If you have keratoconus, your glasses prescription eventually stops keeping up. That isn't a failure of your prescription — it's a shape problem. The good news is that specialty contact lenses can bypass the irregular shape almost entirely, and there are six distinct designs to work with. This page explains what each one does, who it suits, and what it asks of you in return.
A healthy cornea is a smooth dome. In keratoconus it thins and bulges into an off-center cone, so light entering your eye scatters instead of landing on one point. No amount of lens power in a pair of glasses can fix a surface that isn't smooth.
A rigid contact lens can. It creates a new, perfectly smooth optical surface in front of your cornea, and the tear film trapped underneath fills in the irregularity. That single trick is why most people with moderate or advanced keratoconus see dramatically better in a specialty lens than in their best pair of glasses.
Where are you right now?
Keratoconus isn't one condition with one answer. The right lens depends on how steep and how irregular your cornea is, whether you've had surgery, and what you've already tried. Pick the description that fits you best and we'll highlight the designs most often used at that point.
In early keratoconus, well-made glasses or a custom soft lens are often still enough. The priority at this stage isn't heroic optics — it's confirming whether your cornea is changing, because that decides whether you're a candidate for corneal cross-linking. Stopping progression early is worth more than squeezing out one extra line of vision today.
Once glasses stop giving you crisp, stable vision, you've reached the point where a rigid optical surface makes a real difference. Corneal gas permeable lenses, hybrids, and scleral lenses are all reasonable starting places here. Which one wins usually comes down to your corneal shape, your tolerance for adaptation, and how your day is structured.
With a steep or decentered cone, smaller lenses tend to rock, decenter, or pop out, and they can press on the thinnest part of the cornea. Larger designs that vault the cornea completely become the practical choice — they're more stable, more comfortable, and they take the mechanical load off the cone.
Corneal transplants, post-LASIK ectasia, scarring, and previous fitting failures all point the same direction: a lens that doesn't touch the cornea at all. Being told once that you're "not fittable" usually means a particular design was tried, not that every design was. These cases take more chair time and more diagnostic lenses, and that's normal.
Six ways to correct a keratoconic cornea
Each diagram below is a side-on cross-section of the same eye. The grey outline is a keratoconic cornea. The dark line is the lens. The pale blue is trapped tear fluid — and the size of that blue layer is essentially the story of this whole page.
We've also marked what we do and don't fit here, so you know what to expect before you call.
- We fit these fitted here in East Orlando
- Available on request we can, with caveats
- We refer this out handled by a specialist center
1. Custom soft keratoconus lenses
Soft material, thickened center, made to your measurements
We fit theseThese aren't the soft lenses from a standard contact lens exam. They're built with a much thicker center that resists draping into the cone, which lets a soft material mask a surprising amount of irregularity. Parameters are made to order rather than picked off a shelf.
- Diameter 14–15 mm
- Adaptation Immediate
- Best for Mild to moderate
Where it shines
- Comfortable from the first minute — no adaptation period
- Stays put during contact sports and dusty work
- Easy handling if you've worn soft lenses before
- A realistic option if rigid lenses have never been tolerable for you
The tradeoffs
- Vision is usually a step behind rigid designs, particularly at night
- Thick center means less oxygen reaches the cornea
- Loses ground as the cone steepens
- Replaced more often than rigid lenses, so annual cost adds up
2. Corneal gas permeable (RGP) lenses
The original keratoconus lens, and still a strong one
We fit theseA small, firm lens that sits directly on the cornea. Because it holds its own shape, the tear film underneath fills in every dip and ridge of your cornea — that trapped layer is doing most of the optical work. Modern keratoconus-specific designs let us steepen the center independently of the periphery to sit properly on a cone.
- Diameter 8.5–11 mm
- Adaptation 1–3 weeks
- Best for Mild to moderate
Where it shines
- Excellent, crisp optics
- Highest oxygen transmission of any option here
- Small volume of care solution, simple daily routine
- Generally the least expensive rigid option
The tradeoffs
- You feel the lens edge at first; adaptation is real and takes commitment
- Can dislodge during sport or pop out in wind
- Dust and debris getting under the lens is uncomfortable
- On a steep cone, the lens can bear on the thinnest tissue — a fit that needs careful monitoring
3. Piggyback systems
A rigid lens riding on top of a soft one
We fit theseA soft lens goes on first as a cushion, and a gas permeable lens sits on top of it. It's an older approach, but it still solves a specific problem well: you get rigid optics while the soft lens absorbs the mechanical pressure that would otherwise land on a thin, sensitive cone.
