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Saransh’s Story 27-year-old Saransh was referred to a cornea specialist. He faced extreme difficulty while working due to poor vision. Besides, he also encountered pain in his eyes. He slowly developed a fear of blindness and was pretty confused as to what was wrong with his eyes. Moreover, glasses did not provide his eyes with adequate correction, and he was not a fan of contact lenses, especially in the right eye, where the lens continued to pop out despite the best fit. After a thorough checkup, Saransh was diagnosed with Keratoconus as he was experiencing progressive corneal ectasia and deteriorating visual acuity. |
People suffering from keratoconus will certainly relate to this. Keratoconus makes your vision hazy and even makes you see halos and streaks. It hampers your life and limits your day-to-day activities. However, a timely diagnosis and a proper line of keratoconus treatment can make a difference.
Clear Vision Eye Centre is a modernized and comprehensive eyecare clinic specializing in the treatment and surgery for keratoconus and other vision disorders. Our eye multi-specialty eye clinic, founded and run by highly experienced ophthalmologist Dr. Vinay K Agrawal, is widely proclaimed as one of the most trusted eye centers in Mumbai.
What is Keratoconus?
The cornea is the eye’s window. To form a visual image, light passes through the cornea, past the lens, to the retina, and then to the brain. The normal corneal surface is smooth and round in the center, flattening outwards. Light rays passing through it travel undistorted to the retina, where they project a clear image to the brain.
Keratoconus (the name derived from a Greek word for cornea and cone-shaped) patients have cone-shaped corneas. The cornea is not only cone-shaped in keratoconus patients, but the surface is also irregular, resulting in a distorted image being projected onto the brain.
In short, patients having keratoconus experience progressive thinning, weakness, and corneal irregularities, which can lead to shortsightedness and irregular astigmatism. They may also face light sensitivity and visualize multiple ‘ghost’ images.
| Did you know? Keratoconus typically begins in puberty and progresses until the mid-thirties, when it slows and often stops. |
Between the ages of 12 and 35, it can arrest or progress at any time, and there is no way to predict how quickly or if it will progress at all. In general, young patients with advanced diseases are more likely to progress to the point where keratoconus surgery is used as an intervention.
What causes keratoconus?
Despite innumerable keratoconus research studies conducted, no one knows what causes the disease. Probably, this is one of the topmost reasons as to why keratoconus treatment is quite complex.
There have been many intriguing theories, but none have been proven conclusively or consistently replicated by multiple research groups. One theory proposes that deficient collagen crosslinking is caused by free radicals, but there is no scientifically reproducible evidence to support this claim. Others believe that eye rubbing contributes to the progression of keratoconus. The evidence is anecdotal, based on several case reports, but there is no reproducible scientific evidence to back this up.
One of the research groups was the first to show that genetic factors play a significant role in the development of keratoconus. While scientific evidence supports a role for genetic factors, this does not guarantee that your children will develop keratoconus, as only 13-15% of keratoconus patients have a family history of the condition. Nonetheless, it implies that genes play a role in its development, and understanding their role in keratoconus development may one day lead to a permanent cure.
In fact, 1 in every 10 people with keratoconus has a parent who also has the condition.
What are the symptoms of keratoconus?
Keratoconus causes slight blurring and distortion of vision, as well as increased sensitivity to glare and light, in its early stages. These symptoms typically appear in late adolescence or early adolescence. Keratoconus may progress for 10-20 years before slowing down. Each eye may experience different symptoms. The cornea bulges more as keratoconus progresses, and vision may become more distorted.
Other symptoms could be as follows:
- Increased sensitivity to bright light and glare, which can make night driving difficult.
- A requirement for regular changes in eyeglass prescriptions
- Sudden deterioration or clouding of vision
In a small number of cases, the cornea swells, resulting in a sudden and significant loss of vision. The cornea’s protruding cone-like shape causes strain and leads to a tiny crack and swelling. The swelling may linger on for weeks or months as the crack heals while the scar tissue replaces it.
If this unexpected swelling occurs, our doctors at Clear Vision can prescribe eyedrops to provide temporary relief.
How is keratoconus different from other eye disorders?
A mis-shaped cornea causes or contributes to near-sightedness, far-sightedness, or astigmatism in the eyes. In those cases, the cornea is still rounded — it’s just a little too round, a little too flat, or a little wider this way than that. However, it is still smooth and generally round.
Keratoconus causes the cornea to bulge in one or more places, resulting in a cone-shaped appearance. This has an entirely different effect on your vision. When it first appears, it may appear to be simple nearsightedness that can be corrected with standard lenses. However, as the condition worsens, your vision becomes more distorted and differs when you look this way versus that way.
How is keratoconus diagnosed?
Slit-lamp examination and observation of central or inferior corneal thinning is used to diagnose keratoconus. Furthermore, computerized videokeratography can detect early keratoconus and monitor its progression. The thinnest zone on the cornea can also be measured using ultrasound pachymetry.
