How Scleral Lenses Helped Sabreena Drive at Night with Keratoconus
- Dr. Brandon Cohenmehr, OD
- Aug 2
- 7 min read
Night driving can become one of the first things people give up when keratoconus starts changing their vision. Headlights stretch into starbursts. Street signs double. Glare hangs in the air long after a car passes. Even when a standard eye chart looks “good enough,” the real-world experience can feel completely different.
That was the problem for our patient Sabreena.
Sabreena had been diagnosed with keratoconus, a condition that causes the cornea to thin and bulge into an irregular shape. For many people, that irregular shape creates more than blur. It can cause ghosting, glare, halos, and distorted vision, especially in low light.
For Sabreena, the hardest part was driving at night. The combination of dark roads, bright headlights, and reduced contrast made something ordinary feel stressful and unsafe. Glasses and regular soft contact lenses often do not fully correct this kind of irregular corneal shape, so we looked at a more customized option: free form scleral lenses, designed with IContour scleral profilometry and the Visionary Optics Latitude lens.
The result was life-changing in a very practical way. Sabreena was able to drive at night again.
Sabreena’s video testimonial
Why keratoconus can make night driving so difficult
Keratoconus changes the front surface of the eye. Instead of a smooth, round cornea, the cornea becomes more cone-like and uneven. Light entering the eye no longer focuses cleanly in one place. It scatters.
That scattered light is often most noticeable at night because the pupil gets larger in dim conditions. A larger pupil allows more peripheral light rays to enter the eye, and those rays may pass through more irregular parts of the cornea. That can make symptoms worse after sunset.
Common night driving complaints with keratoconus include:
Glare from headlights
Halos around lights
Starbursts
Double images or ghost images
Blur that changes with blinking
Poor contrast on dark roads
Trouble judging distance or lane markings
This is one reason keratoconus can feel so frustrating. A person may be able to function during the day, then struggle badly at night. The issue is not just “needing stronger glasses.” The eye’s shape itself is affecting the quality of the image.
For some patients, glasses can help in early stages. Regular soft contact lenses may also help if the corneal irregularity is mild. But when the cornea becomes more uneven, standard lenses may bend over the irregular surface and fail to create a smooth optical system.
That is where scleral lenses can make a major difference.
What makes scleral lenses different
Scleral lenses are larger than regular contact lenses. Instead of resting directly on the cornea, they land on the white part of the eye, called the sclera. The lens vaults over the cornea, leaving a thin reservoir of preservative-free saline between the back of the lens and the front of the eye.
That fluid layer is one of the reasons scleral lenses can work so well for keratoconus.
The fluid fills in many of the irregularities on the corneal surface. The front surface of the scleral lens then creates a smoother optical surface for light to pass through. For a person with keratoconus, this can mean sharper vision and less distortion than glasses or standard soft lenses can provide.
Scleral lenses can also feel surprisingly comfortable. Because they rest on the sclera rather than the sensitive cornea, many patients tolerate them well once they learn how to insert, remove, and care for them.
For Sabreena, the goal was not simply to read more letters on a chart. The goal was functional vision. She needed vision that helped her feel safer and more capable in everyday life, including behind the wheel at night.
That distinction matters.
A vision plan should account for what the patient actually needs to do. Reading a chart in a bright exam room is not the same as navigating nighttime traffic, glare, and moving headlights.
Why a custom free form design mattered for Sabreena
Not every scleral lens is the same. Some eyes have a relatively regular scleral shape. Others have curves, elevations, or asymmetries that make a standard lens harder to fit.
A traditional scleral lens fitting often involves trial lenses, observation, and adjustments. That process can work well, but more advanced mapping technology can give the doctor a much more detailed view of the eye’s shape.
For Sabreena, we used IContour scleral profilometry to help capture the shape of the eye beyond the cornea. This type of measurement helps show the contour of the sclera, not just the central cornea. That information can guide a more individualized lens design.
We then fit her with the Visionary Optics Latitude lens, a free form scleral lens designed to better match the unique shape of the eye.
The term “free form” means the lens can be designed with more customization than a standard symmetric lens. Instead of assuming the eye has the same shape all the way around, a free form design can account for asymmetry. This can help with:
More even landing on the sclera
Better lens stability
Reduced areas of pressure or lift
Improved centration
A more reliable visual result
That kind of customization matters for patients with complex corneal conditions, including keratoconus. A lens that centers well and stays stable can provide clearer, steadier vision. That stability becomes especially important when the real goal is night driving, where even small changes in lens position can affect glare and clarity.
For patients looking into keratoconus treatment in Los Angeles, this is the kind of detail that can separate a basic contact lens fitting from a medically guided specialty lens process.
