Keratoconus

The treatment of keratoconus depends on its severity and rate of progression. Mild or moderate keratoconus can be treated with corrective glasses or contact lenses, but surgery may be necessary for advanced cases or scarring of the cornea.

The treatment approach to keratoconus follows an orderly progression from glasses to contact lenses to corneal transplantation. Glasses are an effective means of correction for mild keratoconus. As the cornea steepens and becomes more irregular, glasses are no longer capable of providing adequate visual improvement. Corneal transplant surgery is indicated when a patient cannot wear contact lenses for an acceptable period of time or when the vision, even with contacts, is unsatisfactory. Over 90% of corneal transplants are successful with the majority of patients obtaining vision of 20/40 or better afterward with either glasses or contact lenses.

Lenses

• Glasses or soft contact lenses. Early keratoconus can be treated with glasses or soft contact lenses to correct blurry or distorted vision. But because the condition is progressive, most people find they frequently need to change the prescription of their lenses as their corneas' shape changes.


• Rigid gas permeable contact lenses. Hard contact lenses are often the next step in treating progressing keratoconus. Rigid lenses may feel uncomfortable at first, but many wearers grow accustomed to them.


• Piggyback lenses. If you don't like the feel of rigid lenses, your doctor may recommend piggybacking a hard contact lens on top of a soft one. Fitting a combination of lenses takes a lot of precision, so be sure you get fitted by a doctor experienced with keratoconus.


• Hybrid lenses. Also for people who can't tolerate hard contact lenses, these contacts have a rigid center with a softer ring around the outside for increased comfort.


• Customized contact lenses. These rigid gas permeable lenses are custom created for each individual based on topographical measurements of your corneas.


• Scleral contact lenses. These lenses are useful for irregular cornea changes, because they rest on the white part of the eye (sclera) and vault over the cornea, instead of resting on the cornea like traditional lenses.

If you're using rigid or scleral contact lenses, be sure that they're fitted by an eye doctor with experience in treating keratoconus, and that you go in for checkups and re-fittings. A poor-fitting hard contact lens can make keratoconus worse.

Surgery

You may need surgery if you have corneal scarring, extreme thinning of your cornea, or you can't tolerate the contact lens options. Several surgeries are available, depending on the location of the bulging cone and the severity of the disease. Surgical options are:

• Intrastromal corneal ring segments (ICRS). During this surgery, your doctor inserts small, synthetic arcs into your cornea to flatten your cornea's cone, support the cornea's shape and improve vision. First, you are given local anesthetics around your eye. Your surgeon makes an incision in your cornea, either with a precision blade or a laser, and inserts the two arcs in specific locations based on your cornea's shape. The incision is closed with stitches, and a soft lens is placed over your eye to protect it as it heals.
  
  Although this surgery can restore a more normal corneal shape and halt the progression of keratoconus, many people still need to wear corrective lenses following the procedure. However, the surgery makes it easier to fit and tolerate contact lenses. Since the surgery is reversible, some people try ICRS before considering keratoplasty.
  


• Keratoplasty. If you have corneal scarring or extreme thinning, you will need a corneal transplant, called keratoplasty, which can be performed in a number of ways. Intralamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea's surface is replaced. Penetrating keratoplasty is a full-cornea transplant, in which an entire portion of your cornea is replaced.
  
  During a keratoplasty, you may have a general anesthetic, or just your eye may be numbed with a local anesthetic. Your doctor removes a button-shaped portion of your cornea, replacing it with a similar-sized button from a donor cornea. Stitches and a soft lens are placed to protect your eye as it heals. Recovery after keratoplasty can take up to one year, and you will likely continue to need rigid contact lenses to have clear vision

Emerging treatments

A new treatment for keratoconus, called collagen cross-linking, is showing promise. After having riboflavin drops applied to your corneas, you receive 30 minutes of exposure to ultraviolet A (UVA) light. The procedure hardens and stabilizes the corneas, with the goal of preventing further thinning or bulging. The treatment is still in its testing phase and additional study is needed before it's widely available.

If you have just been diagnosed with keratoconus, let me first of all reassure you that there have been many recent advancements in the realm of keratoconus to equip eye care professionals with the proper tools to help you.

Keratoconus is a vision disorder that affects the front surface (cornea) of the eye. The changes that take place occur because the cornea becomes thinner in certain areas. The condition causes the normal regularly shaped cornea to become microscopically irregular in shape. This causes light to scatter in irregular ways causing vision to be blurry, distorted, warped, and haloed as opposed to crisp and clear. Because glasses and normal off-the-rack contact lenses cannot help to make the surface of the eye even and regular, for most keratoconus patients, they are not able to provide ideal vision. Additionally, lasik surgery is not an option for patients with this thinning disorder because lasik surgery thins the cornea in an effort to correct vision. Therefore it would only make the condition worse.

Keratoconus affects thousands of Americans and people all across the world. It is believed that there may be a genetic component to the disease as it has been seen in identical twins. However many keratoconus patients develop the condition after a mild accident, trauma to their eye or after years of eye rubbing. Many other patients are not able to trace the condition to a family member or any type of eye trauma.

The first thing that you should do when you are diagnosed with the condition is ensure that you are under the care of an eye care practitioner who is knowledgeable about the condition. A knowledgeable practitioner will know, understand, and be able to decide on the best course of treatment for you. Although many keratoconus patients appear similar when they present to an eye care office, no two patients are alike. Each has specific needs related to the shape of their eyes and how they use their vision on a daily basis both for work and recreation. It is critical that your practitioner knows both you and your eyes.