At Clear Vision, we are well-equipped with all of these advanced technologies to ensure that our patients receive an accurate and exact diagnosis for their keratoconus issues.
Keratoconus treatment options and their viability
Treatment with Contact Lenses
Vision can be corrected with glasses or regular soft contact lenses in keratoconus, but as the disease progresses, the distortion caused by the irregular corneal surface cannot be corrected with contact lenses. This necessitates the development of more complex contact lens designs.
Our specially trained optometrists will perform a trial to determine which type of Contact Lens is best suited to your eye. To maintain good vision, contact lens fitting must be done carefully and on a regular basis.
Soft Lenses
Soft lenses have a limited role in Keratoconus because they drape over the irregular corneal surface and the front surface of the lens assumes the irregular corneal surface without trapping a fluid reservoir. The effective refracting surface does not improve over the original corneal surface.
Some specially designed thicker soft lenses retain a more rigid shape and may, to some extent, contribute to the liquid lens effect. These are the Keratoconus designs, and they are beneficial in mild to moderate cases.
Rigid Gas Permeable (RGP)
Rigid Gas Permeable lenses conceal the underlying irregular cornea and serve as the eye’s new refractive surface, with the tear film filling the space or gap between the front of the eye and the back of the contact lens. The term “rigid” refers to the type of lens. “Gas Permeable” is how the lens material is described. There are numerous RGP lens designs.
Surgical options
Collagen Cross Linking
Collagen Cross Linking is a Keratoconus treatment that involves manually or with a laser removing the skin (epithelium) from the surface of the cornea and applying custom-made riboflavin eye drops to the cornea every 2 minutes for 20 minutes. After that, the eye is exposed to UVA light for 10 minutes. Following treatment, an eye pad is worn for 1-3 days, and an antibiotic drop is applied to the treated eye four times per day until the surface of the eye heals.
Aim of the surgery: Collagen Cross Linking attempts to slow or even stop the progression of the condition, preventing further vision deterioration and the need for corneal transplantation. However, it is expected that after treatment, the use of spectacles and contact lenses will be required, with occasional changes in prescription.
Advanced Collagen Cross-Linking: This procedure is very similar to standard Cross-Linking, except that the treatment area is limited to the Keratoconic cone and not the entire cornea.
Note: The most important point to remember is that the collagen cross-linking procedure does not cure Keratoconus. It does not help to regularise the irregularities of your keratoconic cornea, and Collagen Cross-Linking is frequently combined with either a Laser Procedure or INTACS for that purpose.
Use of INTACS
INTACS is the trademark name for intra-corneal ring segments, which are implants that are surgically inserted into the mid layer of the cornea and take the form of thin medical plastic, semi-circular rings.
Aim of the surgery: The goal is to remodel the cornea’s architecture, restoring a more natural dome-like shape and improving vision. The arc length of the cornea is reduced by Intacs implants. This decrease in arc length flattens the central cornea, resulting in improved curvature and visual acuity.
Corneal Transplantation surgery
Lamellar Keratoplasty
The anterior diseased layers of the patient’s cornea is removed and replaced with the same layers from a healthy donor cornea in a partial corneal transplant. In this type of keratoconus surgery, there is less risk of corneal graft rejection or failure, and recovery time is reduced.
Penetrating Keratoplasty
Full-thickness corneal transplantation involves replacing all layers of the patient’s cornea with a donor cornea. This is done when the disease has progressed far enough with scarring to preclude a lamellar or partial transplant.
Implantable Collamer Lenses (ICL)
The ICL is an excellent refractive method of vision correction.
| As per the Food and Drug Administration (FDA): Each refractive procedure has a maximum amount of correction. |
Unlike LASIK and PRK, ICL requires no minimum corneal thickness. ICL may be a good option if you have dry eyes. UV protection is provided by ICLs for the inner eye, particularly the macula. UV rays can hasten the formation of cataracts in the natural lens.
Moreover, those with high eyeglass/contact lens prescriptions are prime candidates for ICL. With an ICL, halo, and glare can be removed from the eyes.
Keratoconus Treatment – Customized, Transparent, and Unparalleled procedures JUST for YOU!
Keratoconus can progress until it causes permanent vision loss if not treated properly. Because of advanced technology that allows early detection of keratoconus, such cases are becoming increasingly rare.
At Clear Vision, we are known for successfully managing Keratoconus using cutting-edge diagnostic and treatment methods.
Our clinic is modern and comprehensive in treating cataracts, keratoconus, cornea, ocular surface disorders, glaucoma, and other ophthalmic disorders. Besides, we primarily focus on providing best-in-class solutions for eye treatments such as cornea transplantation, keratoplasty, customized cataract surgery, foldable intraocular lens implants, multifocal IOLs, and Laser Refractive Surgery such as LASIK, PRK, PTK, LASEK, and others. We responsibly guide our patients through all ocular surgery procedures and answer all of their questions about corneal treatments in order to foster trust and satisfaction.
Consult us today!
