Keratoconus
Understanding Keratoconus
The word Keratoconus is formed by two Greek words: kerato, meaning cornea, and konus, meaning cone. The cornea is the clear curved layer at the front of the eye. The precise shape of the cornea allows it to act as a lens, projecting an image into the eye. Sometimes the cornea is not strong enough to hold this round shape and it bulges outwards like a cone. Keratoconus is a condition in which the shape of the cornea, which is usually round, is distorted, developing a cone-shaped bulge, resulting in decreased or distorted vision.
The condition is mostly bilateral and asymmetric – meaning that it usually affects both eyes; however one eye may be more affected than the other. Keratoconus is an inherited condition that sometimes skips generations. Its onset is usually during puberty and is often related to allergies (hay fever, asthma and eczema). Rubbing the eyes can aggravate the condition. The typical patient with undiagnosed Keratoconus complains of deteriorating vision and frequent change in glasses. They may often report multiple images or ghosting of images and often relate a history of frequent refractive correction changes without much improvement in visual acuity. Patients may also report irritating symptoms such as intolerance to light (glare), photophobia and a recurrent foreign body sensation.
The treatment plan for Keratoconus has two aspects, first to stop its progression and second is to look at the refractive error and provide aid to improve the impaired vision. Severe cases may require corneal transplant. Our centres are equipped with the latest corneal topography systems (Pentacam, Orbscan) to help in early detection and monitoring of keratoconus. We offer Keratoconus treatment – Corneal collagen cross linking to stop the progression of the disease, PRK with Cross Linking to improve vision and speciality contact lenses for Keratoconus.
Symptoms
Signs and symptoms of keratoconus may change as the disease progresses.
They include:
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Blurred or distorted vision·
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Increased sensitivity to bright light and glare, which can cause problems with night driving.
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A need for frequent changes in eyeglass prescriptions·
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Sudden worsening or clouding of vision
When to see a doctor
See your eye doctor (ophthalmologist or optometrist) if your eyesight is worsening rapidly, which might be caused by an irregular curvature of the eye (astigmatism). He or she may also look for signs of keratoconus during routine eye exams.
Symptoms of Keratoconus
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Blurring of vision
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Glare
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Difficulty in night vision
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Double vision
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Frequent change of glasses
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Better near vision without the need for reading glasses
Treatment for Keratoconus
Treatment:
Keratoconus and corneal ectasia (thinning) are conditions where the cornea bulges and becomes ‘cone’ shaped. This results in impaired and distorted vision even with glasses. In the early to moderately advanced cases, RPG contact lenses, Rose K contact lenses, miniscleral contact lenses can be used to improve quality of vision. If vision does not improve with contact lenses due to advanced disease or corneal scarring, corneal transplant- DALK 9Deep Anterior Lamellar Keratoplasty) is the last resort.
C3R/ CXL/ Corneal Cross-Linking is the treatment to halt the progression of the disease in progressive cases. It works by strengthening the cornea by cross linking its building blocks (collagen). This can arrest the progression of keratoconus & has also been reported to partially reverse the corneal steepening that has already taken place. In younger patients and documented worsening of disease, CXL is advised. It can be combined with topo-guided PRK, INTACS, CAIRS, and speciality contact lenses.
What can I do to help my recovery?
The success of any surgical procedure depends on the recovery just as much as the procedure.
REST: The main thing you need to do is rest. Vision will be blurry for a while, so it’s difficult to read or watch TV. Most patients like to sleep or listen to music. Let the eye heal and don’t touch the contact lens.
AVOID INFECTION: In order to reduce the risk of infection, it is important to avoid contact with water for the first few days in particular (until your eye has healed). Your surgeon will be in the best position to advise you how long you should wait before swimming or performing heavy exercise. It is also essential to use your antibiotic drops as indicated.
MANAGE PAIN: Especially in the first day or two, stay on top of the pain. Use eye drops and take oral analgesics as advised by your surgeon.
What can I expect after corneal cross linking?
It is really important that you understand that cross linking won’t make the vision clearer. In fact, it may be worse due to residual haze in the cornea for up to a year after treatment. Why have it then? You might ask. Good question. The fact is that corneal cross linking has been clearly shown to decrease the risk of corneal transplant. The younger you are when your keratoconus is diagnosed, the more rapidly your disease will progress and the sooner you will need a graft. Any treatment that avoids corneal transplant is good news. You’ve got to take the long term view here: vision may get temporarily worse, but it will improve slowly over the next year and – if you’ve had an effective treatment – the disease will have been halted or greatly slowed in its progression.