In order to get the best idea of what the shape of your eye is, your practitioner may consider using an instrument called a corneal topographer. This allows them to measure the specific areas of the eye in order to get the best assessment of the shape and contours of the eye. This is extremely helpful in order to properly diagnose, and decide on the proper treatment options.

In mild cases of keratoconus, eyeglasses can still be used to help correct vision. However, in most all cases of the condition, proper vision correction is best achieved with the use of specially designed contact lenses. Depending on the shape of the eye, type of prescription, and discussion with you, your eye care practitioner will decide on an initial contact lens type. In order to get the proper contact lens for you, a contact lens fitting must be performed. This is often times performed as a separate visit to the office. Following this visit, the lenses will be ordered from a contact lens laboratory or manufacturing plant. Typically contact lenses can be made in several days, but it can take up to 2 weeks in some cases for the lenses to arrive back in the office.

Once the lenses arrive in the office, an additional visit is usually scheduled to ensure that the lenses are fitting on the eyes correctly and giving the optimal vision. At this visit you are typically instructed on how to insert and remove the contact lenses. Many times a wearing schedule will be described to you so that you can begin to adjust to the lenses. As with most medical devices and things that are new to our bodies, it may take several days to weeks to adjust to the comfort, vision, and feeling of the new lenses. This is very typical in most cases. Most offices will request a follow up visit within one to three weeks to ensure that the lenses are fitting correctly. Make sure to wear the lenses for several hours prior to this visit as an assessment of the lenses is best done after the lenses have been worn for at least three hours. It is critical to ensure that the fit of the lenses is correct as they can cause damage to the eye if they are incorrect. On occasion the initial type of lens that is tried does not work. This is not uncommon and should not cause alarm. Fortunately as stated earlier, there are many options. The practitioner may switch you from one type of contact lens type to another if your eyes were not able to adapt to the initial lens type.

In very severe cases when contact lenses cannot provide ideal vision, there are also surgical options available. These surgical options are progressing and are showing improving results. However they are not a perfect solution, they require a significant healing time and most patients still must wear specialty designed contact lenses following the procedure.

Keratoconus is a condition that will last a lifetime. Within the past 10 years dramatic insight, knowledge, and research has come out regarding the condition, its diagnosis, and treatment options. Find a practitioner that you can trust and is up to date with the most recent advancements. Make sure that they know everything there is to know about your eyes and vision, but most importantly, they should know you. This is the type of relationship that will last a lifetime.

In very severe cases when contact lenses cannot provide ideal vision, there are also surgical options available. These surgical options are progressing and are showing improving results. However they are not a perfect solution, they require a significant healing time and most patients still must wear specialty designed contact lenses following the procedure.

Keratoconus is a condition that will last a lifetime. Within the past 10 years dramatic insight, knowledge, and research has come out regarding the condition, its diagnosis, and treatment options. Find a practitioner that you can trust and is up to date with the most recent advancements. Make sure that they know everything there is to know about your eyes and vision, but most importantly, they should know you. This is the type of relationship that will last a lifetime.

Article Source - TreatKeratoconus.com

From the *Department of Ophthalmology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel; daggerDepartment of Family Medicine, Clalit Health Services, Rehovot, Israel; double daggerDepartment of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; section signDepartment of Ophthalmology, Rabin Medical Center, Petah-Tiqva, Israel; paragraph signDepartment of Ophthalmology, Barzilai Medical Center, Ashkelon, Jerusalem, Israel; and ||Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.

Abstract

PURPOSE: To evaluate the association between keratoconus (KC) and immune disorders (IDs).

METHODS: A retrospective observational case-control study of all the members in the Central District of Clalit Health Services in Israel who were diagnosed to have KC (years 2000-2007; n = 426) and 1704 age- and gender-matched controls. We calculated the prevalence of the following IDs: rheumatoid arthritis, ulcerative colitis, arthropathy, amyloidosis, systemic lupus erythematosus, celiac disease, multiple sclerosis, myasthenia gravis, polymyalgia rheumatica, idiopathic thrombocytopenic purpura, Crohn disease, Hashimoto thyroiditis, autoimmune hepatitis, irritable bowel syndrome, asthma, and environmental allergy. The odds ratio (OR) of having IDs among patients with KC was compared with controls.

RESULTS: The association between KC and the following IDs was statistically significant: rheumatoid arthritis [OR = 8.1; 95% (confidence interval) CI: 1.5-44.2], ulcerative colitis (OR = 12.1; CI: 1.3-116), autoimmune chronic active hepatitis (OR = 6; CI: 1.01-36), Hashimoto thyroiditis (OR = 2.0; CI: 1.2-3.3), arthropathy (OR = 1.4; CI: 1.1-1.8), asthma (OR = 2.1; CI: 1.4-3.2), environmental allergy (OR = 1.3; CI: 1.02-1.75), and irritable bowel syndrome (OR = 5; CI: 2.1-12.1). Two autoimmune diseases, multiple sclerosis (OR = 2; CI: 0.2-22) and Crohn disease (OR = 1.6; CI: 0.3-8.3), were more prevalent among patients with KC but did not reach statistical significance.

CONCLUSION: Some strong associations between KC and several immune conditions of autoimmune diseases and allergic IDs may point to the role of the immune system in the pathogenesis of KC.

Article Abstract Link - NIH