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Scleral Lenses: Advanced Treatment for Lattice Corneal Dystrophy

Discover how scleral lenses can significantly improve vision and comfort for those with lattice corneal dystrophy. Schedule your fitting today!

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Scleral Lenses: Advanced Treatment for Lattice Corneal Dystrophy Optometrist
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Lattice corneal dystrophy, also known as classic lattice corneal dystrophy or Biber-Haab-Dimmer dystrophy, is a condition that not many have heard of, but for those affected, it can have a profound impact on their daily lives. A rare and hereditary eye disorder, lattice corneal dystrophy affects the clear, outer layer of the eyes, the cornea, and can potentially lead to vision impairment or loss. Understanding what causes lattice corneal dystrophy, its symptoms, types, and treatment options can provide clarity to those grappling with this condition.

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What Causes Lattice Corneal Dystrophy?

Lattice corneal dystrophy typically appears during the first or second decade of life.

The cause of lattice corneal dystrophy can be traced back to genetics. It's a condition that's inherited in an autosomal dominant manner, which means a child only needs to receive the defective gene from one parent to potentially develop the disorder. This disease is characterized by the accumulation of abnormal protein fibers, known as amyloid, in the cornea, causing a progressive alteration of the corneal structure.

Lattice Corneal Dystrophy Treatment

Lattice Corneal Dystrophy Treatment

While there is no known cure for lattice corneal dystrophy, the condition can be managed and its impact on vision and comfort can be minimized. 

Scleral Lenses: A Transformative Solution for Lattice Corneal Dystrophy

Lattice corneal dystrophy can present several challenges, including persistent discomfort and vision distortion. However, an innovative treatment in the form of scleral lenses has emerged as a gold standard solution. Unlike typical contact lenses, scleral lenses have a larger diameter, enabling them to vault over the entire corneal surface, including any irregularities caused by the dystrophy.

These lenses function by creating a new, smooth, undamaged surface for light to pass through, vastly improving visual acuity. Additionally, scleral lenses form a pocket filled with saline solution between the lens and the cornea, helping to keep the eye moist and comfortable throughout the day.

Custom Fitting Scleral Lenses

Scleral lenses fitting is a meticulous process, particularly for those with lattice corneal dystrophy. To provide the best fit and maximum comfort, a comprehensive assessment of the eye's surface is performed. This procedure involves a detailed measurement of the cornea's shape and size and the evaluation of any corneal irregularities.

An accurate fitting is paramount for achieving the maximum potential benefits, including:

  • Comfort: Scleral lenses rest on the less sensitive sclera (the white part of the eye) rather than the cornea, offering improved comfort compared to standard lenses. They also move less and have a pocket for saline solution, keeping your eyes hydrated and comfortable all day long. 
  • Sharp Vision: Designed to correct irregular corneas, scleral lenses facilitate clear and sharp vision by creating a brand new ocular surface.
  • Durability: Scleral lenses are crafted from highly oxygen-permeable materials, enhancing their durability and making them suitable for long-term use.
Lattice Corneal Dystrophy Treatment

Lattice Corneal Dystrophy Treatment

The main types of corneal transplants used for treating lattice corneal dystrophy (LCD) at advanced stages include penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and phototherapeutic keratectomy (PTK). PK is the preferred treatment option once visual symptoms progress to the point where surgical intervention is necessary. Transplant is not usually necessary before the fourth decade, although it may be required as early as the second decade of life. Recurrence of LCD is common after PK, with amyloid deposits forming in the grafted cornea years later. DALK, which retains the Descemet's membrane and endothelium, has similar outcomes to PK but may offer better visual outcomes and lower risks of graft rejection. PTK can be used to improve vision by resolving lattice changes, erosions, and opacifications. However, it is considered a second-line intervention and is unable to address deeper lesions. Each procedure carries its own risks, such as graft rejection, irregular astigmatism, and other complications.

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Symptoms of Lattice Corneal Dystrophy

Symptoms of Lattice Corneal Dystrophy

The symptoms of lattice corneal dystrophy can vary widely among those affected, and they often first appear in childhood or adolescence. These can include:

  • Blurred Vision: This is often the initial symptom and can gradually worsen over time.
  • Eye Pain: Discomfort or pain in the eyes, often described as a constant ache.
  • Light Sensitivity: Increased sensitivity to light, leading to squinting or discomfort in bright environments.
  • Recurrent Corneal Erosion: The outermost layer of the cornea doesn't adhere properly to the layer beneath it, causing severe discomfort.
  • Progressively Impaired Vision: Lattice corneal dystrophy can lead to a significant decrease in vision, with approximately 60-70% of patients eventually requiring corneal transplantation.
  • Foreign Body Sensation: Persistent sensation of having a foreign body in the eye, like a grain of sand or an eyelash.
  • Frequent Eye Infections: Increased susceptibility to conjunctivitis or other types of eye infections due to compromised eye defenses.
  • Corneal Opacities: Visible opacities in the cornea that resemble glass-like deposits, further interfering with vision.
  • Dry Eye Symptoms: Symptoms of dryness and irritation, including burning, stinging, redness, and a constant feeling of dryness in the eyes.

Risk Factors for Lattice Corneal Dystrophy

Lattice corneal dystrophy is primarily a hereditary condition, meaning that those at highest risk are individuals who have a family history of the disorder. The disease is inherited in an autosomal dominant pattern. This means that a single copy of the altered gene in each cell is sufficient to cause the disorder. If one parent has the condition, there is a 50% chance that their child will inherit it.

Gender, Race, and Ethnicity Considerations

It is important to note that both men and women can be equally affected by lattice corneal dystrophy. The disease does not discriminate based on sex, and it has been identified in populations all around the world, implying no racial or ethnic predisposition.

Onset and Progression of the Disorder

Though symptoms often first appear in childhood or adolescence, the onset and progression can greatly vary among individuals, even among those within the same family. Therefore, early detection through regular eye examinations is key, especially for those with a family history of lattice corneal dystrophy.

Spontaneous Cases of Lattice Corneal Dystrophy

In some rare cases, lattice corneal dystrophy may occur in individuals without any known family history of the disorder. These cases are often the result of new mutations occurring in the gene responsible for the condition. Nonetheless, those individuals are then at risk of passing the mutation on to their offspring.

Lattice Corneal Dystrophy Treatment
Lattice Corneal Dystrophy Treatment

Lattice Corneal Dystrophy Types

There are several types of lattice corneal dystrophy, but the two most common are types 1 and 2.

Lattice Corneal Dystrophy Type 1

Type 1, also known as Biber-Haab-Dimmer dystrophy, primarily affects the eyes. Symptoms often appear in childhood, but the severity and progression of the disorder can vary greatly among individuals.

Lattice Corneal Dystrophy Type 2

Type 2, or familial amyloidosis, is more severe and affects more parts of the body than just the eyes. Symptoms are usually systemic and can include kidney disease, heart disease, and nerve damage in addition to eye problems.

Insurance Coverage for Scleral Lenses

Understanding your insurance coverage is essential when considering treatments like scleral lenses. While each insurance policy differs, many do offer some form of coverage for scleral lenses, especially when they're medically necessary, as in cases of lattice corneal dystrophy. However, the exact coverage and out-of-pocket expenses may vary, depending on your insurance plan's specifics. We advise patients to speak directly to your eye doctor's office staff. They can provide guidance and help clarify any questions you may have about your insurance coverage and the potential costs associated with scleral lenses. Remember, the ultimate goal is to find a treatment that not only improves your vision but also aligns with your financial considerations.

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