- Two lenses Per eye
- Adaptation Short
- Best for Sensitive or scarred corneas
Where it shines
- Rescues a rigid fit when comfort is the only thing standing in the way
- Protects a thin or previously abraded cornea
- Improves centration on a decentered cone
- Uses lens designs we can source quickly
The tradeoffs
- Two lenses to insert, remove, clean, and replace — every day
- Stacking two lenses reduces oxygen reaching the cornea
- Two replacement schedules and two ongoing costs
- Largely displaced by scleral and hybrid designs, but still the right answer for some eyes
4. Scleral lenses
Vaults the cornea entirely and rests on the white of the eye
We fit theseThe lens is wide enough to skip over the cornea completely and land on the sclera — the white of your eye, which has almost no sensitivity. You fill the bowl of the lens with sterile preservative-free saline before inserting it, so your cornea spends the whole day bathed in fluid rather than touched by plastic. For most people with moderate to advanced keratoconus, this is the design that finally works.
- Diameter 14.5–19 mm
- Adaptation Often immediate
- Best for Moderate to advanced
Where it shines
- Comfort is frequently better than any lens you've worn, rigid or soft
- Vision stays stable all day — the lens doesn't shift with blinking
- Nothing presses on the cone, so the thinnest tissue is left alone
- The fluid reservoir also helps if you have dry eye alongside keratoconus
- Handles scarring, transplants, and shapes that defeat smaller lenses
The tradeoffs
- Insertion and removal take practice — expect a proper training session
- Fluid can cloud during the day for some wearers, requiring a midday refill
- Highest upfront cost, and fitting takes several visits
- Preservative-free saline is a recurring supply you can't skip
- Corneal health has to be monitored, since the lens limits oxygen flow
5. Hybrid lenses
Rigid optical center bonded to a soft outer skirt
Available on requestOne lens, two materials. The center behaves like a gas permeable lens and delivers the optics; the soft skirt around it handles comfort and holds the lens centered over the cone. On paper it's an elegant compromise, and it's a design we can order for you.
In practice, we don't usually recommend it. We include it here because you'll read about hybrids elsewhere and deserve to know why we tend to steer away — not because the lens is bad, but because our patients haven't done as well in them as they do in scleral lenses.
- Diameter 14.5 mm
- Adaptation Days
- Our use Selective
The theory
- Rigid-quality optics with soft-lens comfort
- Reliable centration even on a decentered cone
- Doesn't dislodge easily, and debris rarely gets underneath
- No saline to fill at insertion, unlike a scleral lens
What we see in practice
- The lens can settle and tighten over the day, so the clearance you fitted in the morning isn't the clearance the eye has by evening
- Removal is genuinely awkward for a lot of people, and that alone drives some wearers to give up
- The junction between the rigid center and the soft skirt is a weak point
- Replacement is frequent and costs add up faster than with rigid lenses
- A meaningful share of wearers end up in scleral lenses anyway — so we'd often rather start there
When we will fit one: if you're already wearing hybrids successfully, there's no reason to change what works and we're glad to keep you in them. If you specifically want to try one, we'll fit it and monitor it properly. We'd just rather tell you our experience up front than have you find out over six frustrating months.
6. PROSE and prosthetic devices
For eyes that defeat every standard design
We refer this outPROSE stands for Prosthetic Replacement of the Ocular Surface Ecosystem. Rather than selecting from standard curves, the device is shaped to your individual eye across an extended series of visits. It exists for the eyes that everything else has failed — severe ocular surface disease, badly asymmetric scleras, complicated transplants, and corneas that no conventional lens will sit on.
We don't fit PROSE, and we'll say so plainly. It requires a formal clinical fellowship and is only offered through a small network of centers. For keratoconus specifically, this is worth keeping in perspective: the large majority of keratoconic eyes do well in a well-fitted scleral lens, and PROSE is reserved for a genuinely small minority.
