Keratoconus Treatment

What is Keratoconus?

Corneal Cross-Linking

Specialty Contact Lenses

Specialty Surgery for Keratoconus

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What is Keratoconus?

Keratoconus is an inherited eye condition that damages the cornea, which is the transparent window in the front of the eye that focuses light. Over time, the cornea becomes deformed and thinner. Normally, the cornea is a circular dome-like shape, but in Keratoconus it develops into a cone-like protrusion.

The deformed cornea will disperse light, which prevents appropriate focusing of light to generate a clear image in your eye. This results in blurry vision.

Blurry and distorted vision

Vision (even with glasses or contacts) isn’t quite clear. Objects are often slightly out of focus. Images may appear slightly distorted; straight lines may look bent or wavy

Trouble focusing, image shadows

Patients may find their eyeglass prescriptions changing dramatically over a year. An image that was clear (left) may have image shadows (right), and will appear out of focus.

Eye redness, itching, or irritation

Keratoconus is associated with eye allergies and frequent eye rubbing. Some patients also have a history of asthma, skin conditions like eczema.

Keratoconus is most often diagnosed in young people during puberty or late adolescence. In the early stages, Keratoconus produces mild blurring and distortion of vision, as well as increased sensitivity to light. Keratoconus will worsen over time, so it’s important to diagnose the condition early.

Keratoconus usually affects both eyes, though often one eye is much worse than the other. Symptoms can differ in each eye, and they can change over time.

In the early stage, keratoconus symptoms can include:

mild blurring of vision
slightly distorted vision, where straight lines may look bent or wavy
increased sensitivity to light and glare
eye redness, itching or irritation

In later stages, keratoconus symptoms often include:

more blurry and distorted vision
increased nearsightedness or astigmatism (when your eye cannot focus as well as it should). Patients may find their eyeglass prescriptions changing dramatically over a year.
difficulty wearing contact lenses. They may no longer fit properly, not provide adequate vision, may become uncomfortable to wear, or easily fall out.
blindness

In keratoconus, the cornea thins out and bulges forward in a cone-like shape.

Keratoconus usually takes years to progress. For some people, though, keratoconus can worsen quite quickly. The cornea can suddenly swell up (a condition called corneal hydrops) and start to scar. Once the cornea has scarring, it loses its smoothness, images become further warped and distorted, and less clear. Vision gets even worse.

Keratoconus is associated with eye allergies and frequent eye rubbing. Some patients also have a history of asthma, skin conditions like psoriasis. The cause for keratoconus is not certain, though it does have a genetic component; about 10% of people with keratoconus have a parent who has it too.

Keratoconus can be diagnosed through a routine eye exam. Your ophthalmologist will examine your cornea. Your ophthalmologist may also map your cornea’s surface using a special imaging device connected to a computer (this is called corneal topography). This detailed image shows the condition of the cornea’s surface, highlights any irregularities, and can detect small changes in the corneal curvature and shape.

How is Keratoconus Treated?

Keratoconus treatment will often depend on the anatomical state of your cornea, and your symptoms. With mild keratoconus, and mild visual distortion, eyeglasses or soft contact lenses can help correct your vision. As keratoconus progresses, additional treatment may be needed. Here are other ways that your ophthalmologist might treat keratoconus:

Collagen cross-linking (CXL): This once-in-a-lifetime procedure is designed to halt the progression of keratoconus. Your ophthalmologist uses a special UV light and eye drops to strengthen the cornea by creating cross-links between the collagen fibers in the cornea, strengthening and stiffening it. This prevents the cornea from bulging further. Most ophthalmologists recommended getting this procedure for mild keratoconus in order to prevent it from getting worse.
Specialty hard contact lenses: Your ophthalmologist may recommend specially fit contact lenses, which serve to act as an artificial surface to bend light. By doing so, you can see better than what glasses or soft contact lenses would allow you to see.
Specialty Surgery for Keratoconus:
Corneal Re-Contouring: For mild-moderate cases of keratoconus. These procedures seek to improve the curvature of a person’s cornea, in order to improve their quality of vision. Techniques for corneal re-contouring include Laser Keratoplasty, CAIRS, INTACS, CTAK
Small-Aperture Optics: For mild-moderate cases of keratoconus. This involves cataract surgery with a specialty lens designed to reduce optical aberrations
Corneal transplant: When the cornea is very steep and cone-like, there is scarring on the cornea, and hard contact lenses are too difficult to wear or don’t provide an adequate level of vision, your ophthalmologist may suggest a corneal transplant. This is a surgery in which your ophthalmologist replaces the diseased cornea with healthy donor cornea tissue.

Further Reading at the American Academy of Ophthalmology

What is Collagen Cross-Linking?

Collagen Cross-Linking (CXL) is a procedure designed to strengthen the cornea. For patients with keratoconus, this can be a life-changing procedure and can halt the progression of keratoconus. Your ophthalmologist uses a UV light and eye drops containing a specially-compounded Riboflavin solution (Vitamin B2) to strengthen the cornea by creating cross-links between the collagen fibers in the cornea. This process stiffens and strengthens the cornea, and can prevent the cornea from bulging further. Most ophthalmologists recommended getting this procedure for mild keratoconus in order to prevent it from getting worse. Further Reading

Your ophthalmologist uses a UV light and eye drops containing a specially-compounded Riboflavin solution (Vitamin B2) to strengthen the cornea

What are Specialty Contact Lenses?

Though most of us are familiar with soft contact lenses, for many patients with keratoconus, such contact lenses may not fit well or provide an adequate quality of vision. Your ophthalmologist may instead recommend wearing specialty contact lenses.

These specialty contact lenses are a safe, painless, non-surgical, and reversible method to vision correction. It involves wearing a customized FDA-approved gas permeable lens that acts as an artificial surface over your cornea. This allows for clear 20/20 vision that glasses or soft contact lenses would otherwise not be able to provide.

Specialty contact lenses have different names and types. Some of these include Rigid Gas Permeable (RGP) Lenses, Scleral Lenses, PROSE Lenses, hybrid lenses or piggyback lenses. Your doctor will work with you to find the lens that best suits your needs.

What is Corneal Hydrops?

In moderate-to-severe Keratoconus, a devastating exacerbation may occur, called corneal hydrops. In corneal hydrops, the back-most layer of the cornea (Descements’ membrane) tears, and fluid from the eye enters the cornea, causing it to swell, thicken, and become hazy. Patients with keratoconus may suddenly feel like their vision is blurry, out of focus. Patients may even have pain and/or sensitivity to light.

An episode of corneal hydrops warrants an urgent visit with your ophthalmologist. Short-term, corneal hydrops can be treated medically with eyedrops, including a salt-water solution called Muro-128. Muro-128 which is meant to reduce the swelling in the eye.

Sometimes with corneal hydrops, a scar may develop after treatment. If the scar is large and interferes with vision, then a corneal transplant may be needed.