What is Keratoconus?
Keratoconus is abnormal thinning and bulging forward of the cornea. Keratoconus is an eye disease characterized by bulging forward of the front surface of the eye due to abnormal thinning of thecornea.The cause of keratoconus is not fully understood, but risk factors include eye rubbing,allergies, and heredity. Some research suggests disruption of normal levels of certain enzymes and other substances in the cornea (including compounds that influence inflammatory responses) is associated with keratoconus, but the underlying cause of this disruption is unclear. The reported prevalence of keratoconus varies widely based on geography and methods used to diagnose the eye disease. One of the most-cited studies of the epidemiology of keratoconus in the United States found keratoconus affects roughly 54 people per 100,000 population (about one in 2,000 people). However, a recent study in the Netherlands found that the estimated prevalence of keratoconus in the general population was 265 cases per 100,000 (one in 377), which is significantly higher than values reported in previous studies. Keratoconus generally begins in a person’s teens or early 20s. It can affect one or both eyes. In the Netherlands study mentioned above, 60.6 percent of diagnosed patients were male. Left untreated, keratoconus is progressive: the cornea eventually becomes irregularly cone-shaped, causing blurred vision that cannot be corrected with yeglasses or conventional lenses. Keratoconus also can cause scarring of the cornea that further decreases best-corrected visual acuity.
Can eye rubbing cause Keratoconus?
It’s unclear whether eye rubbing is a cause or a symptom of keratoconus, or perhaps both.
Keratoconus is considered at least a partly a hereditary disease. So it may be that eye rubbing is a risk factor for keratoconus only among individuals who have genetic factors that may predispose them to developing the disease. More common causes of eye rubbing are eye allergies and pink eye, which produce eyes. However, if you have a family history of keratoconus or if your eye doctor says you may have early signs of keratoconus, you should rather avoid rubbing your eyes. Eye rubbing may increase your risk of developing keratoconus or make your keratoconus worse. Even if you don’t have any risk factors or signs of keratoconus, it’s not a good idea to rub your eyes. Eye rubbing can increase your risk of pink eye and other eye infections by transferring bacteria and other pathogens from your hands to your eyes. Also, aggressive eye rubbing can cause a corneal abrasion and possibly even increase your risk of glaucoma or a retinal detachment.
Can I have LASIK if I have Keratoconus?
LASIK and other laser refractive surgery procedures like PRK and SMILE correct near-sightedness and other refractive errors by reshaping the cornea. In this reshaping process, some corneal tissue is removed, making the cornea thinner.
Because keratoconus is a degenerative corneal disease that causes thinning of the cornea and leads to unpredictable and irregular changes in the shape of the front surface of the eye, LASIK generally is not recommended for anyone with keratoconus.
In fact, there is a small risk that LASIK can induce a keratoconus-type condition called corneal ectasia if too much tissue is removed from the cornea of individuals who are susceptible to this condition.
If you have keratoconus and are interested in refractive surgery to correct your near-sightedness or other refractive errors, the first step is to have your cornea carefully examined by an eye doctor — preferably a keratoconus specialist.
Your doctor may recommend a corneal cross-linking procedure to strengthen and stabilize your cornea prior to considering refractive surgery. Depending on the outcome of this procedure, LASIK or some other type of refractive surgery to decrease your dependence on eyeglasses or contact lenses might be possible.
Does computer use make Keratoconus worse?
There is no clear evidence that computer use or using other digital devices such as tablets, e-readers and smart phones will cause keratoconus to worsen.
However, excessive use of electronic devices with digital displays can sometimes cause dry eyes. Many people with dry eyes tend to rub their eyes, and this eye rubbing could potentially cause keratoconus to progress.
To be safe (even if you don’t have keratoconus), avoid eye rubbing during or after computer use. Also, take frequent breaks to avoid computer eye strain and use artificial tears if your eyes begin to feel dry when spending significant time in front of a computer screen or using digital devices.
Also, be aware that while current research has not shown that computer use makes keratoconus worse, a number of studies have found an association between computer use and myopia and myopia progression, particularly among children. Ask your eye doctor what can be done to reduce your child’s risk of becoming near-sighted (or more near-sighted year after year).
How can I prevent my Keratoconus from getting worse?
If you have been diagnosed with keratoconus, the most important thing you can do to keep your condition from worsening is to follow the advice your eye doctor gives you regarding best treatment options and follow-up care.
Depending on the specific characteristics of your keratoconus, these treatment options may include being fitted with scleral contact lenses, undergoing a corneal cross-linking procedure, or both.
It’s also very important that you refrain from rubbing your eyes.Eye rubbing has been associated with keratoconus getting worse.
And successful management of keratoconus requires frequent and lifelong eye exams to make sure your cornea remains stable and your visual acuity is maintained.
If you are confused or uncertain about the advice you receive from your eye doctor about managing your keratoconus, consider seeking a second opinion from an optometrist or ophthalmologist who is a keratoconus specialist.
How much does the treatments for Keratoconus cost?
The cost of keratoconus treatment depends on the severity of the condition and the type of treatment(s) required.
Because there is no outright cure, management of the disease can extend for decades, adding to the cumulative cost of keratoconus. Fitting contact lenses for keratoconus is a much more complex and customized process than fitting conventional contacts on a normal eye. Also, doctors who specialize in keratoconus must invest in advanced instrumentation such as automated corneal topography machines to diagnose, monitor and manage the disease.
Is Keratoconus a disability?
Keratoconus is an eye disease that may or may not cause loss of visual acuity that is severe enough to be considered a disability. In other words, keratoconus itself is not a disability, but vision loss caused by keratoconus may be severe enough to qualify as a disability.
