Clear Vision Ahead: Navigating Keratoconus and Your Treatment Options

Keratoconus is an eye disease that causes the cornea - a smooth dome-shaped layer covering the eyeball - to become progressively thin, distorting and protruding into the shape of a cone. Due to these changes, vision becomes blurred and sensitivity to light is aggravated. Usually both eyes are affected and in the absence of the treatment it can result in severe vision loss. The exact cause of keratoconus remains unclear, but it is known that timely diagnosis and appropriate treatment are the most important for controlling the disease. They can prevent the disease from getting worse.

Keratoconus and its Causes

Keratoconus may be due to many causes, some of them are:

1. Genetics: If someone in the family has keratoconus, there may be increased chances. There is a genetic link to the disease for some individuals.
2. Eye Rubbing: Eye rubbing on its own has a correlation with keratoconus progression. Individuals with allergies, especially those affected by allergic eye disease, have a tendency to rub their eyes often making them likely to suffer from the disease.
3. Collagen Weakness: Cornea is made from collagen, and any weakness in collagen fibers causes cornea to be irregular in shape.
4. Underlying conditions: There are other systemic diseases which may accompany keratoconus, like Down syndrome, Ehlers-Danlos syndrome or Marfan syndrome.
5. Environmental Causation: The condition may progress in furtherance of prolonged exposure to UV light, contact lens wore visually or otherwise unfit, or due to recurrent eye inflammation.

Symptoms of Keratoconus

Keratoconus symptoms typically start to appear in late adolescence or early adulthood and can worsen over time. Common signs include:

1. Blurred or distorted vision: As the cornea changes shape, the ability to see clearly decreases.
2. Increased sensitivity to light and glare: This can make activities like driving at night particularly difficult.
3. Frequent changes in prescription: A rapid need for adjustments in glasses or contact lens prescriptions is a common indicator.
4. Double vision in one eye: Even with corrective lenses, patients may experience ghosting or double vision.
5. Eye strain and headaches: Due to constant focusing issues, patients often experience fatigue and headaches.

Treatment Options for Keratoconus

While keratoconus can progress over time, modern treatment options can significantly slow its progression and improve vision.

1. Corneal Cross-Linking (CXL)

Corneal cross-linking is an innovative, minimally invasive procedure designed to strengthen the cornea by creating new bonds between collagen fibers. This treatment halts the progression of keratoconus, preventing further corneal thinning and bulging. The two types of CXL procedures are:

• Epi-On: The epithelium outer layer of the cornea is left intact.
• Epi-Off: The epithelium is removed to allow better penetration of the riboflavin solution used during the procedure.

2. Specialized Contact Lenses

For patients with mild to moderate keratoconus, custom-designed contact lenses can significantly improve vision. The following types of lenses are commonly used:

• Rigid Gas Permeable (RGP) lenses: These provide a smooth optical surface by sitting on the cornea, correcting irregularities.
• Scleral lenses: These larger lenses rest on the sclera (the white part of the eye) rather than the cornea, offering comfort and stability for advanced keratoconus cases.
• Hybrid lenses: Combining a rigid center with a soft outer ring, these lenses offer both comfort and sharp vision.

3. Intacs – Intracorneal Ring Segments

Intacs are small, crescent-shaped rings implanted in the cornea to flatten its surface and reduce cone-like distortions. This procedure is often used in mild-to-moderate keratoconus cases and can improve both vision and contact lens tolerance.

4. Topography-Guided Photorefractive Keratectomy (PRK)

Topography-guided PRK is a laser vision correction procedure tailored to the individual’s corneal irregularities. Unlike LASIK, it doesn’t involve creating a corneal flap, making it a safer option for those with keratoconus. PRK helps improve the cornea’s shape and can reduce the need for glasses or contact lenses.

6. Corneal Transplant

For patients with advanced keratoconus where other treatments are ineffective, a corneal transplant may be necessary. This procedure involves replacing the damaged cornea with healthy donor tissue. There are two main types:

• Penetrating keratoplasty (PK): A full-thickness corneal transplant.
• Deep anterior lamellar keratoplasty (DALK): Only the outer and middle layers of the cornea are replaced, preserving the healthy inner layer.

Managing Keratoconus: What You Can Do

While keratoconus can be a challenging condition, certain lifestyle changes and regular eye care can make a significant difference in managing symptoms:

• Avoid rubbing your eyes: This can further weaken the cornea and accelerate the condition.
• Wear UV-protective sunglasses: Protecting your eyes from harmful UV rays may slow disease progression.
• Regular eye checkups: Early detection through comprehensive eye exams can help manage keratoconus before it significantly impacts vision.