Keratoconus is a common yet often misunderstood eye condition that affects the shape and function of the cornea, leading to vision problems that can significantly impact daily life. As the cornea thins and bulges outward into a cone shape, it causes blurry or distorted vision. It may worsen over time and cause progressive vision loss.
Here, we’ll explore what keratoconus is, what causes it, and how it can be effectively managed, including the latest advancements in treatment options available at Vision Clinic Sydney.
What is Keratoconus?
Keratoconus is a progressive eye condition involving the cornea. The cornea is the clear, dome-shaped front surface of the eye. The cornea thins and gradually bulges outward into a cone shape. This abnormal shape can cause blurred or distorted vision and increased sensitivity to light. The condition typically begins in the teenage years or early 20s and can worsen over time.
What Causes Keratoconus?
The exact cause of keratoconus is still unknown. However, several factors are believed to contribute to its development:
- Genetic and Environmental Factors: A family history of keratoconus and certain environmental factors increases the risk of developing keratoconus.
- Vigorous Eye Rubbing: This is associated with keratoconus and can contribute to the weakening of corneal tissue.
- Underlying Medical Conditions: Keratoconus often presents in individuals with a background of asthma, eczema or allergic rhinitis (hayfever). Systemic conditions such as Down syndrome and connective tissue disorders like Ehlers-Danlos syndrome are also associated with keratoconus.
Keratoconus Symptoms
Symptoms of keratoconus can vary depending on the severity of the condition:
- Blurred or distorted vision
- Increased sensitivity to light and glare
- Frequent changes in spectacle prescriptions
- Difficulty seeing at night, with glare and halos, or coma
- Headaches
Diagnosis of Keratoconus
Keratoconus is usually diagnosed through a comprehensive eye examination, which may include:
- Slit-Lamp Examination: A detailed examination of the cornea can reveal thinning and other abnormalities.
- Corneal Topography: This imaging test maps the curvature of the cornea and can detect even early signs of keratoconus.
- Anterior segment OCT: Mapping of the corneal thickness and curvature allows for sensitive detection of corneal shape and transparency abnormalities.
Keratoconus Treatment Options
Treatment for keratoconus depends on the severity of the condition. Early stages may be managed with glasses or contact lenses, while more advanced cases may require surgical intervention.
- Glasses or Soft Contact Lenses: In the early stages, these may help improve vision.
- Rigid Gas Permeable (RGP) Contact Lenses: These lenses provide a more uniform refractive surface by sitting on the irregular corneal surface.
- Hybrid Contact Lenses: These lenses have a rigid centre and a soft outer ring, providing comfort and clear vision.
- Scleral Contact Lenses: Larger than standard lenses, scleral lenses rest on the sclera (the white part of the eye) and vault over the cornea, providing stability and comfort, especially in advanced keratoconus.
- Corneal Collagen Cross-Linking (CXL): This procedure strengthens the corneal tissue by using ultraviolet (UV) light and riboflavin (vitamin B2). CXL may help prevent the progression of keratoconus, potentially stabilising the cornea, and preserving vision.
- Transepithelial Collagen Cross-Linking with Oxygen Enhancement (Epithelium On): This advanced form of cross-linking is performed without removing the corneal epithelium, reducing discomfort and recovery time, and minimising surgical risk. Oxygen enhancement improves the efficacy of the treatment, making it a viable option for early-mid stage keratoconus.
- Femtosecond Laser Assisted Corneal Allogenic Intrastromal Ring Segment Implantation (Femto-CAIRS): This minimally invasive procedure involves the implantation of donor cornea ring segments into the host cornea to reshape and stabilise it. The use of a femtosecond laser ensures precision, improving visual outcomes for patients with keratoconus. This procedure adds tissue to the cornea.
- Topography-Guided Phototherapeutic Keratectomy/Photorefractive Keratectomy (PTK/PRK): These laser-based procedures reshape the cornea to improve vision and reduce irregularities caused by keratoconus. Topography-guided treatment customises the procedure to each patient’s unique corneal shape, enhancing the effectiveness of the treatment.