You are legally blind, in South Africa, when you have acuity of less than 6/60 in the better-seeing eye. This means that the person sees at six metres what a normal sighted individual will see at 60 metres. With regard to visual fields, if your better-seeing eye has a field of vision less than 20 degrees. If you are legally blind, you may still have some useful vision. Being classified as legally blind enables individuals to qualify for certain government benefits.
If you have significant vision loss from keratoconus, visit a keratoconus specialist to determine if one of these new treatment options (or possibly a cornea transplant) can improve your visual acuity and eliminate any potential disability from keratoconus.
Is Keratoconus genetic?
Much is still unknown about what causes the weakening and thinning of the cornea that is characteristic of keratoconus.
It appears keratoconus is partly hereditary (genetic) in origin, but that certain environmental and behavioural factors also play a role. These are called epigenetic factors.In other words, a person may have genetic factors that puts him at greater risk for keratoconus, but the disease may not occur unless certain epigenetic factors also are involved. The prime epigenetic factors associated with keratoconus are eye rubbing, contact lens trauma, and exposure to ultraviolet (UV) radiation. Also, rather than being caused by a single gene mutation, researchers believe keratoconus is a complex disease that involves the interaction of multiple genetic and epigenetic factors.
Is there a cure for Keratoconus?
Currently there is no cure for keratoconus. It is a lifelong eye disease.
Thankfully, however, most cases of keratoconus can be successfully managed. For mild to moderate keratoconus, scleral contact lenses made of advanced rigid gas permeable lens materials typically are the treatment of choice. These lenses are larger than conventional gas permeable (GP) contacts and therefore can vault over even relatively large areas of distorted cornea and provide clear, comfortable vision. For more advanced keratoconus, a relatively non-invasive procedure called corneal cross-linking (CXL)can strengthen and stabilize a thinning, irregularly shaped cornea. It does not “cure” keratoconus, however. In other words, CXL strengthens and may stabilize the cornea, but it doesn’t return the cornea to normal thickness. And there’s no guarantee keratoconus won’t continue to worsen after the procedure. Also, scleral contact lenses or some other type of contact lens typically will still be needed after corneal cross-linking for vision correction. That’s why, Dr. Sachin Bawa offers Intracorneal Ring Segment Implantation that is much more successful in terms of vision clarity. For severe cases of keratoconus, a corneal transplant (keratoplasty) may be required. The successful management of keratoconus — including after keratoconus surgery — requires routine eye exams throughout the affected person’s lifetime. Avoiding eye rubbing also is important, as this behaviour has been associated with worsening of keratoconus.
What are the best contact lenses for Keratoconus?
Generally,scleral contact lenses provide the best fit, comfort and visual acuityfor someone with keratoconus.
Scleral contacts are larger in diameter than conventional gas permeable (GP) contact lenses, which allows them to vault over even relatively large areas of distorted cornea, eliminating much of the irregular astigmatism and other refractive errors caused by keratoconus.
Also, when properly fitted, scleral contacts provide a more stable fit and are less likely to become dislodged from the eye during sports and other activities. (They fit more securely under the eyelids due to their larger size.) However, the best type of contact lens for keratoconus can vary from person to person. In some cases, conventional GP contacts may be a better choice — especially if the wearer has a difficult time applying and removing larger scleral lenses. Hybrid contact lenses — lenses that have a rigid gas permeable central zone, surrounded by an outer zone made of silicone hydrogel contact lens material — are another good option for mild to moderate keratoconus. There even are custom soft contact lenses designed for the correction of astigmatism from keratoconus. The first step in determining the best contact lenses if you have keratoconus is to schedule a comprehensive eye exam and contact lens evaluation with an eye doctor who specializes in contact lenses.
What is corneal cross-linking for Keratoconus?
Corneal cross-linking (CXL) is a relatively non-invasive medical procedure designed to strengthen and stabilize the cornea and thereby halt or slow the progression of keratoconus.
In CXL, a solution of riboflavin (a type of vitamin B) is applied to the cornea and then the front surface of the eye is exposed to a controlled amount of ultraviolet (UV) light. The UV activates a process whereby the riboflavin creates additional bonds between connective tissue fibres made of collagen within the cornea. These “cross-linking’s” provide additional strength and rigidity to the cornea. There are two types of corneal cross-linking, depending on whether the outer layer of the cornea (the epithelium) is left intact or removed prior to the application of riboflavin solution. In “epi-on” CXL, the epithelium is left intact; in “epi-off” CXL the epithelium is removed. Corneal cross-linking also is used to stabilize the cornea in cases of a rare complication of LASIK surgery called corneal ectasia, which produces similar signs and symptoms as those of keratoconus.
What is Intracorneal Ring Segment Implantation (ICRS)
Although Keratoconus can be stabilised with Corneal Cross-linking, some patients are still contact lens intolerant after the treatment and still have poor vision due to a very irregular cornea. We now have a therapeutic option for these patients, namely Intracorneal Ring Segments implantation, called ICRS. ICRS are small arc-shaped rings that vary in thickness and length. They are made of inert plastic which are implanted in a laser cut channel within the cornea. These ring implants cause a flattening of the cone-shaped cornea and subsequently a more regular cornea. It is a safe and effective treatment of Keratoconus and can delay or prevent the need for a corneal transplant. It can also be done in conjunction with CXL. Dr. Sachin Bawa uses a FEMTO laser to create the stromal tunnels to insert the rings, which is a safer and more precise alternative to manual tunnel creation. Each patient will have an individualised treatment plan, based on their corneal maps. It is performed as a day procedure under topical anaesthesia and patients can resume their normal daily activities the next day.