- Nearest clinic Plantation, FL
- Fitting Multiple visits
- Access By referral
If your eye needs it, the closest program to Orlando is the PROSE clinic at the Bascom Palmer Eye Institute in Plantation, Florida — roughly a three-and-a-half hour drive south, and one of only two PROSE centers in the southeastern United States. There's a formal referral pathway between practices, so this isn't something you'd have to arrange alone. You can also browse the full network at BostonSight's provider directory.
Our commitment on this: if we can't get you a good result with the lenses we do fit, we will tell you, and we'll make the referral ourselves rather than keep trying. Being sent to the right place is a better outcome than being fitted repeatedly with the wrong lens.
Comparing the options side by side
No single row wins outright. The right lens is the one whose tradeoffs you can live with every day.
| Lens type | Vision quality | Comfort | Handling | Typical stage | Relative cost |
|---|---|---|---|---|---|
| Custom soft | Good | Excellent from day one | Easiest | Mild to moderate | Moderate, replaced often |
| Corneal GP | Excellent | Needs adaptation | Straightforward | Mild to moderate | Lowest of the rigid options |
| Piggyback | Excellent | Good | Two lenses per eye, daily | Sensitive or scarred corneas | Moderate, doubled supplies |
| Scleral | Excellent | Often the best of any option | Learning curve, then routine | Moderate to advanced | Highest |
| Hybrid | Excellent | Good at first, can tighten | Removal is often the sticking point | Moderate | Higher, frequent replacement |
| PROSE | Excellent | Very good | Extensive training | Complex or previously unfittable | Highest, specialist centers |
Scroll the table sideways to see every column.
The thing most people aren't told
Contact lenses correct your vision. They do not stop keratoconus from progressing. A lens is an optical solution to a structural problem — it makes you see clearly today, but it doesn't strengthen the cornea underneath.
The treatment that addresses progression is corneal cross-linking, a procedure that stiffens the collagen in the cornea and, in most patients, halts further steepening. It works best before significant damage has occurred, which is why the single most useful thing you can do after a keratoconus diagnosis is establish whether your cornea is still changing. If it is, cross-linking should be discussed regardless of how well you're seeing in lenses.
Stop rubbing your eyes
This sounds trivial. It isn't. Vigorous eye rubbing is one of the strongest modifiable risk factors for keratoconus progression, and many people with keratoconus rub constantly because of underlying allergy or dry eye. If your eyes itch, the answer is to treat the itch — not to keep rubbing. Bring it up at your visit and we'll address the cause.
Cross-linking and lenses aren't either-or
Cross-linking stabilizes the cornea but rarely restores the shape it had before. Most people still need specialty lenses afterwards. Think of the two as doing separate jobs: cross-linking protects your future vision, lenses give you usable vision now. It's also common to be refitted a few months after the procedure, since the corneal shape can shift slightly as it heals.
What a specialty lens fitting actually involves
This is not a routine contact lens exam, and it isn't a single appointment. Custom lenses are made for one eye and one eye only, and getting there is an iterative process. Most patients go through two or three lens designs before landing on the final one. That is a normal, expected part of the process rather than a sign anything has gone wrong.
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Mapping your cornea
We measure the shape of your corneal surface in detail, along with corneal health and, where relevant, the shape of the sclera. These measurements are what the lens is designed from — a standard glasses prescription tells us almost nothing useful here.
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Diagnostic fitting
We place trial lenses on your eye and assess how each one sits, how it moves, where it bears, and how well you see through it. You'll be able to compare directly — often the first time someone with keratoconus sees what their eyes are actually capable of.
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Ordering your lenses
Your final parameters go to the laboratory. Custom lenses are manufactured individually, so expect a wait between this visit and the next.
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Dispensing and training
We check the fit and vision, then teach you insertion, removal, and care. Nobody leaves this appointment until they can handle the lenses independently. For scleral lenses in particular, plan for a longer visit.
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Follow-up and refinement
We see you again after you've worn the lenses in real life, because problems show up during a full day that don't show up in the chair. Adjustments at this stage are routine, and they're already part of the fitting.
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Ongoing monitoring
Keratoconus is a long-term condition and specialty lenses need supervision. Regular checks confirm your cornea stays healthy under the lens and catch changes in shape early enough to act on.
