keratoconus diagram.jpg

A disorder of the eye in which you have progressive thinning of the cornea.  In the early stages this may minimally affect vision.  But in latter stages it can decrease vision significantly and may require a corneal transplant.  In this disorder, an area of the cornea becomes thinner and this causes the front surface to bulge out in a cone form. 

Light entering the eye will be distorted by this irregular shape and not allow a clear image to project onto the retina.  As thinning progresses, the cornea may become so thin it leads to the forming of scar tissue which does not allow for light to pass thru.  Dr. Ricardo Silva can monitor the advancement of Keratoconus by using a Corneal Topographer.  This device is used to map the curvature of the cornea which he can track the progression over time.

 At this time, there is no cure for this disorder, but there are steps to take to minimize the advancement of Keratoconus.  One possibility is a new procedure called Corneal Cross-linking.  This procedure is only intended to stop or slow the advancement of the thinning of the cornea.  The only way to truly correct the vision with patients that suffer from this disorder is to create a regular surface with a rigid lens.  This creates a smooth surface which light can pass through without any scattering.  Once a smooth surface is achieved, then a proper prescription can be acquired.

Which Lens is Right for me?

  • Soft Lens – Spherical, Toric, Multi-Focal

  • RGP

  • Scleral Lenses

  • Synergeyes – Hybrid Lens

Some people have experienced frustration trying different ways to correct their vision.  There are options available that many optometrists do not offer due to its complexity.  Dr. Silva specializes in alternative lenses which only a few optometrists in Miami, FL offer these services.

What to expect

Once you have made your first appointment with Dr. Silva, listed below is a breakdown of what to expect.  Most Fittings take up to 3-4 visits.  Some Fittings may take longer depending on the individual circumstances.

First Session

  • Refraction

  • Corneal topography

  • Evaluation of Eye Health

  • Contact Lens Fitting

  • Ordering of Your New Lenses

Second Session

  • Testing New Special Contact Lenses

  • Training of Insertion and Removal of Special Contact Lens

Third Session

                Discuss how lenses functioned in your real world environment which helps Dr. Silva make any additional changes to improve fit and vision with your new contact lenses. If no further changes were required then this would successfully conclude the fit sessions. 


The First Session

First and foremost, this is a painless experience, no matter if it is the first time wearing contact lenses or you are already accustomed to contact lenses in the past.  Dr. Silva will go through a variety of tests to determine the best prescription, size and style lens you may require. 

The Refraction – Dr. Silva will take his preliminary measurements to determine your prescription to be used for your glasses and contact lenses.  If you have ever been to an eye doctor, this process may be familiar to you.

Corneal Topography – After the refraction is completed you will move onto the Corneal Topographer.  In Keratoconus patients, this is an important step.  The function of the topographer is to map the surface of the cornea.  This is done by projecting concentric rings of light onto the eye and a computer takes a scan which then processes this information into a map.  From this map, Dr. Silva will acquire the data needed to determine his starting point.

Evaluation of Eye Health – It is also important to know what is happening on the surface and the inside your eye in a complete eye exam.  Dr. Silva will make sure your eye is healthy enough to proceed onto the following steps.

Contact Lens Fitting – Now that Dr. Silva has the information he needs to continue, he will begin testing new lenses on your eye.  In the case of Keratoconus, he will need to make sure he finds a lens that will remain stable and provide the best possible vision.  The lens should not affect the protruding cone, in order to keep the eye healthy for the long term. 

Ordering of Your New Lenses - Once the appropriate type of contact lens has been identified, then the custom lens will be ordered and may take a few days to a couple of weeks to arrive.

The Second Session

Testing Your New Contact Lenses

Once that the new lenses have arrived, Dr. Silva will have you try them on in-office.  The best-case scenario is that the prescription and fit determined in the first session will not need an adjustment.  Dr. Silva will make sure that the lens sits exactly where it needs to sit on the eye and that you are getting the best possible vision that he can for your needs.  Results may vary.  If it is necessary for further adjustments, then Dr. Silva may order a different lens or return the lenses to make these changes.


Insertion and Removal of Contact Lenses

You will be taught how to properly insert, remove and care for the contact lenses.  There are different techniques depending on the style of lenses Dr. Silva has ordered for you.   Our staff is here to help you find the best technique for you.  Our staff are extremely patient in this process because each person is different and have different levels of sensitivities.  Don’t give up.  Everyone can learn this process.  Dr. Silva and his staff are here to help you and there are also tutorial videos that are accessible on our website. 

Now that you are home with your new lenses, Dr. Silva wants you to test them.  In office, we can only simulate your vision needs but when you step into your personal environment, that is when the true test begins.  Dr. Silva wants you to think about a few main factors.

  • Is the Contact lens comfortable?

  • Is the vision functional at all distances?

  • Can you see at a distance while driving and watching TV?

  • Can you see at near to read book, iPad, or phone?

  • Can you see your computer monitor?

If the vision is not acceptable, Dr. Silva can try to adjust the prescription to help you achieve your expectations. 

If the lenses are uncomfortable, this is especially important to let us know because there is no reason to be in discomfort.  Dr. Silva will find the root cause of the discomfort which could be a simple fix depending on the situation. 

Insertion of Scleral Contact Lenses

Removal of Scleral Contact Lenses

Third Session

When you return from testing your new contacts in your real world situations, Dr. Silva will address any additional changes to improve fit and vision. If no further changes were required then this would successfully conclude the fit sessions.  At any point, if you have questions, call us at 305-279-1737 or send us an email at