Keratoconus Treatment In Mumbai
During the early stages of keratoconus, contact lenses and eyeglasses can provide good vision. Refractive surgical options are very rare and not usually recommended due to very important aspects related to keratoconus. Cornea mapping technology, for example – topography, is one of several diagnostic tests that is performed to gather important information about your cornea to help determine the best treatment option for your unique case.
Become well informed of all your options! Lack of knowledge often creates fear, so learn all that you can about this condition. Ask questions and discuss your concerns with your doctor and follow his/her instructions.
Contact Lens Designs For Keratoconus
Keratoconus is managed by many different contact lens designs. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the practitioner carefully evaluates the needs of the individual situation to find the lens that offers the best combination of visual acuity, comfort and corneal health.
Aspheric lens designs gradually flatten from the center toward the periphery, approximating the steep cone vs. flat periphery curvature relationship seen in keratoconus. These designs are indicated for small to moderate nipple cones. The goal of this lens is to vault the apex of the cone, or lightly touch it, and align the more normal peripheral cornea. Because the nature of an aspheric lens allows for plus power in the periphery, presbyopic keratoconics may find this lens preferable if the fit is acceptable. The lens needs to center for the optics to work.
Corneal Collagen Cross-Linking (C3R):
Corneal Collagen Cross-Linking with Riboflavin is specially developed for Keratoconus treatment in Mumbai. It is popularly known as C3R treatment. It is a minimally invasive procedure that stabilizes the keratoconus and prevents further deterioration of vision.
This treatment has undergone various trials and proven effective in arresting the progression of keratoconus and other corneal ectasias.
The goal of this treatment is to increase the amount of collagen cross-linking, which are the natural “anchors” within the cornea that bond collagen fibres together.. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular.
The cross-linking procedure is performed with two different methods:
Epithelium-off cross-linking:
- In this technique, the epithelium layer of the cornea is removed and Riboflavin solution, a type of vitamin B, is introduced into the cornea.
- This Riboflavin solution is then activated with controlled UV light.
Epithelium-on cross-linking:
- Also known as transepithelial cross-linking, in this method, the corneal epithelium is left intact during the treatment.
- The Riboflavin solution is introduced over this layer, and controlled UV rays are used to activate it.
- The epithelium-on method requires more time for the riboflavin to penetrate into the cornea but also facilitates less risk of infection, less discomfort and faster visual recovery.
- A simple non-invasive treatment
- This treatment strengthens the cornea. Only one-time treatment of C3R is required for keratoconus patients with less risk.
- C3R treatment helps to reduce the cone shape of the cornea that is occurred due to keratoconus disease. An in-depth study of professional researchers stated that C3R helps to flatten the curvature entirely on a long time basis.
- The main advantage of C3R treatment is: it can give some relief from progressive Ectasia.
Lamellar cornea transplantation
Lamellar keratoplasty is a surgery in which diseased corneal tissue is removed and replaced by donor lamellar corneal tissue. This is also called Lamellar cornea transplantation. The procedure aims to improve vision or provide structural support to the cornea.
Lamellar keratoplasty is often recommended to treat advanced keratoconus when wearing contact lenses or spectacles no longer gives vision correction.
Advanced keratoconus often requires surgery to preserve or correct corneal anatomy and improve vision. Keratoconus patients become eligible for lamellar keratoplasty for a corneal transplant when spectacle or contact lenses are insufficient for vision correction.
Traditionally, penetrating keratoplasty (PK) was performed for treating advanced keratoconus. Now, Lamellar keratoplasty (LK), especially deep anterior lamellar keratoplasty (DALK), has become an alternative procedure to PK.
Depending on the location of the corneal abnormality, depth of dissection and technique, the following types of lamellar keratoplasty are performed.
Superficial Anterior Lamellar Keratoplasty (SALK) | Anterior Lamellar Keratoplasty (ALK)/Midstromal ALK | Deep Anterior Lamellar Keratoplasty (DALK) |
Level: dissection <200 microns of the anterior stroma. Technique: microkeratome-assisted or femtosecond laser–assisted Apposition: sutureless | Level: dissection 200–400 microns of the stroma Technique: manual/microkeratome-assisted or femtosecond laser-assisted Apposition: sutures required | Level: dissection >400 microns of the stroma. Technique: stromal air/viscoelastic injection/manual near DM dissection Apposition: sutures required. |
DALK surgery replaces the recipient’s corneal stroma, and preserves healthy Descemet membrane (DM) and endothelium; hence is the ideal keratoconus-affected eye surgery that needs a transplant.
DALK techniques are usually preferred because they are largely considered faster and more reliable, making the surgeon confident to have performed optimal stromal removal with a good visual prognosis.
