Category Archives: Keratoconus

Keratoconus Specialist: Treating keratoconus with scleral contact lenses, keratoconus glasses, keratoconus hybrid contact lenses, intacts, cross-linking, and other new treatment modalities.

Advantages and Disadvantages of Cornea Transplant and Scleral Lenses For the Treatment of Advanced Keratoconus

Cornea Transplants and Scleral Lenses for Keratoconus

Picking the right treatment for any disease plays a vital role in recovery. There are several different treatment methods for advanced keratoconus. But in this article, we will try to help you understand just two treatment types better – cornea transplant and scleral lenses.

These two keratoconus treatment options are among the most popular treatment options. They are regularly touted as the easiest and most effective treatment methods in some quarters. But when you are done reading this article, you’d be well informed to form your own opinions about them.

Keratoconus is a progressive medical condition of the eye that affects the cornea. The cornea thins and bugles out like a cone, leading to vision problems. Keratoconus treatment helps to halt the progression of the disease. And in some cases, they help keratoconus patients with partial visual rehabilitation. New treatment methods are still being discovered, so there’s no particular best treatment or most effective. It all depends on you.

For non-medical students or practitioners, the definition and explanation of keratoconus given above is still very likely to leave you confused. Let me break it down for you to understand much better.

Keratoconus is a disease which makes the cornea of the eye, which is the transparent tissue in front of the eye, to bulge outward. When a person suffers from keratoconus, the clear dome-shaped tissue that covers the eye, particularly the cornea, thins, and bulges outward into a cone shape.

The cause of this disease is yet to be known, and it affects a small population of the world. The occurrence of keratoconus can be found in about one in every two thousand people*.

Click here to continue the article ‘The Advantages and Disadvantages of Cornea Transplant and Scleral Lenses For the Treatment of Advanced Keratoconus’

My Keratoconus Experience: Baltimore’s top Keratoconus Doctor

Diagnosed with keratoconus at 14 years of age this patient has tried it all! He started off with soft contact lenses together with hard lenses, and then had his first corneal transplant in 1980. In 1990 he had a second corneal transplant but still left with poor vision. He was then prescribed hard lenses (RGP) but they were very uncomfortable and constantly popped out of his eyes. He finally found Dr. Azman, Baltimore’s top keratoconus doctor who prescribed him with scleral lenses. With the scleral lenses, he can wear them comfortably all day, they stay in his eyes, he can drive at night with no glare, and has the best vision he has had in many years!

Undiagnosed Eye Condition, Diagnosed as Keratoconus

A new patient to our office, a doctor himself, who sees his eye doctor on a routine basis, continues to comment that he still cannot see well with his new glasses. After seeing three different eye doctors there was no diagnosis and the patient was still unhappy with his vision. After a very thorough examination with Dr. Azman, the patient is diagnosed with keratoconus. With proper keratoconus treatments, the patient will have clear consistent vision with no glare! #ExcellentEyeCare #GreatVision #Keratoconus#NoDiagnosis Keratoconus Specialists of Maryland






Ravens Brandon Williams seeing more clearly after surgery to combat Keratoconus

By Childs Walker – Contact Reporter
The Baltimore Sun

(Kenneth K. Lam / Baltimore Sun)

Brandon Williams sat in his usual seat near the back of the Ravens’ meeting room, but something was wrong. The dry-erase board down front had dissolved into a blur of colors and squiggles. Williams squinted and blinked furiously but couldn’t bring the image into focus.

“Like I got sand in my eye almost,” the Ravens defensive tackle recalls.

Like many elite athletes, he had been able to count on near-perfect vision for most of his life. But seemingly overnight, he could not achieve this most basic of physical functions.

Williams finally went to his doctor and after a round of tests, learned he was suffering from keratoconus, a degenerative condition in which the corneas weaken and eventually bulge out, leading to blurry or distorted vision.

Click Here to Continue the Story

PROSE Lenses – Pellucid Marginal Degeneration (PMD)

Pellucid Marginal Degeneration:

Pellucid Marginal Degeneration is a sub-category of Keratoconus. Pellucid corneas involve a larger distorted geographic area usually extending from the inferior corneal margins up to the center of the cornea. It is not unusual for 50% or more of the corneal surface to be involved. Because so much of the cornea can be affected, fitting this type of cornea can be challenging. The problem we face as eye care practitioners is fitting the steep areas if the cornea without adversely affecting the flatter areas.

