• Mortimer Hirst's Dr Aki Gokul.


Tackling conical cornea with the latest contact lens and imaging technology

Keratoconus is a chronic condition that affects the cornea, the transparent, dome-like tissue located at the front of the eye. It is characterised by progressive thinning and protrusion of the cornea. As a result, the cornea increases in curvature, protruding and taking up an irregular, conical shape (like a traffic cone), as opposed to a regular, spherical shape (like a soccer ball), leading to reduced vision.

Keratoconus is relatively common in New Zealand, estimated to occur in between 1/500 and 1/1000 of the general population. The condition usually develops in the early teenage years, followed by the disease getting progressively worse until age 30-40. The symptoms of keratoconus are non-specific; most patients simply experience blurry or fuzzy vision. In the earliest stages of keratoconus there may be no or minimal symptoms at all. Fortunately, a specialised imaging device called a corneal topographer, which maps the shape of the cornea, is used by the optometrists at Mortimer Hirst to detect keratoconus in these early stages.

In the early stages of keratoconus, when the shape of the cornea is relatively normal, spectacles or soft contact lenses provide adequate vision; however, as the disease progresses and the corneal shape becomes more irregular, rigid (hard) therapeutic contact lenses are required to adequately compensate for the abnormal shape of the cornea. With proper care, regular replacement of the lenses as they degrade, and regular eye exams to ensure the contact lenses do not compromise the health of your eyes, well-fitting contact lenses can provide lifelong visual rehabilitation for keratoconus.

All the members of our clinical team at Mortimer Hirst are highly experienced in fitting and maintaining the specialty contact lenses required for keratoconus. As you may have read on our website, in 1943 Gene Hirst accepted, with great success, a challenge by an Auckland ophthalmologist to manufacture the first contact lenses in New Zealand for a keratoconic patient. You can read more about the fascinating history of contact lens manufacturing at Mortimer Hirst on our home page www.mortimerhirst.co.nz.

The technology used to fit and manufacture contact lenses has changed substantially since 1943, but one thing that has not changed is Mortimer Hirst’s commitment to being at the forefront of developments in the assessment and management of keratoconus, using the latest technology and research to provide you with the best possible eye care. These commitments from the clinical team include post-graduate study and research into keratoconus.

Members of the clinical team teach contact lens fitting for keratoconus in the Bachelor of Optometry programme at the University of Auckland and have received scholarships for specialist training overseas in the fitting of scleral lenses for keratoconus.

Early detection of keratoconus is vital; if the condition is allowed to progress unchecked, the corneal shape can become too irregular for contact lenses to be worn safely and comfortably and corneal scarring can limit vision (often to the level of legal blindness). In these cases, transplantation of a human donor cornea is necessary and this occurs in about 20% of cases. Fortunately, a recently developed, relatively simple surgical procedure called corneal collagen cross-linking has been shown to stop or slow down disease progression and dramatically reduce the risk that a corneal transplantation is required. The clinical team at Mortimer Hirst works closely with eye specialists in the public and private sector who perform corneal collagen cross-linking and corneal transplantation, so you can be assured that surgical options will be explored if required.

The clinical team at Mortimer Hirst can diagnose keratoconus, assess its severity and determine if it is progressing using the latest technology. Based on this, they can formulate a customised treatment plan that will provide visual rehabilitation so that keratoconus does not prevent you from doing the things you want to do.  

Optometrist and contact lens specialist Dr Aki Gokul completed his PhD in keratoconus in 2016. A large portion of his research involved a large study conducted through Mortimer Hirst. Dr Aki lectures globally on his ground-breaking research into keratoconus and its management, including the use of the latest contact lens technology. Dr Aki continues to be actively involved in research into keratoconus and its management with contact lenses and surgery at a post-doctoral level, through Mortimer Hirst, the University of Auckland and the Auckland District Health Board.