Scleral Lenses for Lattice Corneal Dystrophy
What Is Lattice Corneal Dystrophy?
Lattice corneal dystrophy is an inherited eye condition caused by a gene mutation, most often in the TGFBI gene, that leads to abnormal protein deposits building up inside the cornea. These deposits form a branching, lattice-like pattern that your eye doctor can see during an exam. Over time, the deposits cloud the cornea and cause a range of vision problems.
The deposits in lattice dystrophy are made of amyloid protein, a substance that does not belong in healthy corneal tissue. They collect in the stroma, which is the thick middle layer of the cornea, and gradually disrupt its normal structure. As the deposits build up, they create an uneven surface and reduce the cornea's ability to transmit light clearly.
One of the most painful features of lattice dystrophy is recurrent corneal erosions. These happen because amyloid deposits interfere with how the outermost layer of the cornea, called the epithelium, attaches to the layer below it. When the connection is weak, the epithelium can tear away, often during sleep when the eyelid lifts off a dry eye surface. This causes sudden, severe pain, tearing, and light sensitivity upon waking, and these episodes tend to return over and over again as the deposits continue to spread.
In the early stages of lattice dystrophy, glasses may still correct your vision reasonably well. As the deposits grow and the corneal surface becomes more irregular, they cause a type of distortion called irregular astigmatism, which glasses cannot fix. Many people also notice increasing glare, halos around lights, and reduced contrast that make reading and night driving more difficult.
Treatment Options for Lattice Corneal Dystrophy
There is no treatment that stops the underlying gene mutation causing lattice dystrophy, but there are good options for managing its effects on vision and comfort. The right approach depends on how far the condition has progressed and how much your daily life is being affected.
When an erosion occurs, your eye doctor will typically treat it with lubricating ointments, bandage contact lenses, and sometimes antibiotic drops to prevent infection. For patients who have frequent or severe erosions, other procedures such as diamond burr polishing or corneal scraping may help the epithelium reattach more securely. These treatments ease symptoms but do not eliminate future erosions because the underlying deposits remain.
When irregular astigmatism makes glasses and soft contacts ineffective, scleral lenses are often recommended. These larger, rigid lenses vault completely over the cornea and rest on the white of the eye, called the sclera. They create a smooth optical surface that compensates for the irregular corneal shape and can restore clear, comfortable vision. As an added benefit, the lens shields the fragile corneal surface from friction caused by blinking, which may reduce how often erosions occur during waking hours.
For patients with more advanced lattice dystrophy, surgical options may become necessary. Phototherapeutic keratectomy, known as PTK, uses a laser to remove amyloid deposits from the surface of the cornea and can reduce erosion frequency. For deeper deposits and significant corneal clouding, your eye doctor may discuss corneal transplant surgery, which replaces the affected tissue with healthy donor cornea. Both deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) are options depending on how much of the cornea is involved.
How Scleral Lenses Help with Lattice Corneal Dystrophy
Scleral lenses are considered one of the most effective tools for managing vision loss from lattice dystrophy. Their unique design addresses the specific challenges that amyloid deposits create for the corneal surface and the optical system.
Because scleral lenses vault over the entire cornea without touching it, the space between the lens and the eye fills with a fluid reservoir of preservative-free saline. This fluid layer fills in the bumps and irregularities caused by amyloid deposits, creating a smooth front surface for light to pass through. The result is often significantly better vision than glasses or soft contacts can achieve on an irregular cornea.
During waking hours, the eyelid moves across the cornea with every blink. In lattice dystrophy, this friction can weaken the already fragile epithelium. A properly fitted scleral lens keeps the eyelid from making direct contact with the corneal surface, reducing one of the triggers for erosion episodes. Your eye doctor may also recommend overnight lubricating ointments to address the separate issue of lid sticking during sleep, when lenses are not being worn.
For many patients, scleral lenses can delay or postpone the need for corneal transplant surgery by maintaining functional vision and managing surface problems for years. Surgery carries risks and requires a long recovery period, so it is often preferable to continue with scleral lenses as long as they provide adequate vision and comfort. When and whether surgery becomes necessary is a conversation your eye doctor will guide you through based on how your condition progresses.
What to Expect from Scleral Lens Fitting
Fitting scleral lenses for lattice corneal dystrophy is a specialized process that requires expertise in both the condition and the lens design. Our optometry team has deep experience fitting complex and medically necessary contact lenses, and we take the time to find the right fit for each individual cornea.