PVR PROSE Lenses | GPVR PROSE Treatment:

PVR PROSE- Precision Vision Rehabilitation  Prosthetic Replacement of the Ocular Surface Ecosystem

Our PVR PROSE Treatment is a process that uses a prosthetic device, like a scleral lens, to replace the ocular surface to provide functional vision to complex corneal conditions. Utilizing our knowledge, experience, and technology, like the Vistante- Optical Coherence Tomography OCT, we are able to customize a prosthetic PROSE lens, with the precise measurements down to the micron. With an exact fit, there is proper movement, comfort, and perfect vision.

PROSE Lenses are large-diameter gas permeable contact lenses specially designed to vault the entire corneal surface and rest on the “white” of the eye (sclera). In doing so, PROSE scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by, keratoconus, Lasik failures, post-surgical complications, and other corneal irregularities.

Because PROSE Lenses / scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with corneal irregularities caused by keratoconus and other corneal irregularities A special liquid fills the space between the back surface of the lens and the front surface of the cornea. This liquid acts as a buffer and protects the compromised corneal tissue. Scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses. These lenses are almost always very comfortable and the vision provided by them is extremely good. The great majority of patients are able to wear their scleral lenses almost all of their waking hours without problems.

Dr. Irwin Azman, Keratoconus Specialists in Maryland, prescribes PVR PROSE Lenses for a variety of hard-to-fit eyes, including patients with Stevens-Johnson Syndrome, Radial Keratotomy and Lasik Complications and Lasik failures, keratoconus, Corneal Ectasia, Post-Surgical Vision Loss, and Pellucid Marginal Degeneration.

Dr. Irwin Azman specializes in keratoconus, LASIK failures and other corneal irregularities neither avoids nor declines the challenge of prescribing the most difficult cases.

Post Lasik Ectasia

Post Lasik ectasia of the cornea is one of the most severe complications of Lasik (Laser in situ Keratomileusis).

The Lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Corneal ectasia results in the visual deterioration.

Keratoconus vs Ectasia

Keratoconus and post Lasik ectasia (keratectasia) are histologically two different processes. Keratoconus is a corneal disorder that isn’t related to surgery and affects both eyes. It begins usually in late teenage years or around puberty. Keratectasia is a result of corneal manipulation during surgery, like Lasik. If the patient didn’t have keratoconus before surgery and didn’t have any family history of the disease, then the post Lasik weakening of the cornea is probably keratectasia (ectasia).

Risk factors of Post Lasik Ectasia

Most common risk factors of post Lasik Ectasia in order of significance are:

  • Abnormal preoperative topography
  • Low residual stromal bed (RSB) thickness
  • Young age
  • Low perioperative corneal thickness
  • High myopia

Post Lasik Ectasia

Treatment of Post Lasik Ectasia

Treatment options for post Lasik ectasia include:

Contact lenses

Contact lenses are helpful in the rehabilitation of vision in patients with post Lasik ectasia. The types of contact lenses best for the patient can be variable as per the exact symptoms and case along with patient’s personal preference. Some of the options include:

  • Rigid gas permeable contact lenses (RGP)
  • Scleral contact lenses
  • Soft contact lenses (custom wavefront guided)
  • Hybrid contact lenses
  • Tandem soft contact lenses

Preferably scleral lenses and rigid gas permeable contact lenses are chosen for the patients. However if they are intolerant to the rigid gas permeable lenses they can be advised the tandem soft contact lenses, hybrid contact lenses and the scleral contact lenses as the next options.

Intracorneal ring segments

Intracorneal ring segments (ICRS) are used in post Lasik ectasia patients having thin cornea that can’t tolerate the contact lens. The size, symmetry, location and number of segments to use are dependent on the individual case and surgeon’s decision.

Corneal collagen cross-linking

The anterior thin layer of cornea is weakened during the flap creation. Most of the cross linking effect occurs in that almost 200 microns of anterior layer of cornea. Cross linking has been claimed to stop the progress of ectasia therefore corneal collagen cross-linking (CXL) can be used to stop post Lasik ectasia from getting worse.

