The Common Causes of Keratoconus and How to Treat It

In 1859, British sugeon William Bowman accurately explained how to use mirror in a ophthalmoscope to see the shape of the cornea. Keratoconus could then be identified.

Keratoconus occurs in 1 out of every 2,000 people. Diagnosis often occurs in youth.

This eye disease causes the normally round cornea to become thinner. Over time, a cone-shaped bulge develops. This distortion causes visual impairment. Keratoconus is present in both eyes but can affect one eye more severely than the other.

Read on for the basics about keratoconus including causes and keratoconus treatment.

What Causes Keratoconus?

There is no conclusive data on keratoconus causes. Several factors have been named as contributing to this eye condition and so it is likely that there is no one single cause.

Allergies, asthma and eczemas are commonly associated with this disease. Eye rubbing aggravates the condition and people with allergies and eczema likely rub itchy eyes frequently.

Keratoconus can also be hereditary. Children of people with the condition should be checked annually by an optometrist for signs of the disease.

Some studies point to a decrease in protective antioxidants in the cornea as a cause of keratoconus.

If there are fewer antioxidants in the eye, the collagen is no protected and so weakens. As a result, the cornea develops the bulging, cone shape indicative of keratoconus. If antioxidants levels are low, the collagen weakens and the cornea bulges out.

Symptoms of Keratoconus

The symptoms of keratoconus change as the condition worsens. In the early stages of keratoconus, people will notice distorted or blurry vision. Eyeglasses prescription may change frequently in the early stages.

This is often the first indication that someone has keratoconus. It’s important to have your eyes checked by an eye care professional if you suspect you have keratoconus.

Other symptoms include seeing a glare on objects and seeing ghost images. In other words, seeing several copies of one object at once.

Keratoconus Treatments

There are many treatments that can help correct the vision and strengthen the cornea.

Glasses

In the mildest cases of keratoconus, prescription glasses can fix the vision problems caused by the disease. Often a prescription for astigmatism will also be needed.

As the cornea gets thinner and thinner and more cone-shaped, glasses will no longer be able to offer the right amount of vision correction. So this option is only viable in the early stages of keratoconus.

Contact Lenses

When glasses no longer provide good vision, contact lenses become a good solution.

Hard or custom soft contact lenses are specifically designed to correct vision problems due to keratoconus. They even out the irregularities in the cornea.

Gas permeable lenses cover the cone-shaped portion of the cornea and provide a smooth surface for refraction.

Scleral contact lenses have a much larger diameter. These contact lenses rest on the whites of the eyes. The whites are called sclera.

The benefit of these lenses is that because they are so large, the entire eye is protected from dust and debris. Because the edges of the contact rest above and below the eyelid margins, wearers do not see the edges of the lens.

In some cases of keratoconus, contact lenses are no longer an option due to fit or comfort. In these cases, surgical options should be considered.

Surgery

When keratoconus progresses beyond the help of contact lenses, your eye care professional may recommend corneal surgery.

Corneal Transplants

One option for a surgical keratoconus treatment is a corneal transplant. This procedure involves replacing the affected cornea with a healthy cornea from a human donor.

The precise lasers that are used in laser vision correction techniques have been adapted for corneal transplants.

The entire cornea may be replaced in severe cases. Other times, a corneal transplant may just replace a few layers of the cornea. Your eye specialist can recommend the best procedure for you.

Corneal Crosslinking

Corneal crosslinking is a procedure that stops the progression of the disease. An eye specialist will drop vitamin B2 into a patients eye. Then the cornea is exposed to UV rays.

Together, these two processes form a chemical reaction that stiffens the cornea and stops the progression of the disease. This treatment is pretty new and more studies are required for accurate statistics.

However, studies show that the failure rate is less than 3% and the complication rate is less than 1%.

Though this procedure can’t bring back the cornea to the normal shape, it can stop the keratoconus from becoming any worse.

Intracorneal Rings

These rings are inserted into the irregular-shaped cornea using a laser. The rings flatten the shape of the cornea back to a regular round, dome shape.

This option is for people who can no longer wear contact lenses but where the disease has not progressed extensively yet. Intracorneal rings improve vision and allow the patients to possibly wear contact lenses again.

Toric implantable Contact Lenses

This surgery is basically implanting permanent contact lenses into the patient’s eyes. This option is available to those who have keratoconus that is no longer progressing.

