate appointments where clinically appropriate.
Specialised contact-lens fitting usually requires more than one appointment. The exact number of visits depends on the complexity of the eye, the lens design and whether modifications are required.
Patients travelling internationally should contact the practice before booking flights or accommodation so we can discuss appointment availability and the likely treatment process.
What to Expect
Many of our patients are referred after struggling with vision despite multiple prescriptions.
Our focus is to:
- Help avoid or delay surgical intervention where possible
- Achieve clearer vision than glasses alone
- Provide comfortable, stable lens wear
Why Choose Westmead Eyes Optometrists for Keratoconus Care?
Customised Lens Design
We fit specialised corneal and scleral lenses according to the individual shape, visual needs and ocular health of each patient.
Experience With Complex Corneas
We regularly assess keratoconus, post-cross-linking corneas, previous corneal grafts and patients who have struggled with earlier lens fittings.
Advanced Corneal Imaging
Detailed corneal topography and tomography help us assess corneal shape and thickness, monitor change and guide contact-lens design.
Interstate and International Patients
Patients travel to Westmead Eyes from across Australia and overseas for complex contact-lens assessment and customised lens fitting.
Coordinated Corneal Care
When ophthalmic assessment is required, we coordinate referral and provide the treating corneal surgeon with relevant imaging and clinical findings.
Bulk-Billed CXL Pathway
Eligible patients may be referred to private corneal surgeons providing bulk-billed cross-linking without needing to wait through the public hospital pathway.
Frequently Asked Questions
Common questions about keratoconus, corneal cross-linking and specialised contact lenses.
Does corneal cross-linking improve vision?
Corneal cross-linking is mainly performed to strengthen and stabilise the cornea. Some patients experience changes in vision after treatment, but improving vision is not its primary purpose.
Glasses or contact lenses may still be required after treatment.
Will I still need contact lenses after cross-linking?
Many patients continue to require glasses or contact lenses after cross-linking because the treatment does not completely remove the existing irregular corneal shape.
Contact-lens fitting may need to be reviewed once the cornea has stabilised following treatment.
Can glasses correct keratoconus?
Glasses may provide good vision in early keratoconus. As irregular astigmatism increases, specialised contact lenses may provide clearer and more stable vision than glasses.
Do scleral lenses stop keratoconus progression?
No. Scleral lenses are used to improve vision and do not stop the underlying condition from progressing.
Corneal progression should be monitored separately, and cross-linking may still be considered when clinically appropriate.
Are scleral lenses comfortable?
Many patients who have struggled with smaller corneal RGP lenses find scleral lenses more stable or comfortable.
Comfort varies between patients and depends on lens design, ocular-surface health, handling and wearing time.
How often should keratoconus be monitored?
Monitoring frequency depends on your age, scan findings, previous progression and whether cross-linking has been performed.
Younger patients and those with suspected progression may require more frequent corneal imaging.
Should I avoid rubbing my eyes?
Frequent or forceful eye rubbing is associated with keratoconus and should be avoided.
Patients with itchy eyes or allergies should discuss appropriate treatment with their optometrist, GP or ophthalmologist.
Is bulk-billed cross-linking available to everyone?
No. Bulk-billed cross-linking is available only to eligible patients who are considered clinically suitable by the treating corneal surgeon.
Westmead Eyes can assess your corneas and arrange referral where appropriate.
Do I need a referral to attend Westmead Eyes?
No referral is required to book a keratoconus assessment. Patients may also be referred by their optometrist, GP, ophthalmologist or corneal specialist.
How long must I stop wearing contact lenses before my assessment?
The appropriate lens-free period depends on the type of contact lens, your cornea and the purpose of the assessment.
We normally recommend at least 72 hours without most rigid lens types, but individual instructions may vary. Please contact Westmead Eyes before your appointment.
How many visits will I need for specialised contact lenses?
Specialised lens fitting usually requires an initial assessment followed by fitting, collection and aftercare appointments.
The exact number of visits depends on the complexity of the eye, the selected lens design and whether modifications are required.
Keratoconus Information and Support
For further information or support you can visit the Keratoconus Australia website: www.keratoconus.org.au. The Keratoconus group on Facebook and Keratoconus Support, Australia Forum are great support networks with individuals all sharing their stories.
If you have keratoconus and are having trouble with your vision, schedule your eye test and explore your treatment options today.