Specialty Contact Lens
Keratoconus Contact Lens Seattle · modern combination management since 2002
The Carlson family practice has fit keratoconus contact lenses since Paragon CRT FDA approval in 2002. Today's standard of care combines scleral lens fitting with corneal cross-linking referral coordination — both anchored by Dr. Curtis Ono's 25+ years of specialty CL experience.
years fitting Ortho-K + scleral · since Paragon CRT FDA approval
typical fitting time · diagnosis to all-day comfort
co-management with referring corneal surgeons
Is this for you?
Keratoconus is a progressive thinning of the cornea that produces irregular astigmatism — vision standard contacts can't correct. The modern answer is two-part: scleral lenses (to restore functional vision now) plus corneal cross-linking (to slow or stop progression). PSEC fits the scleral side in-office and co-manages cross-linking referrals with Seattle-area corneal surgeons. The fit takes 3–5 visits over 6–10 weeks for most patients.
When this is the answer
When keratoconus management is the right answer
Newly diagnosed keratoconus
Progressive corneal thinning + cone formation; vision can't be corrected with standard glasses or soft contacts
Stable keratoconus with vision complaint
Cross-linking unnecessary if disease is stable; scleral lens restores functional vision
Progressive keratoconus, pre-cross-linking
Cross-linking referral + interim scleral lens; PSEC coordinates with corneal surgeon
Post-cross-linking keratoconus
Cross-linking stops progression but doesn't restore vision; scleral lens delivers vision
Failed soft toric or RGP fit
Standard rigid gas-permeable and toric soft lenses often fail with KC; scleral works
Bilateral keratoconus
Both eyes can be fit in parallel; sclerals work even with asymmetric progression
Your specialist
Dr. Curtis Ono, OD
Eye evaluations for all ages with emphasis in ocular disease management and challenging contact lens fits.
- Indiana University Optometry School
- 25+ years specialty contact lens experience
- AOA President's Award · OPW Jack Hale Lifetime Achievement Award
- Consumers' Research Council of America · Top Optometrist
- Ocular therapeutic drug + laser + injectable medication certified
- Past President · GWCO · OPW · Pierce County Optometric Society
What to expect
What to expect
Visit 01 · 60-75 min
Diagnostic Workup
Corneal topography (3D surface map), pachymetry, anterior segment OCT, manifest refraction, slit-lamp exam. Disease staging (Amsler-Krumeich) + cross-linking candidacy assessment. Plan discussion.
Visit 02 · Same-day handoff
Cross-Linking Referral (if indicated)
If progression is documented or risk is high, PSEC refers to a Seattle-area corneal surgeon (Pacific Cataract & Laser, UW Medicine, or Eye Associates NW). Coordination letter + topography files sent.
Visit 03 · 60-90 min
Diagnostic Scleral Trial Fit
Trial scleral lens placement each eye. Vault assessment via OCT or slit-lamp. Settling time + over-refraction. Custom lens parameters specified for the lab.
Visit 04 · 60 min
Dispensing Visit
Custom lenses arrive 2-3 weeks after Visit 3. Insertion + removal training. Care protocol. Fluid solution prescriptions. Wear schedule + adaptation expectations.
Visit 05 · 30 min each
1-Week + 1-Month Follow-Ups
Wear time + comfort assessment. Lens-cornea relationship re-check via OCT. Minor design refinement if needed. Final fit confirmation at month one. Schedule annual re-eval.
Cost + insurance reality
Transparent pricing · we verify before we fit
| Service component | Range |
|---|---|
| Initial keratoconus consult + corneal topography + workup | $250–$450 (typically medical-billable for KC) |
| Custom scleral lens (per eye) | $1,500–$2,500 |
| Annual replacement lens (per eye, Year 2+) | $400–$800 |
| Cross-linking referral coordination | Included; cross-linking itself billed by referring surgeon |
| Maintenance: 1–2 follow-ups/year | $150–$300 per visit (typically medical-billable for KC) |
| Bilateral first-year typical total (scleral lens portion) | $3,500–$6,000 |
Medical insurance typically covers fitting + follow-ups for medically-necessary keratoconus under CPT 92072 + 92313. Vision plans (VSP, EyeMed, MetLife) do NOT cover keratoconus scleral fitting — it's strictly medical. HSA/FSA fully eligible. CareCredit financing available for the patient-paid portion.