Clear Vision Eye Centre is a dedicated eye care facility, having a team of highly qualified ophthalmologists and eye surgeons and is equipped with the latest diagnostic and surgical eye treatments.
Book an appointment to seek keratoconus or other eye-related treatment.
Implantable Collamer Lenses (ICL)
The use of Implantable Collamer Lenses (ICL) in refractive surgery is growing. ICLs are frequently considered an alternative to laser-based corneal procedures like LASIK and photorefractive keratectomy (PRK).
For patients with high eyeglasses or contact lens prescriptions, ICL is a great method of vision correction. According to the Food & Drug Administration, a maximum amount of correction can be achieved with each refractive procedure (FDA). Contrary to LASIK and PRK, ICL has no minimum corneal thickness needed. If you have dry eyes, ICL can be a good option. ICLs provide the inner eye, especially the macula, with UV protection. UV radiation can hasten the development of cataracts in the natural lens.
ICLs’ reversible implantation is an additional advantage. ICL might not be an option for you if you’re under 21 or over 45, though. According to the FDA, only individuals aged 21 to 45 can use ICL. Contrarily, people above the age of 18 may undergo LASIK.
ICL can only treat astigmatism and myopia. Therefore, ICL is not yet an option if you have hyperopia. ICL recovery is typically relatively painless but can take a little longer than LASIK, around a week. This healing period resembles PRK in certain ways. The intraocular pressure may increase if the ICL is positioned improperly or occupies an excessive amount of space in the eye. This might result in glaucoma, which can impair vision.
Complex computation procedures are used to calculate the ICL’s power. Sadly, they are not faultless. This occasionally leads to under- or overcorrection. This could imply that glasses or contact lenses will still be required after surgery. This problem can occasionally be fixed by doing another process.
Those with high eyeglass/contact lens prescriptions are some of the greatest candidates for ICL. Halos and glare can be eliminated from the eyesight with an ICL. Since presbyopia and cataracts begin to grow later in life and may affect vision clarity, a patient should be relatively young, between the ages of 21 and 45.
When contemplating this refractive surgery option, it’s crucial to balance the benefits and drawbacks of implanted contact lenses. Consult an expert at Clear Vision Clinic today to find out if ICL is a good option.
Intrastromal Corneal Ring Segments (ICRS):
The goal of Intracorneal rings is to “defer” a corneal transplant and “stabilize” the cornea so that contact lenses or glasses can provide functional vision.
Intracorneal rings (ICRs), also known as ‘intrastromal corneal implants’, are two micro-thin, semicircular, bi compatible plastic rings of varying thicknesses.
These rings are used for keratoconus patients to reinforce the cornea and for reducing the elongated shape of the cone.
- The procedure is performed under topical anaesthesia.
- First, the geometric centre of the cornea is marked with a Sinsky hook as a reference point.
- With the help of a calibrated diamond knife, a 1 mm radial incision is created at 70-80% depth of the cornea.
- Following which, corneal pockets are created on each side of the radial incision with pocketing hooks, and these pockets are further incised, and two semicircular tunnels are formed. These tunnels can be created using semicircular dissectors or a femtosecond laser.
- Finally, the synthetic rings are inserted in these tunnels
Intracorneal rings are designed using the latest surgical technologies and are perfectly tolerated by the eye. There is no risk of rejection. Although they are designed especially for treating low myopia (nearsightedness), they are mostly used for keratoconus patients of all ages.
- Surgery can be performed within the peripheral cornea without disturbing the central optical zone.
- Quick and predictable results
- Risk-free from visual adverse effects
- Long term convenient refractive correction
- Easily removable and exchangeable
- Ideal for treating irregular astigmatism
Frequently Asked Questions:
The signs and symptoms of Keratoconus include:
- Eyesight that is blurry and distorted
- One closed eye causing double vision
- Three “ghost” images
- Halos at night time
- Streaks when looking at bright lights
- Common headaches and light sensitivity.
Make a Keratoconus screening appointment if these signs or symptoms occur.
Keratoconus may impact your vision, which may lower the quality of life. Reading, working, watching TV, and driving may be difficult for those with this illness. Additionally, it can cause stress, undermine your self-esteem, prevent you from appreciating life’s crucial moments, limit your participation in leisure sports, and may impact your personality.
People tend to underestimate how common Keratoconus is. In the past, it was expected that 1 in 2,000 persons would have it; however, the current estimate is 1 in 400. The reason for this growth is that more people are receiving a correct diagnosis due to technological advancements, increased awareness, and optometrists like me who have committed their careers to assisting people in overcoming this illness.
