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What is keratoconus?

Keratoconus is a condition in which the cornea becomes progressively thinned out and bulges like a cone. It results in visual blurring or distortion from myopia and irregular astigmatism.

What causes keratoconus?

The causes of keratoconus are hard to identify. Keratoconus is often labelled “a dystrophy of unknown origin”. Researchers believe that oxidative damage to the corneal tissues, genetic factors, allergies, or chronic inflammation can contribute to the condition.
In our opinion, the contrast between the marked deformatory changes seen in the corneal wall of keratoconus patients and the relative absence of specific genetic and biomolecular findings in these eyes make genetic and inflammatory factors unlikely causative factors. We believe that keratoconus is primarily a mechanical disease, with the main cause being eye rubbing.

What are the symptoms of keratoconus?

Blurred and distorted vision and frequent change in eyeglass prescription are the first symptoms of keratoconus. However, blurred and distorted vision can occur as a result of many other types of eye disease, and so it is important for you to consult an experienced eye care professional immediately when any changes in vision are noticed. Typically, keratoconus occurs in both eyes, but with one eye more severely affected than the other. Additional symptoms of keratoconus include increased light sensitivity, difficulty driving at night, halos and ghosting (especially at night), eye strain, headaches and vague eye discomfort and irritation. Many individuals with keratoconus admit to excessive eye rubbing.

How is keratoconus diagnosed?

Keratoconus is usually discovered when a patient consults an ophthalmologist for decreased or blurry vision. It can usually be diagnosed by clinical examination and corneal topography (a test that determines the curvature (shape) and thickness patterns in the eye).

How is keratoconus treated?

In early disease, glasses or soft contact lenses may be able to improve vision for some patients. However, in moderate to advanced disease, keratoconus is primarily treated with rigid gas permeable or scleral contact lenses. In such cases, glasses and soft lenses are unable to visually correct the irregular form of the cornea. Surgical treatment with intracorneal rings (eg Intacs) are also available and are typically used when contact lens wear is no longer possible. In advanced cases, corneal transplantation (deep anterior lamellar keratoplasty) may be required.

I was told RGP (rigid gas permeable contacts) will stop keratoconus from worsening. Is this true?

No. This is not true. It is an “old wives’’. When worn, the RGP lenses temporarily flatten the non-structural epithelium (skin) of the cornea. This creates the illusion of reversing the disease process, but it does not truly prevent keratoconus from progressing. With time, the contact lenses must be continually refitted and replaced to keep up with worsening disease. In our experience, cessation of eye rubbing is the best method of arresting disease progression. We have demonstrated this in many of our patients, and they are described in detail here in this website.

What is the purpose of cross-linking? Will this improve my vision?

The last four of years has seen a marked increase in the prominence of corneal collagen cross-linking as a treatment strategy for progressive Keratoconus. This interest has arisen from a body of evidence documenting the biomechanical and cellular changes induced by cross-linking. Corneal cross-linking is not expected to improve vision. Corneal collagen cross-linking is, from our point of view, a practice whose effectiveness is doubtful. Our extensive experience in this field shows that stopping eye rubbing suffices to halt the progression of the disease. A possible benefit of cross-linking may be a consequent of one of its side-effects, and this is indirectly related to eye rubbing. The reduction of corneal sensitivity seen after cross-linking may reduce ocular pruritus, and this in itself can inhibit the urge to rub. This could account for the purported stabilization observed after cross-linking procedures for keratoconus.

Will I go blind from keratoconus?

Keratoconus does not typically lead to blindness. However, the disease can degrade vision to a level where one’s quality of life may be affected, especially if contact lens intolerance develops. Corneal hydrops (extensive swelling and then scarring of the cornea) can occur as the disease progresses, and this can compromise vision further. In some of these cases, corneal transplantation may be necessary to prevent vision deteriorating to legal blindness.

Does early diagnosis make any difference in keratoconus progression?

Definitely. In early disease, vision is minimally affected, and the goal of treatment would be to arrest the disease at this stage and prevent it from deteriorating further. This is where cessation of eye rubbing is key and is the cornerstone of treatment. We have seen in all our patients that once eye rubbing stops, keratoconus ceases to evolve.

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