For referring physicians
Coordinating keratoconus care with the referring physician or corneal surgeon.
Dr. Ono coordinates routinely with Pacific Cataract & Laser Institute, UW Medicine Cornea Service, and Eye Associates of Northwest for keratoconus cross-linking. Every patient receives a referral-back letter documenting fit, follow-up plan, and outcomes — sent to the referring physician within 7 days of the dispensing visit.
Send referrals to scleral-referrals@pugetsoundeyecare.com or fax (206) 526-5224.
FAQ
Common questions
What is keratoconus, exactly?
Keratoconus is a progressive eye disease where the cornea — the clear dome over your iris — thins and bulges into a cone shape. The irregular cone causes light entering the eye to scatter rather than focus, producing distorted vision that glasses and standard contacts cannot correct. It usually starts in late adolescence (ages 15–25) and progresses for 10–20 years before stabilizing. Both eyes are usually affected, often asymmetrically.
Why can't regular glasses fix keratoconus?
Glasses correct a regular cornea by adding spherical or cylindrical power. A keratoconic cornea has irregular astigmatism — the irregularity changes from point to point across the cornea. No single glass prescription can correct that. A scleral lens works because it vaults over the cornea entirely and creates a new, smooth refracting surface in the fluid reservoir behind the lens.
Should I get corneal cross-linking, scleral lenses, or both?
Both, in most cases. Cross-linking is a surgical procedure that strengthens the cornea and slows or stops progression — it doesn't restore vision. Scleral lenses restore functional vision but don't stop progression. Modern keratoconus management combines both. If your keratoconus is stable (no progression documented over 12+ months), cross-linking may be optional. If you're newly diagnosed or progressing, both are indicated. Dr. Ono coordinates cross-linking referrals with Seattle-area corneal surgeons.
How is keratoconus diagnosed?
Diagnosis combines corneal topography (3D surface map), pachymetry (cornea thickness measurement), and slit-lamp examination. Staging follows the Amsler-Krumeich classification (Stages 1–4 by corneal curvature, thinning, and best-corrected vision). PSEC performs all three diagnostic tests in-office during the initial consult.
What happens if my keratoconus is too advanced for scleral lenses?
Stage 4 keratoconus with significant corneal scarring may require corneal transplantation (DALK or PKP) before scleral lens fitting. PSEC co-manages post-transplant patients with the corneal surgeon — fitting scleral lenses over the graft to restore vision once the eye has healed (typically 6–12 months post-op).
Does insurance cover keratoconus contact lens fitting?
Medical insurance typically covers fitting (CPT 92072 + 92313) for medically-necessary keratoconus. Vision plans (VSP, EyeMed) do NOT cover keratoconus management — it's strictly a medical billing category. The lens itself is usually patient-paid even with medical insurance. We verify your specific benefit before the fitting begins. HSA/FSA + CareCredit financing apply.
How long does it take from diagnosis to wearing lenses full-time?
Initial consult to fully comfortable all-day wear: typically 6–10 weeks across 4-5 office visits. Complex cases (severe disease, post-cross-linking, post-graft) may run 12+ weeks. Each visit averages 30-90 minutes.
Book your specialty contact lens visit
“The first 30 seconds of a keratoconus diagnostic fit tell me whether sclerals are going to work for that eye. The lens vaults the cornea — it doesn't sit on it. By visit three, most of my keratoconus patients are reading 20/20 or 20/25 for the first time in years. The fit is technical, but the outcome is the same story I've watched unfold for 25 years: standard contacts fail because the cornea is irregular. Sclerals work because they don't touch it.”
Primary-source evidence
Sources cited on this page
- [1]Romero-Jiménez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: a review. Contact Lens & Anterior Eye 2010;33(4):157-66. View source →
- [2]Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. American Journal of Ophthalmology 2003;135(5):620-7. The original cross-linking publication. View source →
- [3]Hashemi H, Heydarian S, Hooshmand E, et al. The Prevalence and Risk Factors for Keratoconus: A Systematic Review and Meta-Analysis. Cornea 2020;39(2):263-270. View source →
- [4]Severinsky B, et al. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes. Contact Lens & Anterior Eye 2014;37(3):196-202. View source →