Keratoconus: Understanding the Condition and its Management
2 Dec 2024
What is Keratoconus?
Keratoconus is a progressive eye condition where the cornea—the transparent, dome-shaped outer layer of the eye—gradually thins and bulges outward into a cone-like shape. This results in blurry or distorted vision, increased sensitivity to light, and, if left untreated, can lead to irreversible vision loss.
The onset of keratoconus typically occurs during puberty or late teens and early 30s, with gradual progression over a decade or more. Both eyes are usually affected, though one eye may experience more severe symptoms than the other.
Patients with keratoconus often experience stress and anxiety due to the impact on their quality of life. While keratoconus is a chronic condition that cannot be fully cured, the good news is that most cases can be effectively managed. With early diagnosis, advanced treatment options, and expert care, patients with keratoconus can maintain an active, healthy lifestyle.
Keratoconus Symptoms:
Symptoms and their intensity vary depending on the stage of the condition—whether in early or advanced stages.
Blurred vision
Frequent changes in eye power
Irritation or itching in the eye
Sudden worsening of vision
Distorted or double vision
Astigmatism
Sensitivity to light
Difficulty seeing in dim light or at night
Halos or glares around light
Fleischer ring (brown or greyish-green rings around the cornea)
Keratoconus Causes:
While the exact cause of keratoconus remains unknown, several risk factors are associated with its development:
Frequent or excessive eye rubbing
Use of poorly fitting contact lenses or improper lens care
Family history of keratoconus (about 1 in 10 people with keratoconus have a parent with the condition)
Chronic eye inflammation/ Eye Allergy
Corneal scarring or damage due to eye injury
Severe eye complications
Congenital disorders (eye conditions present at birth)
Genetic factors, including Down Syndrome
Loss of collagen in the cornea (collagen is the protein that makes up the middle layer of the cornea)
Keratoconus Diagnosis:
Keratoconus is diagnosed through a comprehensive eye examination, corneal assessment, and a review of family and medical history. Some of the diagnostic tests include:
Slit-Lamp Examination and Refraction Test: A slit-lamp examination closely examines the cornea, and an eye refraction test evaluates the eye’s refractive (spectacle) power.
Corneal Topography/Tomography: This non-invasive imaging technique maps the curvature of the cornea and is one of the most accurate tests for diagnosing keratoconus and to monitor progression.
Pachymetry: This test measures the thickness of the cornea, which is essential for assessing keratoconus progression.
Optical Coherence Tomography (OCT): This is another non-invasive imaging technique of the cornea that produces high-quality images to assist in the detection and monitoring of the progression of keratoconus.
Keratoconus Treatment and Management:
While keratoconus cannot be fully cured, it can be effectively managed through various treatment options depending on the severity of the condition. Your ophthalmologist will recommend the most suitable treatment based on the severity of the condition and lifestyle.
Glasses or Contact Lenses: In the early stages, glasses or soft contact lenses are prescribed for vision correction.
Specialty Contact Lenses: As Keratoconus progresses, specialty contact lenses such as scleral lenses, PROSE lenses, or rigid gas permeable (RGP) lenses may be recommended. Your ophthalmologist will suggest the best option based on your condition.
Corneal Cross-Linking (CXL): This minimally invasive procedure is performed to slow the progression of keratoconus by stabilizing the cornea, preventing further thinning and bulging. The process involves applying riboflavin (vitamin B2) drops to the cornea, followed by exposure to ultraviolet light using a specialized machine. While CXL does not directly improve vision, it reduces the need for a corneal transplant.
Intracorneal Ring Segments (ICRS): ICRS implantation is a minimally invasive surgical treatment for keratoconus. These small, crescent-shaped implants are inserted into the cornea to flatten it and reduce the cone-shaped bulge, thereby improving vision.
Topography-guided Photorefractive Keratectomy (Topography-guided PRK or TG-PRK): This laser procedure uses Contoura laser technology to reshape the cornea and improve vision in patients with keratoconus. It is a minimally invasive procedure typically performed to make the irregular cornea more regular, improving vision and enhancing the fit of contact lenses.
Phakic IOLs (Implantable Collamer Lens): In patients with stable keratoconus and high spectacle power, vision can be corrected using these lenses, providing spectacle independence.
Corneal Transplant (Keratoplasty): In advanced stages, where the cornea becomes extremely thin or vision can no longer be corrected through other means, a corneal transplant may be required. The damaged cornea is replaced with a healthy donor cornea. Depending on the case, either a full-thickness transplant (penetrating keratoplasty) or a partial-thickness transplant (deep anterior lamellar keratoplasty, or DALK) may be recommended.
Frequently Asked Questions:
1) When should I consult an eye doctor for Keratoconus?
Consult an eye doctor if you experience blurred, double, or distorted vision, or frequent changes in your eye power.
2) What are the early signs of keratoconus?
Early signs include blurry vision, difficulty seeing at night, double vision, frequent changes in your eyeglass prescription, and distorted vision. In advanced stages, the abnormalities in the curvature of the cornea may be visible.
3) How can keratoconus be detected early?
If you notice any early symptoms, consult your eye doctor as soon as possible. Annual eye examinations are recommended, especially if you are at higher risk, to detect keratoconus early.
4) Can Keratoconus be fully cured?
While keratoconus cannot be fully cured, it can be effectively managed with glasses, contact lenses, specialty lenses, corneal cross-linking, or corneal transplants, depending on the severity of the condition.
5) Will I develop Keratoconus if I have a family history of the condition?
While having a family history of keratoconus increases your risk, it does not imply that you will definitely develop the condition. Regular annual eye checkups can help in early detection and prevent potential complications.
6) Can Keratoconus lead to permanent vision loss?
In advanced stages, keratoconus can cause significant vision impairment and, if untreated, may lead to permanent vision loss. However, timely treatment can prevent this in most cases.
7) Will Keratoconus affect my daily lifestyle?
Keratoconus can impact daily activities, such as driving or reading, but with proper treatment, most people can maintain an active lifestyle.
8) How can I slow down Keratoconus progression?
Your ophthalmologist will recommend the best treatment options, such as corneal cross-linking, to slow down keratoconus progression.
9) What is the cost of Keratoconus treatment or surgery?
The cost of treatment varies based on the procedure and severity. Treatments like corneal cross-linking, specialty lenses, or corneal transplants have different costs. Consult your ophthalmologist for a detailed estimate based on your needs.
Keratoconus Care at Pristine Eye Hospitals:
Our team offers advanced treatment options, including:
Corneal Cross-Linking (CXL): A cutting-edge procedure to stabilize the cornea.
Custom Contact Lenses: Special lenses designed for keratoconus patients, including scleral and hybrid lenses.
Corneal Transplants: For advanced cases, our skilled surgeons perform DALK and PK surgeries with unmatched precision.
Experience life with clearer vision and renewed confidence.