Typically, vision loss can be corrected early with spectacles; later, irregular
astigmatism requires optical correction with rigid contact lenses. Contact lenses
provide a uniform refracting surface and therefore improve vision. Contact lenses
can improve vision,however can also scar the cornea. Patients should be informed
upon diagnosis that they will likely require contact lenses eventually.
The latest revolutionary Keratoconus treatment is C3R (Corneal Collagen Crosslinking
with Riboflavin) that has been proven to strengthen the weak corneal structure &
by increasing collagen crosslinking, which are the natural “anchors” within the
cornea. These anchors are responsible for preventing the cornea from bulging out
and becoming steep and irregular, consequence of advanced Keratoconus.
Causes of Keratoconus:
Keratoconus rarely results in total blindness although it can significantly impair
vision and, according to experts, leads to the need for a corneal transplant in
up to 20% of cases. While nobody knows the cause of keratoconus, there is evidence
that the disease has genetic origins, possibly made worse by environmental factors.It
normally affects both eyes, though it typically progresses at different rates.
In most people, keratoconus begins during their teen years and slowly worsens before
stabilizing in their 30s or 40s.
Keratoconus is a corneal disease affecting 1 in 2000 individuals. The disease usually
starts in young adults in most people, keratoconus begins during their teen years
and slowly worsens before stabilizing in their 30s or 40s and is characterized by
progressive thinning and outward protrusion of the cornea.
It is normally treated with rigid contact lenses or specialize keratoconus contact
lenses which are contoured to address the bulging cornea and to improve vision.
With newer treatments like C3R, the progression of the keratoconus can be arrested.
If keratoconus left untreated can result in severe corneal thinning, bulging and
scarring of the cornea (corneal hydrops) making the patient blind. The scarred cornea
would eventually require a corneal transplant procedure.
Signs & Symptoms
- Frequent changing of glasses or contact lens prescriptions.
- Blurring and distortion of vision.
- Glare and sensitivity to light especially during night Irritation.
- Scarring of the cornea.
The early detection of keratoconus is important to arrest the progression of keratoconus
and corneal irregularities. In early stages, keratoconus can be diagnosed after
a detailed eye examination, which includes Retinoscopy, Slitlamp examination and
tests like Topography, pentacam to check the curvature of cornea and Pachymetry
to determine corneal thickness.
In advance stages keratoconus, is easily diagnosed on slit lamp and topography.
In advanced stages, corrective prescription glasses do not help the patient to see
clearly and they have to switch to using hard or semi soft contact lenses. A proper
contact lens fit is crucial to obtain adequate vision and wearing comfort. Poorly
fit or outdated contact lenses can be uncomfortable and lead to additional complications
like corneal abrasions, scarring or infection.
Although there are no medicines known which will prevent progression of the disease,
mild cases of keratoconus can be successfully treated with glasses or specially
designed contact lens.
The keratoconus changes are first detected on the back surface before they present
on the corneal front surface. Thus keratoconus can be detected early before any
signs & symptoms by evaluating corneal back surface topography map. Today progressive
keratoconus are stablised by a Corneal Collagen Cross Linking (C3R) procedure, INTACS
and avoiding Corneal transplant surgery.
Collagen Cross linking with Riboflavin (C3-R) Treatment:
It is non-invasive treatment for keratoconus. It strengthens the collagen tissue,
which forms the fabric of the cornea. It is a simple 60 minutes in-office procedure.
Eye drops containing Riboflavin (VitaminB2) are applied on the cornea and then activated
by Ultra-violet light. The collagen cross-linking increases the strength of the
cornea by 300 percent, thereby stopping it from bulging outwards and arresting keratoconus
progression. In severe cases, C3-R treatment can also be combined with Intacs to
achieve more flattening the Keratoconus cone.
It is non-invasive treatment for keratoconus. Intracorneal rings have been approved
by the FDA for the treatment of keratoconus. These crescent-shaped plastic rings
are surgically placed in the substance of the cornea. The principle being to flatten
the keratoconus cone and improving their vision. The intacs primarily make the cornea
more regular and the C3R stabilize the progression and strengthens this weak cornea.
Intacs are used to regularize the shape of the cornea. After the above procedures
of intacs and C3R specialized contact lenses or implantable contact lenses can be
given to achieve full visual potential. INTACS MADE MORE EASIER,SAFER,AND ACCURATE
WHEN DONE BY FEMTOSECOND LASER. The advent of femtosecond laser has made creation
of accurate channels for intacs or corneal rings at precise depth and size in the
cornea, thus entering the effectiveness after corneal rings to flatten the keratoconus.
Benefits of Intacs for Keratoconus:
- Safe, removable, replaceable.
- Reduces myopia and astigmatism associated with keratoconus.
- Restores the cornea to a more natural dome shape.
- Minimally invasive surgical procedure.
- Recovery period is days, compared to months for a corneal transplant.
- Improves quality of life.
- May delay need for corneal transplant.
Keratoplasty (Corneal Transplantation):
It is the option when not all the above methods help patients to get optimum useful
vision. In this procedure the cornea, which forms the transparent outer covering
of the eye, is replaced by a donor cornea. It is an intraocular surgery and requires
long-term and consistent follow-up.
Keratoconus is a disease that causes a progressive thinning of the cornea (the clear
front portion of the eye). As a result of this condition, the normal outward pressure
from within the eye causes the cornea to progressively bulge into a cone-like shape.