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Keratoconus

Definition


Disease: Keratoconus Keratoconus
Category: Eye diseases

Disease Definition:

When the clear dome-shaped surface of the eye, the cornea, thins out and starts to form cone-shaped bulge in the front of the eye, keratoconus occurs.
A cone-shaped cornea causes headaches from eyestrain, blurred vision and may cause increased sensitivity to light and glare.

 

Usually, keratoconus begins during puberty or late teens, and then progresses over about 10 years. This disease usually affects both eyes.

 

Vision problems caused by the distorted corena can be corrected with soft contact lenses or glasses during the early stages of keratoconus. However, in advanced stages of keratoconus, a person may be fitted with special rigid gas permeable contact lenses. Surgery may be needed in some advanced cases of keratoconus.
 

Work Group:


Symptoms, Causes

Symptoms:

As this disease progresses, its signs and symptoms may change.

 

They include:

 

  • Disturbed night vision
  • Blurred or distorted vision
  • Increased sensitivity to bright light and glare
  • Headaches from eyestrain
  • Hydrops, a condition in which the back of the cornea ruptures and fills with fluid, causing clouded vision.

 

A person should ask his/her eye doctor about keratoconus during routine eye exam if he/she has astigmatism and their eyesight is worsening rapidly, despite the fact that the doctor will automatically look for signs of keratoconus in these exams.

 

Most people who are seeking laser assisted in situ keratomileusis (LASIK) eye surgery have keratoconus and have become frustrated because glasses and contact lenses haven't worked.

 

In case a person wants to do LASIK surgery because their vision is unclear even when wearing glasses or contacts, the doctor should check the patient for signs of keratoconus before the surgery.
 

Causes:

In most cases, the cause of corneal thinning in keratoconus is not clear. A person may be causing injury to his/her corneas, gradually distroting their shape and making them thin out if he/she has the habit of rubbing the eyes vigorously. A small percentage of pepole develop keratoconus as a result of rubbing their eyes.
 

Complications

Complications:

The corena might become scarred in advanced cases of keratoconus, especially at the point of the cone. A scarred cornea induces more disturbances in vision, and the only way to correct it is by corneal transplant surgery.
 

Treatments:

The severity and rate of keratoconus progression is what determines the treatment of keratoconus. Corrective glasses or contact lenses could treat mild to moderate cases of keratoconus, however, for advanced cases or scarring of the cornea surgery may be necessary.

 

LENSES: 

Rigid gas permeable contact lenses:

Often, the next step in treating progressing keratoconus is hard contact lenses. Many people who wear rigid lenses grow accustomed to them despite the fact that at first they may feel uncomfortable.

Glasses or soft contact lenses:

Glasses or soft contact lenses are used to correct unclear or blurry or distorted vision in early stages of keratoconus. Most people find that they need to change the prescription of their lenses quite often, as their corneas' shape changes because this condition is quite progressive.

Piggyback lenses:

The doctor may recommend piggybacking a hard contact lens on top of a soft one if the patient doesn’t like the feel of rigid lenses. A person should make sure that his/her doctor is experienced with keratoconus because fitting a combination of lenses needs a lot of precision. 

Scleral contact lenses:

These lenses rest on the white part of the eye (sclera) and vault over the cornea instead of resting on the cornea like traditional lenses.
These lenses are quite useful for irregular cornea changes.

Hybrid lenses:

These contacts have a rigid center with a softer ring around the outside and are more comfortable. These lenses are available for people who can't tolerate hard contact lenses.

Customized contact lenses:

Based on the topographical measurements of the corneas, rigid gas permeable lenses are custom made for each individual.

 

Because a poor-fitting hard contact lens could make keratoconus even worse, in case a person is using rigid or sclera contact lenses, they should make sure that the doctor who is fitting these lenses is experienced in treating keratoconus.

 

SURGERY:

In case a person can't tolerate the contact lens options, or if he/she has corneal scarring or extreme thinning of the cornea, they may need surgery.
The type of surgery is determined based on the severity of the disease and the location of the bulging cone.
Some of the surgical options include:

Intrastromal corneal ring segments (ICRS):

In order to flatten the cornea's cone, support the cornea's shape and improve vision, small synthetic arcs will be inserted into the cornea.
The patient will be given local anesthetics around the eye, either with a laser or a precision blade, an incision will be made in the cornea, and two arcs will be inserted in specific locations, depending on the shape of the cornea.
After that, the cut is stitched and in order to protect the eye until it heals, a soft lens is placed over it.

 

Many people still need to wear corrective lenses after the procedure despite the fact that this procedure restores a more normal corneal shape and blocks the progression of keratoconus. Some people try ICRS before considering keratoplasty because this procedure is reversible. Fitting and tolerating contact lenses are made easier with this surgery.

Keratoplasty:

A person will need a corneal transplant called keratoplasty in case he/she has corneal scarring or extreme thinning. This operation could be done in more than one way:

 

  • Intralamellar keratoplasty: Only a section of the cornea's surface is replaced in this procedure. It is a partial-thickness transplant.
  • Penetrating keratoplasty: An entire portion of the cornea is replaced in this procedure. It is a full-cornea transplant.

 

During this operation, the patient could either have local anesthetic, in which only the eye is numbed, or he/she could have a general anesthetic. A button-shaped portion of the cornea will be removed and replaced with a similar-sized button from a donor cornea. As the eye heals, stitches and a soft lens will be placed on it. After this procedure, in order to have clear vision, the patient will need rigid contact lenses. The recovery period after keratoplasty could take up to one year.

 

EMERGING TREATMENTS:

Collagen cross-linking is a new promising treatment for keratoconus. It is about receiving 30 minutes of exposure to ultraviolet A (UVA) light after having riboflavin drops applied to the corneas. To prevent further thinning or bulging, this procedure hardens and stabilizes the corneas.
Before this treatment is widely available, it needs additional study because it is still in the testing phase.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
Certificate:
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Expert's opinion:

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Clinical Trials:

Not available

 

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