The fitting process was about more than lens power
With keratoconus, the prescription is only one part of the story.
A standard glasses prescription mainly tells us how to focus light. A scleral lens fitting must do more. It has to create the right optical correction while also fitting the eye in a healthy, comfortable way.
For Sabreena, IContour profilometry helped give us a detailed map to guide the design. The Latitude lens allowed that design to be shaped around her eye, rather than forcing her eye to adapt to a more generic lens.
That is especially valuable when night vision is the concern. Halos, ghosting, and glare can sometimes persist if the lens decentrates, flexes, dries out, or does not align well with the eye. A custom design gives us more control over these variables.
The process also includes patient training. Scleral lenses have a learning curve. Patients need to learn how to fill the lens with saline, apply it without bubbles, remove it safely, and clean it properly. These skills become routine with practice, but they are an important part of success.
Sabreena’s story is a reminder that the right technology is only part of the outcome. Careful fitting, follow-up, and patient education all matter.
What changed for Sabreena
The biggest change was simple: Sabreena could drive at night.
That may sound ordinary to someone who has never lost the ability to do it comfortably. But for a person with keratoconus, getting back behind the wheel after dark can mean getting back a level of independence.
Night driving is tied to daily life in ways people often do not think about until it becomes difficult. It can affect the ability to:
Leave work after dark
Attend evening events
Visit family or friends
Run errands after sunset
Drive in winter months when daylight is shorter
Feel confident on unfamiliar roads
For Sabreena, scleral lenses helped reduce the visual barriers that had made night driving so challenging. The goal was not perfection in a clinical sense. The goal was meaningful improvement in a situation that mattered to her.
That is one of the most rewarding parts of fitting scleral lenses for keratoconus. The outcome is not just a number on a chart. It is freedom, comfort, and confidence in daily life.
Why specialty lens technology can change the experience
Keratoconus care often includes more than one type of treatment. Some patients may need corneal cross-linking to help slow progression. Some may use glasses, soft lenses, hybrid lenses, corneal gas permeable lenses, or scleral lenses. In more advanced cases, surgical options may be discussed.
In many keratoconus patients, the cornea is too irregular for glasses to fully correct the distortion. A scleral lens can place a smooth, regular surface in front of that irregular cornea. The fluid reservoir between the lens and the eye helps neutralize the uneven shape beneath it.
When the lens is designed from detailed eye shape data, it can be even more precise. IContour scleral profilometry and the Visionary Optics Latitude lens are part of that approach. They help move the fitting process away from guesswork and toward a design that respects the individual eye.
For people researching scleral lenses in los angeles, this is an important point. The success of a scleral lens often depends on both the lens design and the fitting process. A custom lens is only as good as the measurements, evaluation, and adjustments behind it.
What patients with keratoconus should know about night vision
If keratoconus has made night driving difficult, it is worth bringing that up clearly during an eye exam. Do not assume that reading the chart is the only measure that matters.
The details of the symptom can help guide care. For example, there is a difference between blur, ghosting, glare, dryness, and lens movement. Each can point toward a different issue.
These details can help determine whether scleral lenses may be a good option, and what kind of design may be needed.
It is also useful to set realistic expectations. Scleral lenses can dramatically improve vision for many patients with keratoconus, but every eye is different. Some people need more than one design adjustment. Some need added optics to address residual distortion. Some need treatment for dryness or allergies to improve wearing time.
A careful fitting process gives the best chance of success.
The takeaway from Sabreena’s story
Sabreena’s experience shows what can happen when keratoconus care focuses on the person, not just the diagnosis.
She was not simply fit with a contact lens. Her eyes were measured with IContour scleral profilometry. Her lens was designed using the Visionary Optics Latitude free form scleral lens platform. The goal was specific and practical: help her see well enough to drive at night.
That goal became possible.
For patients living with keratoconus, especially those struggling with glare, halos, and night driving, scleral lenses may offer a level of visual quality that glasses or standard contacts cannot provide. The right design can make the road look clearer, headlights feel less overwhelming, and daily life feel more manageable again.
This article is for informational purposes only and does not replace a medical eye exam. Keratoconus and specialty contact lens care should be evaluated by an eye care professional familiar with corneal disease and scleral lens fitting.
Cohenmehr Optometry is in network with common vision plans including VSP (Vision Service Plan), EyeMed, and many others. These plans often cover partial or the full amount for scleral lenses. Contact us at 310-828-2010 to verify your details.
Sabreena’s story is a reminder that better vision is not only about seeing smaller letters. Sometimes it is about getting back something that felt out of reach, like the simple confidence to drive after dark.