Combination therapies

Some patients might need and benefit from the combination therapies including intracorneal ring segments or corneal crosslinking or any other combined therapy.

Penetrating keratoplasty

Penetrating keratoplasty (PKP) is used as the last resort in patients with post Lasik estasia.

Global Complex Eye Care was specifically designed, equipped, and staffed to provide patients with nothing but the finest in professional eye care. As Post LASIK specialists, we have successfully treated patients with Post Lasik Ectasia, Keratoconus, LASIK Dry Eye and other side effects, Pellucid Marginal Degeneration, Stevens-Johnson Syndrome, and other irregular corneas. Optometrists and Ophthalmologists from all over Maryland and surrounding states refer patients to Dr. Irwin Azman.

For more information please call, (240) 782-2020
to schedule your complimentary telephone consultation.


Scleral lenses related to post Lasik side effects

Scleral contact lenses are specialized lenses that are made of a high oxygen permeable material and are larger in diameter as compared to conventional lenses.

Scleral contact lenses aren’t a contact lens in strict sense, as they don’t have any contact with the cornea of an eye. The lens rests on the sclera of the eye and doesn’t move with the movement of the eyeball.

Scleral lenses for post Lasik complications

Scleral contact lenses are helpful in a lot of post Lasik complications and side effects including corneal ectasia, irregular astigmatism, dry eyes, etc.

Scleral contact lenses don’t come in contact with the cornea of the eye, therefore they’re helpful in patients having sensitive or irregular cornea, where soft and conventional contact lenses can’t be used.

There is a film of tear between the scleral contact lens and the cornea, which provides a cushion as well as helps in uniform refraction while the light rays pass through the lens, cornea and the gap in between.


Scleral contact lens for post Lasik ectasia

Corneal damage in post Lasik patients can lead to corneal ectasia. Conventional and soft lenses that rest on the cornea are useless in this condition as they sit on the cornea and cannot maintain their contour as they adjust with the corneal surface.

Scleral contact lenses rest on the sclera and have no contact with the cornea directly; therefore their shape isn’t affected by cornea irregularities and ectasia, providing unaffected refraction of light from the lens surface.

Scleral contact lenses and dry eyes

As scleral contact lenses don’t come in contact with the cornea of the eye, they are useful in patients who can’t tolerate the contact lenses otherwise due to the dry eyes.

Scleral contact lenses and nearsightedness or farsightedness

Patients left with refractive errors or having an over correction can use scleral contact lenses to correct the myopia or hyperopia in their eyes.

Scleral contact lenses and irregular astigmatism

Scleral contact lenses can be helpful in patients suffering with irregular astigmatism after the Lasik procedure.

If you’re having any complications after Lasik procedure consult a specialist to discuss the post Lasik side effects in your case and the best possible treatment options for you.

Dr. Oz Show Discusses Long-term Side Effects of LASIK

An episode of the Dr. Oz Show, which aired on October 3rd, 2013, featured an investigative report about the potential life-long side effects of LASIK eye surgery.

As a popular elective surgery, nearly 800,000 people get Lasik every year. FDA clinical data trial shows that every modern laser left 1 out of 5 patients seeing worse after LASIK. Side effects include seeing double, seeing halos or starbursts (especially at night), and dry eye pain.

Investigative reporter Elisabeth Leamy has been investigating the harmful side effects of LASIK for over two years. During her undercover consultations with doctors, she discovered that the side effects were minimalized and the procedure was treated like an easy, no-risk procedure.

Morris Waxler, the former FDA official responsible for getting LASIK surgery approved, is now working to get it banned. He says that the side effects of LASIK are actually injuries and that LASIK harms 20% of patients.

lasik problems

LASIK eye surgery works by cutting a flap of the top layer of the cornea and then using a laser to reshape the exposed cornea. Complications can occur when the flap of the cornea is cut too thick, too thin or too far into the cornea. However, even if this cut is perfect, when the flap is put back down it doesn’t necessarily heal perfectly. Years later it can become dislodged and trigger negative side effects. In addition, if there were underlying issues prior to the LASIK surgery that were not treated, LASIK surgery (and enhancement touch-ups) will most likely exacerbate the issues. Unfortunately many post LASIK patients now have life long side effects, ranging from the smallest amount to the most severe.

