If you’re reading this web site, chances are that you know what it’s like to wear painful contacts and struggle to do daily tasks that require vision.  I do too because I originally had the steep fit the textbooks of today teach doctors to use.  I couldn’t wear my contacts beyond three hours and even that was a constant struggle.  So, you can imagine my surprise when within one day of wearing flat fit aspheric lenses I wasn’t even conscious of the contacts being in my eyes. 

Steep Fits Actually Worsen Health of the Cornea

My doctor explained that the steep fit will grip onto the cornea like a suction cup, trapping tears.  This caused constant dry eyes for me, and acidic tears burned my eyes, which led to the sharp pain I constantly felt.  With the flat fit, the doctor told me that he was ignoring the steep part of the eye and fitting according to the healthy portion of the cornea.  He told me the contact would rock and allow tear flow, unlike the steep fit.  Within a week of wearing the flat fit, something interesting started to happen.  My eyes started to flatten and normalize in response to the lenses.  My doctor ordered a flatter pair of lenses for me every week until I stabilized several months later.  He told me that he once tried to fit the end result on a patient, but it wouldn’t balance on the cone.  Therefore, it was necessary to gradually flatten the lenses similar to braces that are gradually tightened.

How to Tell if You Have a Good Lens Fit

It’s been so many years I’ve been working with this fantastic lens fitter that I can tell by sensation what’s wrong with my contacts.  Hot, steamy, or dry means the contact is too steep.  If I don’t think about them at all, I have a good fit.  I only once went too flat, and the best way I can describe it is that my eye felt “yucky.”  My doctor told me it was because mucus sticks to the lens. 

Lenses Must Be Aspheric

Whenever I tell another doctor that I am wearing a flat fit, they always say I will scratch or scar the cornea.  I’ve been wearing this type of fit for over a decade not only without any damage to the cornea, but actually an unheard of improvement in my KC.  My doctor explained to me that the damage from flat fits is being caused by spheric, not aspheric lenses like I have.  Spheric lenses are, not surprisingly, spherical.  The aspheric lenses are “S” shaped.  He said that an irregularly shaped cornea should have an irregular shaped lens.  Unfortunately, aspheric lenses are triple the cost of spheric, so most practitioners don’t use them. 

Why is it that the advanced cone hurts worse?

I always found it interesting that the mild eye could still tolerate the lousy steep fit and asked my doctor why.  I am copying his response below.  It is a bit technical, but basically this occurs because there is less differences in curvature on the milder cases.  I included his answer because I thought it was a nice description of how the lens really should be fitting:

The mild cone is less dimpled in the inferior and the superior is usually less flat in curvature than the central nipple or flat central keratometry reading (measured at approx 3 mm).  If  measurement is still made at the superior intermediate at approximately 6.5 mm from center, the lens will fit the whole cornea more comfortably if it centers on the cornea, rocks on a fulcrum point or see saw on the central horizontal spilling old tears out on one blink and scooping fresh oxygen tears in behind the other blink. The lens acts like the eyelid smearing tears around the corneal surface and lenses should be attached to the upper lid for this to happen.  Decentered lenses cause more distortion.  In mild cones, there is more tolerance to error in going steep.  However if you fit to the superior intermediate alignment, the lens feels better, you see better (len sits closer to the eyes or cornea’s vision center), the patient improves unaided vision and topographery overall improves.  This is corneal rehabilitation or reforming I have seen in all keratoconus, mild or severe.  RGP aspherics, in my experience, contour the irregular surface better and create less staining and distortion.

Finding a Flat Fitter

The bad news is that the flat fit is absolutely necessary if you want to wear lenses and have advanced or severe KC.  Unfortunately, very few doctors are fitting flat.  A good way to find a flat fitter is to ask the eye doctor for his/her transplant rate because the flat fitter will have a very low rate.  My doctor has only had two transplants out of about 390 patients.  However, practitioners using the steep fit will likely have the average American rate of 25%. 

My doctor can work cases for people who live far away, but it will initially involve a few trips to Phoenix, Arizona.  However, most people stabilize at some point after the first year, can get by on a yearly check-up after that.  I am currently in my second major re-fit because my KC is regressing as a result of diet.  However, I don’t know any other KC patients who made the dietary changes I did.  Therefore, his other patients have tended to stabilize.