PATIENTS WHO have irregular corneas can often be effectively managed with GP contact lenses. However, when surgical intervention is deemed necessary, the comanaging eyecare practitioner can play a vital role in managing the patient’s visual needs during the postoperative period and beyond, particularly if specialty lens wear is still required afterward.

When the corneal irregularity is an undesirable outcome of a corneal surgery (rather than the reason the surgery was performed), it is critical to help the patient regain functional vision with specialty contact lenses. In both scenarios, the patient is often eager to begin or resume lens wear, and the practitioner may wonder when it is safe to proceed.

It is reasonable to consider contact lens fitting after refractive surgery for several reasons. If the corneal shape is still somewhat regular, residual ametropia, anisometropia, and presbyopia may be addressed once the refraction is stable and the cornea has healed, usually in two to three months after the procedure (assuming an enhancement procedure is not recommended instead).

If the shape is irregular or ectatic, the refraction may not easily stabilize, but fitting may be more urgent. Additionally, patients may be frustrated and unhappy with their vision. Ectasia can present as soon as a week after refractive surgery (Moshirfar et al, 2021) and patients exhibiting this should consider corneal cross-linking (CXL) prior to lens fitting when possible.

When CXL is performed, either for a progressive keratoconus patient or a post-refractive surgery patient who has ectasia, the standard wait in most scenarios for contact lens fitting is one month postoperatively, sometimes less. To speed this up, sometimes a fit can be started prior to the procedure; in particular, if scleral lenses are used, some pre-procedure lens choices might work after the surgery as well. This may also be true with patients who have intracorneal ring segments implanted, though the changes in corneal shape may be less predictable with this procedure (Figure 1).

When fitting contact lenses after keratoplasty, there is much to consider. Complete stabilization of a full penetrating keratoplasty may take up to two years, though contact lenses can often be introduced anywhere from three to six months after the procedure, depending on the healing of the cornea (Chang and DeLoss, 2018). Suture removal can complicate lens fitting with resultant large changes in astigmatism/corneal shape over many months. Deep anterior lamellar keratoplasty is similar in this regard. Grafts involving only the posterior layers of the cornea (e.g., endothelial keratoplasties) may heal faster and allow for lens fitting sooner.

Consultation with the corneal surgeon is often needed to determine when it is safe to proceed, and the patient’s visual needs may dictate the urgency required. In general, the appropriate time to begin or resume contact lens wear after corneal surgery depends on the stability of the cornea, the risk of complications, and the patient’s need for improved vision. CLS

References

1. Moshirfar M, Tukan AN, Bundogji N, et al. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther. 2021 Dec;10:753-776.
2. Chang C, DeLoss K. Contact Lenses After Corneal Transplantation. Contact Lens Spectrum. 2018 Jun;33:36-41,51.