Regarding the etiology of Keratoconus, the medical world is divided. We do, however, know that it appears when the eye’s collagen protein fibers deteriorate. The cornea may lose its form if the collagen in the eye deteriorates. (Recall the playground days when a rubber ball developed a bulge on one side and became lopsided.)
Free radicals in your eyes could be a contributing factor to this impairment. Your corneas create dangerous byproducts called free radicals every day. Antioxidants generally neutralize these free radicals in your eyes, but those with Keratoconus don’t create enough antioxidants to do so. As a result, the corneas lose resilience and start to sag when collagen levels drop. Regular eye rubbing might also contribute to weakness. Given that people with KC in their family are more likely also to have the ailment, there may also be a genetic component.
An optometrist will use specialized equipment to examine your eyes and check for vision issues during eye refraction. A circle of light is focused into your cornea by your eye doctor to perform keratometry, which measures the reflection and examines the cornea’s shape.
The slit-lamp examination uses a microscope to examine the surface of your eye while an eye specialist shines a vertical beam of light on it. This examination evaluates your cornea’s shape and possibly identifies other issues.
A more sophisticated approach called corneal mapping employs corneal topography and specialized optical coherence tomography to map the shape of your cornea.
You could receive one of the following treatments for your Keratoconus, depending on the kind you have:
- Standard eyewear, only the mildest KC forms
- Conventional soft lenses
- Customized soft lenses
- Small RGP lenses with a soft lens skirt are called hybrid lenses.
- Specifically designed small RGP (rigid gas permeable) glasses for Keratoconus
- RGPs that are small and have a piggyback soft contact lens underneath them
- RGP (or “Scleral”) lenses that are large
The severity of your keratoconus and how rapidly it is progressing will determine how you are treated. In general, there are two ways to treat keratoconus: by reducing the disease’s progression and by enhancing your vision.
Spectacles or soft contacts
In early keratoconus, hazy or distorted vision can be treated with glasses or soft contact lenses. But when the shape of their corneas changes, people frequently need to alter their prescription for eyeglasses or contacts.
Therapies
In this technique, eye drops containing riboflavin are applied to the cornea, and it is also exposed to ultraviolet light. As a result, the cornea becomes cross-linked, stiffening it to stop additional shape changes. By stabilising the cornea early in the disease, corneal collagen cross-linking may assist in lessening the likelihood of progressive vision loss.
Surgery
If you have corneal scarring, severe corneal thinning, poor vision even with the strongest prescription lenses, or cannot wear any contact lenses, surgery may be necessary.
For Keratoconus, early detection is essential, just like with most disorders. In addition, you could require Corneal Crosslinking therapy if your Keratoconus is advancing if you want to stop it. According to studies, it is 98% effective.
Age-related worsening of the degenerative eye ailment keratoconus is possible. However, progressive Keratoconus can be stopped with the help of the CXL or C3R (corneal cross-linking) surgery. If you have Keratoconus, it is strongly advised to routinely see a Keratoconus specialist to check it and track its progression.
Not every case of Keratoconus affects both eyes equally. Some patients may only have symptoms in one eye that are more severe. Keratoconus can be stopped using corneal cross-linking; however, doing this on both eyes isn’t always essential. When one eye is more affected than the other, corneal cross-linking may be done while the other eye is being tracked over time.
Not all cases of Keratoconus result in eye pain. However, it can result in discomfort and other issues due to its symptoms. Some of Keratoconus’s most typical signs and symptoms are astigmatism, poor vision, and thinning, bulging, or rounding of the cornea. In addition, some people may develop corneal scarring and become unable to wear contact lenses. To fix this issue, some people may need corneal transplants.
If you have Keratoconus and suddenly have eye pain, you should seek immediate advice from a keratoconus specialist.
Keratoconus is a lifelong and irreversible eye condition. A corneal graft may be required in extreme situations; however, Keratoconus persists. Specialized contact lenses can lessen the impact of Keratoconus in people with less severe cases (hard, hybrid, piggyback, or scleral). A special kind of contact lens called a scleral lens rests on the Sclera, the eye’s white area, rather than the cornea.
Tears are necessary to moisturize your eyes and lessen discomfort and dryness. However, due to your eyes’ inability to disseminate tears throughout your uneven cornea, Keratoconus can cause dry eyes.
People with Keratoconus may naturally have dry eyes or as a side effect of wearing contact lenses, further hindering their eye’s ability to lubricate with teardrops.
Although both eyes are typically affected by Keratoconus, one eye is commonly more affected than the other. People usually start to have symptoms between the ages of 10 and 25. The situation could deteriorate gradually for ten years or more.