Your eye doctor begins by mapping your corneal surface using a technology called corneal topography, which captures the shape and elevation of your cornea in detail. This mapping shows where amyloid deposits are located and how they affect the surface. The scleral lens must vault high enough to clear the elevated deposits while keeping the fluid reservoir thin enough to avoid blurring your vision. If your cornea has scarring from prior erosion episodes, those areas are factored into the lens design as well. Dr. Paul Zerbinopoulos, who has specialized in scleral lens fittings since 2008, Dr. Earle Scharff, with decades of experience fitting medically complex cases, and Dr. Lori Boivin, trained at Massachusetts Eye and Ear, are all available to guide patients through this process.
Scleral lenses require a consistent daily care routine to stay clean and safe to wear. Before inserting your lens, you fill the bowl of the lens with preservative-free saline to create the fluid layer that sits against your cornea. After removing the lens at the end of the day, you clean it with a daily surfactant cleaner and disinfect it overnight. Handling the lens gently and keeping the optical surface scratch-free is important for maintaining clear vision. If you experience sudden pain upon waking, even while using lenses during the day, let your eye doctor know, as this may indicate a corneal erosion that needs attention.
Lattice dystrophy progresses over time, which means your scleral lens fit may need to be adjusted as your cornea changes. At each follow-up visit, your eye doctor evaluates the density and spread of amyloid deposits, assesses your corneal clarity, and checks how well your vision is performing through the lenses. If the deposits advance to a point where scleral lenses can no longer provide functional vision, your eye doctor will discuss next steps including PTK or corneal transplant surgery.
Frequently Asked Questions
Here are answers to some of the questions patients with lattice corneal dystrophy commonly ask about scleral lenses and managing this condition.
Scleral lenses reduce friction on the corneal surface during the hours you wear them, which can lower the risk of daytime erosion triggers. However, most erosions happen during sleep when lenses are not being worn, so scleral lenses alone are not a complete solution. Your eye doctor will likely recommend overnight lubricating ointments as well, and in some cases may suggest additional treatments such as PTK to strengthen the epithelial attachment and reduce overall erosion frequency.
Lattice corneal dystrophy follows an autosomal dominant inheritance pattern, meaning a parent with the condition has a significant chance of passing the gene mutation to each child. If you have been diagnosed, a baseline corneal examination for your children and siblings is a reasonable step. Early detection means that if family members do show signs of the condition, they can begin appropriate monitoring and treatment before vision problems become more severe.
In lattice dystrophy, amyloid deposits and potential corneal scarring create unpredictable surface elevations that are not present in many other scleral lens candidates. The fitting process requires more detailed topography analysis and often more trial and adjustment to find a vault that clears all the irregular areas without creating excess fluid pooling that blurs vision. As deposits progress over time, follow-up adjustments to the lens design may also be needed more frequently than in conditions where the corneal shape is more stable.
Yes, and this is actually a common scenario. Corneal transplant grafts often heal with irregular astigmatism that glasses cannot fully correct, and scleral lenses are one of the most effective ways to restore sharp vision after surgery. Once the transplanted cornea has healed and sutures have been managed, your eye doctor will take new corneal measurements and begin the fitting process again with the post-surgical surface. Many patients find that scleral lenses are just as useful after transplant as they were before.
If corneal clouding from amyloid deposits becomes too dense for scleral lenses to compensate for, surgical options become the next consideration. PTK can remove superficial deposits and improve corneal clarity in some cases. For deeper involvement, corneal transplant surgery (either DALK or PK depending on how much of the cornea is affected) replaces the diseased tissue with healthy donor tissue. After transplant, scleral lenses may still be needed to correct any remaining irregular astigmatism from the graft, making the expertise to fit them just as relevant after surgery as before.
Because a properly fitted scleral lens vaults over the cornea entirely and rests on the sclera, the lens does not make contact with the deposits. Most patients do not feel the deposits at all while wearing their lenses. If discomfort does occur, it is more likely related to the fit of the lens edge on the sclera than to the corneal deposits themselves. Any persistent discomfort should be reported to your eye doctor so the fit can be evaluated and adjusted if needed.
Expert Scleral Lens Care at Rhode Island Eye Institute
Our specialty contact lens team at Rhode Island Eye Institute brings years of experience fitting scleral lenses for medically complex conditions, including lattice corneal dystrophy, across our locations throughout Rhode Island. We combine advanced diagnostic technology with personalized care to help you get the clearest, most comfortable vision possible at every stage of your condition. If you are struggling with vision loss or discomfort from lattice dystrophy, we encourage you to schedule a specialty lens consultation and find out whether scleral lenses are the right fit for you.