Being diagnosed with keratoconus can feel overwhelming, but there’s hope. This condition affects each person differently, making it complex to treat with no single solution. In fact, there are at least eight treatment options that can be combined in various ways to improve vision and halt further loss. Each procedure requires a recovery period, making the journey to good vision up to two years long. Patience from both the patient and the corneal surgeon is essential. Losing patience means losing the battle. Many healthcare providers may not be aware of the incredible advancements in keratoconus treatment, leading to misinformed patients losing hope. Today, even freedom from glasses and contact lenses is possible for some patients.
In this blog, I will start by explaining the basics and then move on to the treatment options. You can also click here to watch the video.
Keratoconus is a non-inflammatory eye condition where the normally round, dome-shaped cornea (the clear window of the eye) progressively thins, causing a cone-like bulge to develop. This change in shape brings light rays out of focus, resulting in blurry and distorted vision, making daily tasks like reading or driving difficult. Keratoconus can cause significant visual impairment, but not everyone experiences the same progression or severity.
Doctors are not entirely sure why people develop keratoconus. It appears to be a combination of genetic, allergic, and other factors. About 1 in 10 people with keratoconus have a parent with the condition. Keratoconus is often first diagnosed in the late teens to early 20s, with vision symptoms worsening over 10 to 20 years before stabilizing. In Sub-Saharan Africa, keratoconus is seen in children as young as eight. Each eye can be affected differently.
Avoid vigorous eye rubbing, which can damage the thin corneal tissue and worsen symptoms. If you feel the urge to rub your eyes due to itching, consult your ophthalmologist about medications to control allergies. If itching persists, try rubbing the inner corner of your eye against the nasal bone to relieve the itch without damaging the cornea.
Keratoconus often affects both eyes differently, and symptoms can change over time.
Early-stage symptoms include:
Later-stage symptoms include:
Keratoconus usually progresses slowly over years but can worsen quickly in some cases. Sudden corneal swelling and scarring can further distort and blur vision. In late-stage keratoconus, glasses and scleral contact lenses may no longer correct vision adequately.
Keratoconus can be diagnosed during a routine eye exam, but additional tests may be needed.
Keratometry: Measures the cornea’s shape by focusing a circle of light on it.
Optical Coherence Tomography (OCT) and Corneal Topography: Create detailed maps of the cornea’s inner and outer surface and measure its thickness, aiding in treatment planning.
Treatment depends on symptom severity. Mild symptoms can be corrected with glasses. Later, special hard contact lenses called scleral lenses may be needed to keep vision in focus.
Your optometrist will refer you to an ophthalmologist if:
Different procedures can be combined based on the case:
Cross-Linking Procedure
Cross-Linking Bonds
2. Intra-Stromal Corneal Ring Segments:Small, curved devices placed in the cornea using a femto-second laser to flatten the cornea and improve vision.
ICRS
3. Corneal Allogenic Intrastromal Ring Segments (CAIRS):Uses donor corneal tissue to improve vision and corneal shape, avoiding risks associated with synthetic rings.
Corneal Transplant
4. Photorefractive Keratectomy (PRK):Laser surgery to correct mild to moderate refractive errors after cross-linking and corneal rings.
PRK
5. Implantable Contact Lenses:Correct low to high refractive errors associated with keratoconus.
Implantable Contact Lenses
These procedures are often combined for optimal results. For older patients, cross-linking and corneal rings can be followed by cataract surgery with an intraocular lens to further improve vision.
Corneal Transplant for Advanced Keratoconus
When symptoms are severe or the cornea is scarred, a corneal transplant may be suggested. This surgery replaces part or all of the diseased cornea with healthy donor tissue.
Options include:
Penetrating Keratoplasty (PKP):Full-thickness central cornea replacement with donor tissue. Sutures are removed after a year, with vision improving over this period. Additional refractive laser surgery may be needed later.
The treatment of keratoconus is complex, requiring a specialist for optimal results. Cross-linking should be considered upon diagnosis to slow disease progression and prevent further vision loss. If glasses cannot correct your vision, scleral contact lenses are an excellent option. If scleral lenses are intolerable, more complex surgical options should be considered. Contrary to popular belief, freedom from glasses and contact lenses is possible for some keratoconus patients.
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