THE KERATOCONUS AND EYE RUBBING PROSPECTIVE ONLINE STUDY

BACKGROUND

Keratoconus is a condition whose origin has long been unknown. Through our clinical interactions with thousands of keratoconus patients over the years, we strongly believe that the origin of keratoconus may no longer be an enigma, and that eye rubbing is the all-important causative factor for this disease.

Despite the cumulative evidence, it is difficult to formally prove this assertion. For one, it is not possible, due to ethical reasons, to conduct a prospective study where patients are asked to rub their eyes vigorously and repeatedly to determine if keratoconus could be induced. However, it is possible to take advantage of the large number of keratoconus patients seen and monitored at our Institution to study the impact of eye rubbing on not only the genesis of the disease but also on its progression. If our assumption that eye rubbing is responsible for the onset and evolution of the disease is correct, then the cessation of eye rubbing must, at least in the early and moderate forms, arrest the progression of keratoconus.

A novel and effective way of monitoring clinical cases and sharing their progress is to document them prospectively in an open fashion online.

This is what we have done on this website.

The idea of building this keratoconus and eye rubbing portal came about in late 2016. Since then, whenever a patient is newly diagnosed with keratoconus by our team of doctors, or when a patient with known keratoconus presents to us for a routine review, the collection of the necessary clinical data including relevant photos and video recordings for the study is initiated, and the information uploaded to this website.

This website now displays more than 70 cases of keratoconus. Each case is thoroughly analyzed, at inclusion and at subsequent visits. The statistics and percentages reported here will be updated over time, and this series of cases will constitute the core of a future publication in a peer-reviewed medical journal.

AIMS OF THE STUDY

The study aims to determine the following:

  1. If there is a correlation between eye rubbing and keratoconus in terms of laterality, frequency and intensity.

  2. If there is a correlation between sleeping position and keratoconus

  3. If stabilization of keratoconus is achievable through the cessation of eye rubbing alone: this is the most important point.

DATA COLLECTION

Consecutive cases of keratoconus or ectasia post-refractive surgery newly seen or reviewed in consultation by Dr. Damien Gatinel since January 2017 are included in the study.

Other than the full set of paraclinical investigations (including manifest refraction, topography, corneal hysteresis, other biomechanical measurements and aberrometry), a detailed history taking of the presence or absence of eye rubbing and the patients’ sleeping habits is performed, and pictures of their eye profiles and sleeping positions taken. Video recordings of eye rubbing techniques and interviews of patients and their relatives are initiated whenever appropriate. These are all taken with the patients’ full informed consent.

Progression or stabilization of the keratoconus is documented objectively via difference maps.

PATIENT MANAGEMENT, EDUCATION AND COUNSELLING

All patients with a positive eye rubbing history are instructed to stop rubbing their eye(s) immediately. Those with an unhealthy sleeping posture are instructed to alter their sleeping position or prescribed eye shields. Patients who deny eye rubbing or are unaware of their habits are interrogated again at subsequent visits, and accompanying relatives are questioned when necessary to corroborate their stories.

OUR RESULTS AND CONCLUSIONS SO FAR…

Our on-going analysis of these cases has so far strongly supported the hypothesis that eye rubbing is the root cause of keratoconus.

There is a striking correlation between the more advanced side of keratoconus and the side that is rubbed more, as well as the sleeping position.

Complete cessation of eye rubbing has resulted in stabilization of the corneal deformation (average follow-up: 2 years). Interestingly, progression is only seen in patients who admit to being unable to abandon their eye rubbing habit.

If these results are confirmed in the future, it will enable us to conclude that the corneal deformation and thinning which are hallmarks of keratoconus are initiated and aggravated by the act of vigorous and repeated eye rubbing.