- Implantable Collamer Lens (ICL) Insertion: For patients with keratoconus who can achieve optimal vision correction with glasses, an ICL can be inserted to correct refractive errors and reduce the often significant shortsightedness and astigmatism.
Advanced Keratoconus and Corneal Transplantation
When keratoconus progresses to an advanced stage, the cornea becomes significantly scarred and vision can no longer be corrected with lenses. In these cases, corneal transplantation may be necessary. There are different types of corneal transplants:
- Deep Anterior Lamellar Keratoplasty (DALK): Only the outer and middle layers of the cornea are replaced, preserving the inner endothelial layer.
- Penetrating Keratoplasty (PK): A full-thickness corneal transplant, where the entire cornea is replaced.
It is important to note that for all keratoconus treatments, the effectiveness of treatments can vary between individuals. Your cornea subspecialist ophthalmic surgeon can help determine the best approach for your specific case. Note that the above transplantation options are only offered to themost severe cases.
How To Book an Assessment
To request an appointment or if you have an enquiry, please contact us via the following ways:
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Email us: reception@visionclinicsydney.com.au
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FAQs
If you have any more questions about keratoconus, please don’t hesitate to contact us today. In the meantime, see our FAQs below that may provide you with the additional information you’re looking for.
What is keratoconus and how does it affect vision?
Keratoconus is a condition where the cornea thins and bulges into a cone shape, distorting vision. This abnormal shape of the cornea leads to blurred or distorted vision, increased sensitivity to light, and frequent changes in prescription. Over time, these vision problems can worsen, making everyday activities like reading or driving more challenging.
What causes keratoconus to develop?
The exact cause is not fully understood, but genetic factors, vigorous eye rubbing, and underlying medical conditions are known to contribute to its development. These factors can weaken the corneal tissue, causing it to thin and protrude into a cone shape. Early detection and avoiding eye rubbing can help manage the risk of progression. Pregnancy can also worsen keratoconus, if the patient has not already undergone collagen cross linking.
How is keratoconus diagnosed?
Keratoconus is diagnosed through a comprehensive eye exam that includes slit-lamp examination to detect abnormalities, corneal topography to map the curvature of the cornea,and anterior segment OCT to map and measure corneal thickness. Early diagnosis is key to managing the condition effectively, as it allows for timely intervention with treatments like corneal cross-linking to stop or slow progression. Regular check-ups are essential to monitor any changes in the condition.
What treatment options are available for keratoconus?
Treatment options include glasses, various types of contact lenses, and corneal collagen cross-linking to strengthen the cornea. In advanced cases, corneal transplantation may be necessary to restore vision.
Modern minimally invasive keratoconus management includes options such as transepithelial (epithelium on) collagen cross linking with oxygen enhancement, femtosecond laser assisted CAIRS (corneal allogenic intrastromal ring segment implantation), and topography guided PTK/PRK. These options collectively aim to stop progression, regularise the cornea, improve quality of vision and prevent the need for the more invasive forms of cornea transplantation (DALK and PKP) altogether.
Each treatment is tailored to the individual’s condition and needs, ensuring the best possible outcome. Consulting with a cornea specialist is crucial to determining the most appropriate treatment plan.
Can keratoconus be cured?
While there is no cure for keratoconus, its progression can be managed effectively with treatments such as transepithelial collagen cross-linking with oxygen enhancement. With proper care and regular monitoring, many individuals with keratoconus can maintain good vision and continue to lead active lives. Early and ongoing treatment can help preserve vision and quality of life.
General Information Disclaimer: The content provided here is for informational purposes only and is not intended as medical advice, diagnosis, or treatment. Always seek the advice of your health professional with any questions you may have regarding a medical condition. The information on this site is general in nature and may not reflect current medical developments or research. Your reliance on any information provided by this site is solely at your own risk.
