The term keratoconus originates from the Greek ‘keras’ meaning cornea, and ‘conus’ meaning cone. Keratoconus causes progressive thinning of the cornea. It usually affects both eyes, although one eye is usually affected more than the other. If there is delay in detection or treatment of keratoconus, it can result in significant deterioration of vision.
Key facts about keratoconus:
- Causes progressive thinning of the cornea, resulting in astigmatism.
- Symptoms include blurred vision, double vision and imbalance between the eyes.
- Affects both eyes, although one eye is usually more significantly affected than the other
- More common in certain ethnicities, e.g. Asians and Middle Eastern populations
- Cause is unknown, although likely to be multifactorial
- Occurs in in late childhood to early adulthood, and often (but not always) stops progressing by the age of 35 years.
- Progression of keratoconus can be halted by cornea collagen cross-linking.
- Treatment of keratoconus is stepwise:
- Spectacles or soft contact lens
- Hard contact lens
- Laser refractive surgery combined with cornea collaged cross-linking
- Cornea transplantation
What are the causes?
The initial step in Keratoconus treatment includes vision evaluation with an auto-refractometer. A visual acuity test to assess the amount of astigmatism is crucial before planning for Keratoconus treatment.
A thorough slit lamp examination to identify the thinning and irregular surface of the cornea with a retina evaluation to assess for secondary retinal disorders would be the second step. But the most important of them all is the Corneal Topographic Machine that will give you a clear idea about the level, area and thinning present.
This is crucial while evaluating modalities for the Keratoconus cure. However, these modalities may differ a bit from one clinic to another in London.
Keratoconus treatment modalities
Glasses and soft contact lenses
Hard contact lenses
Laser refractive surgery
Collagen Cross linking (Keratoconus cross-linking)
Keratoconus Corneal Transplantation
Keratoconus corneal transplantation is advised when the cornea becomes dangerously thin or the scarring too prominent for enabling any vision. It involves replacing the thin conical cornea surgically with a normal donor cornea for improving the previously impaired vision.
People with advanced Keratoconus damage or with severely impaired vision following complications after a Keratoconus treatment are ideal candidates for Keratoconus corneal transplantation. Additionally, people ineligible to wear any contact lens due to an extremely steep cornea or people with ulcerative keratitis due to infection with contact lenses are also eligible for Keratoconus corneal transplantation. You can be more sure about your eligibility for the procedure by talking to an expert doctor at AI Vision, London.
Two types of Keratoconus corneal transplantation, namely Penetrating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty (DALK) are indicated depending on the severity of the condition. It is a fairly successful procedure involving 1 out of every four transplants. It is performed under general anesthesia. The cornea is sutured after the surgery and monitored closely for two weeks, followed by weekly follow-ups. Such Keratoconus corneal transplantation provides a lasting benefit for Keratoconus patients and is amongst the most popular Keratoconus treatment modalities to date.
Factors leading to Keratoconus treatment
Various risk factors like rubbing your eyes frequently due to allergic conditions and improper contact lens fitting may lead to corneal thinning and subsequently result in Keratoconus. That’s why avoiding rubbing eyes by managing the allergic conditions and doing a regular contact lens evaluation will ensure you don’t require any Keratoconus treatment in the long term.
Sometimes genetic conditions like a family history of Keratoconus with conditions like Retinitis Pigmentosa and Ehlers-Danlos Syndrome may lead to Keratoconus treatment. Early evaluation and diagnosis and timely management is the best solution compared to any other Keratoconus treatment modalities.
Frequent asked questions (FAQs):
Risk factors for keratoconus include modifiable and non-modifiable risk factors. Modifiable risk factors are eye rubbing and eye allergy. Treating eye allergies helps minimise eye rubbing, although the latter can also be a habit not related to eye rubbing.
The gold-standard treatment to stop keratoconus getting worse is cornea collagen cross-linking. If there is evidence of progressing keratoconus, this treatment should not be delayed.
Cornea collagen cross-linking is performed using the latest technology at the AI vision clinic, reducing the treatment time from 45 minutes to 15-20 minutes.
If keratoconus is mild, then patients can see well with spectacles or soft contact lenses. Some patients see well without visual correction. In moderate to severe keratoconus, the options are:
- Rigid gas permeable contact lens
- Hybrid contact lens
- Semi scleral or scleral contact lens
- Cornea transplantation (partial or full thickness)
You will be assessed by an advanced contact lens optometrist for specialised contact lenses, and the cornea specialist will explain the management options that are suited to your case.
There are numerous research studies showing an association between eye rubbing and keratoconus. It is advisable that eye rubbing is avoided or at least minimised by the patient. Treating eye allergies is an important aspect of keratoconus treatment, and will help you avoid rubbing of the eyes.
Yes, keratoconus can be treated with laser that is combined with cornea collagen cross-linking. However, there is a lack of robust long-term trials of the effectiveness of this treatment and risk of long-term worsening of keratoconus. At the AI Vision Clinic, this treatment is not performed because of the poorly established long-term safety profile.
At the AI Vision Clinic, we use OCT-based cornea tomography. This is the latest and most robust technology enabling extremely high definition actual measurements of each corneal layer. This technology is available in few clinics around the world. Furthermore, AI is utilised to aid in clinician diagnoses.
Artificial Intelligence (AI) is utilised by the AI Vision Clinic to improve keratoconus assessment. Mukhtar Bizrah is working with the AI faculty of Imperial College London to develop improved keratoconus assessment methods using AI.