Cost and insurance
Specialty contact lenses cost more than standard lenses, for a straightforward reason: they're custom-manufactured for your eye and the fitting takes substantially more clinical time. There's a fitting fee that covers the diagnostic process and follow-up visits, and a separate cost for the lenses themselves.
Many medical insurance plans cover contact lenses for keratoconus as medically necessary rather than cosmetic, because glasses cannot provide functional vision. Coverage rules differ significantly between plans and often depend on documented visual acuity in glasses. This is worth checking properly before you assume it isn't covered — call us with your plan details and we'll help you find out where you stand.
When to contact us straight away
Specialty lenses are safe when they're fitted and monitored properly, but any contact lens on an irregular cornea deserves respect. Take the lens out and call us if you notice:
- Eye pain, especially pain that continues after removing the lens
- Significant redness, discharge, or new light sensitivity
- A sudden drop in vision, or vision that becomes foggy and stays foggy
- A feeling that something is stuck under the lens that doesn't clear
A sudden, marked worsening of vision in one eye with pain and heavy watering can indicate corneal hydrops, a break in one of the inner corneal layers that lets fluid into the cornea. It's uncomfortable and alarming but treatable, and it needs prompt attention rather than a wait-and-see approach. Call (407) 930-5566.
Common questions
Can glasses correct keratoconus?
In early keratoconus, yes — often quite well. As the cornea steepens and becomes more irregular, glasses reach a ceiling they can't get past, because a spectacle lens can only correct regular, predictable focusing errors. Irregular astigmatism needs a smooth optical surface placed directly on the eye.
Are scleral lenses better than corneal GP lenses?
Better for most people with moderate to advanced keratoconus, but not universally. Corneal GPs deliver the same optical quality, let more oxygen through, and cost less. Scleral lenses win on comfort, stability, and their ability to handle shapes that a small lens can't sit on. Corneal shape and your daily life decide it, not a ranking.
Will contact lenses slow down my keratoconus?
No. This is a persistent myth, and a version of it — that a tightly fitted rigid lens flattens the cone — was once taught. It isn't supported, and a lens fitted flat against the cone can cause scarring on the thinnest tissue. Lenses correct vision. Cross-linking addresses progression.
I was told I'm not a candidate for contact lenses. Is that final?
Very often, no. That conclusion usually follows one design that didn't work rather than an exhaustive search. Corneas that defeated a corneal GP fifteen years ago are routinely fitted with scleral lenses today. It's worth a second opinion, particularly if the last attempt was some years ago.
Can I sleep in specialty lenses?
No. These are daily wear lenses and they come out every night. Sleeping in them raises infection risk substantially, and with a scleral lens the fluid reservoir becomes stagnant. Overnight wear on an already compromised cornea is not a risk worth taking.
How long do specialty lenses last?
Rigid corneal and scleral lenses typically last one to two years with good care, though a change in your corneal shape can mean an earlier replacement. Hybrid and custom soft lenses follow shorter, defined replacement schedules. We'll be specific about your lenses when we dispense them.
Is inserting a scleral lens difficult?
It's unfamiliar rather than difficult, and almost everyone gets there. The lens is larger than you expect and it's filled with saline before it goes in, so the technique is different from any lens you've worn. We train you in person and you'll practice with us until it's comfortable. Most people are handling them confidently within a week or two.
My vision fogs up in the middle of the day. Is that normal?
It's a common scleral lens issue and it's usually fixable. It happens when debris or tear film components accumulate in the fluid reservoir, and the causes range from lens edge alignment to dry eye to the solutions being used. Don't accept it as the price of wearing sclerals — tell us, and we'll work out which cause applies.
Do I need a referral to be seen?
No. You can book a specialty contact lens evaluation with our office directly. If you're already under the care of a corneal surgeon, bring any recent scans and reports along — they're genuinely useful.
Let's find out what your eyes can actually do
If glasses aren't keeping up, or you've been told nothing more can be done, a specialty contact lens evaluation is the place to start. Dr. Anthony Huynh fits keratoconus and irregular corneas at our East Orlando office.
This page is general education about keratoconus and contact lens options, not medical advice for your individual eyes. Which lens suits you can only be determined by examination. Always seek the advice of a qualified eye care provider with questions about your vision or eye health.