Keratoconus: symptoms, causes & treatment

November 27, 2020

What is Keratoconus: Symptoms

Keratoconus is a condition that causes progressive thinning of the cornea over time. It tends to onset in a  patient’s teens to early twenties and usually stabilizes sometime in their thirties. The cornea develops a localized area of steep curvature which causes it to resemble a cone. This uneven curvature of the cornea can induce high amounts of irregular astigmatism, which can cause other keratoconus symptoms: blurry vision, double vision, halos, glare, eyestrain, headaches, and more. It often occurs in both eyes but can be asymmetric, causing more visual distress in one eye versus the other.

Keratoconus Causes

The absolute cause of keratoconus is unknown; however, factors that may play a role include genetics, eye allergies, and excessive eye rubbing. It can also be related to connective tissue disorders.

Can Keratoconus Be Cured?

We all wish there was a keratoconus cure. Unfortunately, we haven’t found one yet. However, many treatments can help patients manage the condition.

Top 9 Keratoconus Treatments

1. Glasses

When a patient has mild keratoconus, glasses may be used. Glasses have the ability to correct myopia and astigmatism, two common refractive errors in keratoconus. However, glasses are only able to correct regular astigmatism. Keratoconus causes irregular astigmatism, which glasses don’t correct very well.

Also, people with keratoconus often have high amounts of refractive error. This can cause their glasses to look quite thick. In addition, high prescription lenses can cause visual distortion. While glasses may be suitable for those with very mild keratoconus, they often don’t work well for more advanced cases.

2. Soft Contact Lenses

While soft contact lenses are more cosmetically pleasing than glasses, they are still not able to properly correct the irregular astigmatism of keratoconus. With high prescriptions, they don’t cause the distortion that glasses do. They are also usually quite comfortable. However, vision is often still blurry, especially in moderate to severe keratoconus.

3. Corneal Rigid Gas-Permeable Contact Lenses (RGP)

Gas-permeable (RGP) contact lenses are rigid in the material. In keratoconus, light normally enters the eye through the irregular corneal surface, causing scatter. RGP contact lenses allow light to refract through their smooth and even surface, rather than the irregular cornea. This enables them to correct vision quite well. Unfortunately, though, RGP lenses can be uncomfortable. Also, while RGP lenses enable clear vision while they’re worn, they do nothing to treat the actual condition of keratoconus.

4. Piggyback Contact Lenses

Soft contact lenses have the benefit of being comfortable, but they don’t provide a great vision for people with keratoconus. While RGP contact lenses correct vision better, they can be uncomfortable. Because of the limitations of these two types of lenses, patients are sometimes fit with both an RGP contact lens and a soft lens. The soft lens is worn on the cornea, acting as a pillow for the RGP lens, which sits on top of it. This provides better vision and comfort than either lens worn alone but can drive expenses up. It also doesn’t treat the underlying keratoconus.

5. Hybrid Contact Lenses

Hybrid contact lenses are made of two different materials: gas-permeable and soft. The central portion of the lens is made of an RGP to allow for crisp vision. Attached to the central piece is a ring of soft lens material. This outer portion is often called a “skirt”, as it drapes around the central RGP button. The soft skirt is what sits on the eye, so it offers improved comfort relative to a corneal RGP. While the vision and comfort of hybrid lenses can be appreciated, their expense is sometimes a limiting factor. They can be difficult to insert, remove, and handle as well. Finally, hybrid lenses don’t reverse or stabilize keratoconus.

6. Scleral Contact Lenses

Scleral contact lenses are made of the same material as corneal RGP lenses, but they are much larger. Because of their size, they rest on the sclera of the eye, rather than the cornea. The lenses don’t move as much as corneal lenses do, making them more comfortable. The sclera is also much less sensitive than the cornea, which adds to this improved comfort. These lenses provide a good balance of vision and comfort but can be tricky to insert, remove, and handle. The cost can also be an issue here. Finally, they unfortunately don’t treat the underlying condition.

7. Corneal Crosslinking (CXL)

Corneal crosslinking is a procedure that strengthens the thin and weakened cornea in keratoconus. It involves the use of riboflavin (vitamin B) eye drops, in combination with ultraviolet light. This process strengthens the collagen bonds in the cornea. While corneal crosslinking doesn’t reverse keratoconus, it does help to stabilize the condition so it doesn’t continue to progress as it normally does. Not only does it slow the progression of the disease, but it also can help to flatten the cornea slightly, potentially improving vision. When considering how to treat keratoconus, CXL is a great option. CXL is now approved by the FDA for treatment of progressive keratoconus and corneal ectasia post LASIK. The Avedro system is
used at the Kraff Eye Institute

8. Intacs

Intacs are intrastromal ring segments that are inserted into the cornea surgically. These plastic inserts are strategically placed in the cornea to smooth out its curvature. By improving the shape of the cornea, vision is improved. This procedure can be combined with corneal crosslinking for keratoconus to freeze the results in place.

9. Corneal transplant

In advanced cases of keratoconus, especially when there is corneal scarring, a corneal transplant may be needed. This procedure involves using donor corneal tissue to replace the patient’s cornea. This surgery is rather invasive, so it’s reserved for advanced cases. There is also a chance that keratoconus could recur post-transplant.

Conclusion

While there are many ways to improve vision in keratoconus, many of them do not treat the underlying condition. CXL is the exception to this. By treating early with CXL, it can prevent cases from progressing. This keratoconus natural treatment can stabilize the shape of the cornea and potentially improve vision. Corneal crosslinking treats the root cause of this condition. If you’re looking for the best treatment for keratoconus, this may well be it. Please contact us today to schedule an appointment to explore your options.

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Dr. Colman R. Kraff

Committed to advancing new technologies in the field of ophthalmology, Dr. Colman Kraff helped to pioneer laser vision correction. In February of 1991, as part of a five-site, U.S., FDA clinical trial team, Dr. Kraff successfully performed the first excimer laser procedures in the Chicagoland area using the VISX Excimer Laser.

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