Dr. Irwin Azman provides treatment for people who underwent LASIK, PRK, and RK sugery but are now experiencing post-surgical side effects and complications.

According to Dr. Azman:

“While LASIK surgery can be successful under optimum eye conditions, unfortunately many patients do experience side effects due to pre-existing conditions. However, there is hope. Utilizing our vast experience and expertise, as well as an array of new technologies, we are able to treat these side effects with non-surgical techniques.”

For more information about treatments for Post LASIK side effects and complications visit or call (240) 782-2020.

Diagnosing Keratoconus

We are now able to detect the presence of keratoconus well before subjective symptoms develop. Diagnosing keratoconus with Wavefront Corneal Topography and Aberrametry measurements have become the standard of care in diagnosing and management of keratoconus. Utilizing new technology, ophthalmic instruments now capture images of the shape of the cornea together with the entire optical system by taking tens of thousands of data points. The results are instantly analyzed and Wavefront topography maps are generated. These printouts will show Dr. Azman a map of the eye-print  (just like a finger print) of the location and severity of any corneal distortion and high order aberrations (HOA).
Keratoconus w/ IntacsKeratoconus Uncorrected with HOAsKeratoconus Corrected with contact lenses
Corneal specialists agree that it is best to exhaust all non-surgical options for keratoconus before undergoing corneal transplant surgery, especially for younger patients. Optometrists and Ophthalmologists from all over Maryland and surrounding states refer their challenging keratoconus patients to Dr. Azman.
Keratoconus Evaluation
keratoconus Tear Scan
keratoconus Tear Osmolarity
keratoconus Anterior OCT
keratoconus Posterior OCT
keratoconus Tear Film Analysis and Dry Eye Evaluation
keratoconus Lid Evaluation
keratoconus Wave front corneal topography
keratoconus Aberratometry
keratoconus Specular Microscopy
keratoconus Refraction
keratoconus Pupil measurement
keratoconus Ulltrasound corneal thickness
Keratoconus Treatment Options
keratoconus Keratoconus Glasses
keratoconus Scleral contact lenses
keratoconus Keratoconus soft contact lenses
keratoconus Hybrid contact lenses
keratoconus IPL
keratoconus LIPIFLOW
keratoconus CRT CORNEAL Reshaping Therapy
keratoconus Dry eye treatment
keratoconus Intacs
keratoconus Cross linking
keratoconus Corneal transplant(last option)
keratoconus Prescription and/or OTC medication
tear scanAnterior OCTPosterior OCT
Tear ScanAnterior OCTPosterior OCT

Keratoconus Specialist in Baltimore

English: Scheme of keratoconus compared to nor...

English: Scheme of keratoconus compared to normal cornea Polski: Schemat porównujący prawidłową rogówkę do stożka rogówki Hrvatski: Skica keratokonusa u usporedbi s normalnom rožnicom (Photo credit: Wikipedia)

Keratoconus is a condition in which the cornea (the lens of the eye) begins to have structural fluctuations, causing it to thin and change to a more conical shape than its normal gradual curve.

The cornea has three major parts, the outer layer, epithelium, the central structural portion, the stroma, which provides the cornea’s shape, and the endothelium, which prevents swelling of the cornea. Keratoconus is a disease of the corneal stroma. The stroma comprises over 85% of the cornea, and is made up of collagen, similar to the material on the tip of your nose. With keratoconus, the cornea loses its usual round shape, and develops in to a cone-like shape.

In the initial stages of keratoconus, vision will fluctuate, causing astigmatism.  As the condition progresses, the cornea becomes too irregular for the use of glasses, and special contact lenses, called Scleral Lenses are needed.  The new generation of Scleral lenses are now very comfortable in the eye and most importantly correct the distortion caused by keratoconus.

Keratoconus is a progressive corneal condition, and regularly starts in the teenage years.  Now with Scleral lenses, people with keratoconus can have great comfortable vision. It’s always in a person’s best interest to avoid corneal transplants and other surgical procedures.

Dr. Irwin Azman specialists in the fitting of Scleral contact lenses for keratoconus, Lasik failures and complications, Pellucid Marginal Degeneration, Stevens-Johnson Syndrome, and other corneal irregularities.