Keratoconus is a progressive disease of the eye in which the cornea becomes thin and begins to bulge into a conical shape. Since this results in irregular refraction of light rays entering the eye, resulting in blurred, distorted vision and a high astigmatic error (high cylindrical power of glasses).
Keratoconus usually affects both eyes, but can be asymmetric. It often presents during teenage, or early twenties.
What are the symptoms?
As the shape of the cornea becomes irregular, it causes a progressive blurring of vision and distortion of objects. It may be corrected with cylindrical lenses in the early stages and continues to progress over time. Patients often notice a sudden and rapid increase in the power of their glasses, especially in the cylindrical correction.
In more advanced stages, this decrease of vision can no longer be corrected with spectacles alone. Patients often also complain of glare and sensitivity to light. In case of a complication called hydrops, patients experience acute pain, a decrease in vision accompanied by excessive tearing and redness of eyes.
What is the treatment?
The treatment for Keratoconus is dependent on the stage and severity of your condition, and its rate of progression. In case of mild to moderate Keratoconus, eyeglasses or contact lenses may suffice to provide perfect vision. The disease can also be self-limiting, and stabilize after a few years. In case of rapidly progressive disease or advanced Keratoconus, surgical intervention may be necessary.
Spectacles
A good refraction with the proper prescription of glasses can solve most visual needs of patients with early Keratoconus or forme fruste Keratoconus.
Contact Lenses
The most common treatment modality for Keratoconus is the use of contact lenses. Your doctor will try the regular contact lenses first, and they can help in early stages of the disease. Most patients, however, require specialized contact lenses. These are some of the options that you will need to choose from:
- Soft Contact Lenses: Since soft lenses can only correct a limited amount of astigmatism, their use is limited to few patients with the early Most patients who achieve good vision with spectacles may be considered for these lenses. However, you must be prepared for a frequent change in your prescription of glasses or contact lenses.
- Rigid Gas Permeable or Hard Contact Lenses: These are offered to patients who do not get functional vision with the use of soft contact lenses. You might find that these lenses are uncomfortable at first, but most people eventually adjust to wearing them. These can correct corneal astigmatism better than soft lenses.
- Piggyback Lenses: These are special lenses, and your doctor will offer you these if you find the rigid lenses to be very uncomfortable. In this, your doctor will give you a combination of two lenses, a procedure that requires specialized Hybrid lenses, on the other hand, apply the same logic in a single lens. These lenses have a softer ring or frill around a rigid center, providing the advantages of both lenses. The rigid lens corrects high astigmatism, while the soft frill keeps you more comfortable. These contact lenses are considerably more expensive
- Scleral Contact Lenses and Rose K Lenses: These lenses are especially useful in advanced cases of Keratoconus, and are specially manufactured for patients with advanced disease. These lenses are large diameter lenses and rest on the sclera, which is the white part of the cornea, and vault over the irregular cornea. These are also expensive, and their fitting requires the services of a specialist.
Fitting contact lenses in a patient of Keratoconus is an especially tricky job, and you must make sure you remain under the care of a cornea specialist for this, and ensure regular follow up to avoid any complications.
Surgery
Surgery is usually indicated in advanced disease or rapidly progressive disease. In case your vision remains poor even with contact lenses, or if your cornea becomes very thin, or if you are contact lens intolerant, or if the power changes very rapidly, your eye doctor may suggest a surgical option.
The most commonly used surgical techniques for restoring vision in patients with Keratoconus are the following:
- Corneal Cross-Linking (C3R): This is popularly known as C3R or CXL which is a new therapeutic non-surgical treatment with a much higher success rate than conventional treatments. In this, your surgeon uses riboflavin drops and exposes the eye to controlled ultraviolet radiation which makes the cornea stronger, and helps flatten it. Because of this, the progression of Keratoconus can be halted, and usually, most patients can go back to good vision with glasses, thus obviating the need for corneal transplants.
- INTACS, Corneal Inserts or Intracorneal Ring Segments: In some cases, your eye surgeon may prefer to insert two half-moon shaped clear plastic rings in the cornea to stabilize it via small incisions, and flatten the conical protrusion of the cornea. Like C3R, INTACS can also slow progression of the disease, and decrease the need for a corneal transplant, while making it easier to fit contact lenses.
- Cornea Transplant or Keratoplasty: In cases of advanced disease with severe scarring and thinning, eye doctors prefer to replace the cornea with a donated cornea, the surgery is called Keratoplasty. Depending on the extent of scarring and corneal thickness, your surgeon may decide to perform a full thickness procedure called Penetrating Keratoplasty, or a partial thickness procedure called Lamellar Keratoplasty. As is self-explanatory, the former is more invasive and carries a higher rate of complications and failure. Lamellar keratoplasty techniques have undergone dramatic developments and Deep Anterior Lamellar Keratoplasty, DALK, combines the added efficacy of a penetrating Keratoplasty with the lesser complication rate of the Lamellar Keratoplasty.
Which is the best hospital for Keratoconus treatment?
Any disease which is a serious threat to vision, Envison Lasik Centre finds great pride in being equipped fully with state of the art equipment to perform each of these procedures. The extremely skilled and trained cornea specialists are well versed in the surgical techniques of managing Keratoconus and bring the state of the art, affordable patient care to each of their patient interactions.