Keratoconus- Corneal Bulge
The information below has been provided with permission from the National Keratoconus Foundation (NKCF).
What Is Keratoconus?
(Ker-a-to-co-nus)
Keratoconus, often abbreviated to “KC”, is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment. Keratoconus may cause substantial vision distortion, with multiple images, streaking, and extreme light sensitivity. The early symptoms of the disease may look no differently than normal refractive defects of the eye. It is important to know more about keratoconus, because it often times goes undiagnosed, and has to be confirmed with corneal topography.
Who Gets Keratoconus?
Although the actual incidence of KC is not known, it is estimated to affect one in 500 to one in 2,000 people. While not rare, it is also not highly common. Keratoconus is generally diagnosed during adolescence or early adulthood and can affect individuals worldwide. Certain ethnic groups, such as South Asians, and individuals with conditions like Down Syndrome, are more likely to develop the disorder.
What Happens? Corneal Thinning and Bulging.
The cornea is the transparent, dome-shaped layer at the front of the eye that refracts most of the incoming light. When the cornea’s structure is compromised by corneal thinning, as is the case with keratoconus, it distorts the way light enters the eye. This leads to significant vision issues, making everyday tasks like driving, watching TV or reading a book difficult. In its earliest stages, keratoconus may cause mild blurring, light sensitivity, distorted vision, often appearing during a person’s late teens or early twenties. The condition may worsen over 10 to20 years before stabilizing, with the eye potentially being affected differently.
Keratoconus Symptoms and Treatment
Symptoms:
- Blurred or distorted vision
- Increased sensitivity to light
- Seeing multiples images or streaking
- Difficulty performing daily tasks, such as driving or reading
Treatment:
In the early stages, keratoconus treatment typically involves eyeglasses or soft contact lenses correct the mild nearsightedness and astigmatism. As the condition progresses and corneal thinning worsens, rigid gas permeable (RGP) contact lenses are generally prescribed to maintain clearer vision. These lenses require careful fitting and frequent checkups to accommodate the changing shape of the cornea.
In some cases, Intacs (intracorneal rings) may be used to improve the fit of contact lenses, offering more comfort and better vision correction.
Call 281-407-9062 for an appointment.
Riboflavin Corneal Collagen Crosslinking
Corneal crosslinking is a new treatment option under investigation, to halt the progression of keratoconus. In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue. CXL works by increasing collagen crosslinks, which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular.
During the corneal crosslinking treatment, custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. This process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea Collagen crosslinking is not a cure for keratoconus. The aim of this treatment is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation. Glasses or contact lenses will still be needed following the cross-linking treatment (although a change in the prescription may be required) but it is hoped that it could limit further deterioration of vision.
This procedure, developed at the Technische Universität Dresden, Germany has been shown to slow or arrest the progression of keratoconus in published European studies. CXL is currently in US Food and Drug Administration (FDA) clinical trials.
Corneal Transplants
Although only 15-20% of those with keratoconus ultimately require corneal transplant surgery, for those who do, it is a crucial and sometimes frightening decision. However, it helps to know more about keratoconus and what to expect before, during and after surgery. Those who do are better prepared and feel more in control of their health care.
In keratoconus, a corneal transplant is warranted when the cornea becomes dangerously thin, or when sufficient visual acuity to meet the individual’s needs can no longer be achieved by contact lenses due to steepening of the cornea, scaring, or lens intolerance. Lens intolerance occurs when the steepened, irregular cornea can no longer be fitted with a contact lens, or the patient cannot tolerate the lens
If you suspect you, or a loved one, may have keratoconus, or if you’re experiencing eye pain, bulging, and severe vision problems, it’s time to seek help from Dr. Goosey.
Call 281-407-9062 for an appointment.
Understanding Ectasia
Ectatic corneas are both a contraindication and an occasional consequence for a LASIK patient, who should have never had the surgery to begin with. In a healthy cornea, when you do LASIK, the cornea maintains its shape, and you receive the benefits from LASIK for a long period of time. But, in an unhealthy cornea, the tissue keeps thinning on its own after the procedure, and you eventually lose the benefits from LASIK. These patients have to go into hard contact lenses to achieve best possible vision. That is why Dr. Goosey is very selective on who he will perform surgery on. Because it can be easy to miss subclinical signs of keratoconus, we use the best corneal topographer available today, the Oculus Pentacam. It can detect even the most negligible signs of ectasia or keratoconus.
Unstable Radial Keratotomy
Radial Keratotomy (RK) was a refractive procedure for treating myopia, (nearsightedness) that was very popular throughout the 80’s & 90’s. A flattening of the cornea was achieved by making radial incisions in the cornea. The number of incisions in the cornea, were commensurate with your degree of myopia. Some patients had as many as 16, or even up to 64 incisions in their cornea. The problem with RK is that it was a very unstable procedure. Over a period of 15 to 20 years of the cornea flexing due to changes in intraocular pressure, the cornea collapses centrally and the patient is left with hyperopia (farsighted). But, there is good news for post RK patients, we are able to enhance these patients with either LASIK, PRK, or a Lens Exchange procedure with a monofocal intraocular lens. Multifocal Intraocular Lenses are a contraindication for post RK patients, because the optics in the lens will cause severe glare and halos for these patients.