These implanted contacts make it possible for patients to stop using glasses or contacts to correct their vision in some cases. Depending on the severity of the condition, glasses might still be required for good vision.

Final Thoughts

We hope you found this guide on keratoconus treatment informative. As you can see, there are a variety of treatments available for this eye disease.

Contact Focal Point Vision to make an appointment to discuss the right treatment plan for your needs.

A Brief Guide to Corneal Cross-Linking (CXL) for the Treatment of Keratoconus

As common as vision problems are, most people expect that their vision will be healthy until they’re older. After all, many of the most popular eye-related illnesses like cataracts tend to develop later in life.

That’s why it can be so shocking for a young person to hear about their keratoconus diagnosis.

The good news is that keratoconus is a treatable condition. In the past few years, the FDA has approved a highly successful keratoconus treatment called corneal crosslinking.

Here’s what you need to know about keratoconus and about this unique treatment.

What is Keratoconus?

Keratoconus is an eye condition that affects your cornea. Your cornea is the dome-shaped, clear tissue at the front of your eye. It’s the part of your eye that focuses light into your eye.

In a typical eye, the cornea is round. However, in a patient with keratoconus, the cornea gradually gets thinner and this causes it to bulge into a cone-like shape. When the cornea is shaped differently, light doesn’t focus correctly in your eye. This leads to blurry vision and can make you more susceptible to light sensitivity or night blindness.

It’s unfortunate, but we don’t know what causes keratoconus so there isn’t a known way to prevent it. It appears to have a genetic link, but it isn’t always a condition families share. Keratoconus is also more common in people with Down syndrome, although researchers don’t know why.

How Keratoconus Progresses

In most cases, keratoconus starts to develop in a patient’s late teens or early 20s. It gradually gets worse over the following years or decades, and it tends to stop progressing by age 40.

While keratoconus doesn’t tend to cause blindness the way most people think of blindness, it can make your vision so blurry that most tasks are difficult. If the condition becomes severe, some patients may need a cornea transplant.

The good news, though, is that corneal crosslinking is an effective way to slow or stop keratoconus’ progression.

What is Crosslinking for Keratoconus Treatment?

Corneal crosslinking, sometimes called CXL, is a way to strengthen the cornea. This stops the thinning and bulging that keratoconus causes.

How Corneal Crosslinking Works

The term “crosslinking” means to form new bonds between molecules, that that’s what CXL does. Corneal crosslinking is a procedure that strengthens the molecular structure of your cornea, protecting you against the progressing effects of keratoconus.

CXL was first performed in 1998 in Germany. However, it finally gained FDA approval in 2016. CXL works because of the reaction between riboflavin (vitamin B2) and precise UVA light. When your eye has enough topical B2 and the right amount of UVA light is applied, it produces new bonds between the collagen fibers in your cornea, creating a strengthening effect.

Two Types of Corneal Crosslinking

There are two basic approaches to CXL: removing an area of epithelial tissue (Epi-Off) or keeping the epithelial tissue intact (Epi-On).

While Epi-On is a less invasive procedure, Epi-Off can provide a more substantial result. Your eye doctor will determine the best option for you based on your keratoconus’ progression and your specific needs.

The Corneal Crosslinking Procedure

Whether or not our doctor starts by clearing epithelial tissue, the next step is to apply riboflavin drops. The riboflavin needs to saturate your corneal tissue to a certain level, which typically takes about 30 minutes.

As the riboflavin saturates, it also helps to protect your lens, retina, and other eye tissues from the effects of the UVA light.

After 30 minutes, your doctor will check to ensure that your corneas have enough riboflavin. When they reach this level, your doctor will use a specialized device to apply targeted UVA light to your eyes. The UVA exposure will last for about 30 minutes, and the doctor will apply more riboflavin every few minutes along the way.

When your procedure is finished, our doctors will rinse away the remaining riboflavin. They will apply a topical antibiotic, a topical anti-inflammatory, and a bandage contact. They will give you instructions about what drops to apply and how to care for your eyes as they heal. If you had an Epi-Off procedure, you’ll keep the bandage contact on for up to five days while your epithelial tissue heals.

After Your Corneal Crosslinking Procedure

For most patients, their vision is worse in the first month or two after their CXL procedure. This is because your eyes are healing, and it shouldn’t worry you. In most cases, by the third month your vision will be back to what it was before the procedure.

Some patients see improvements in their vision after this point, potentially continuing until a year after their procedure. While this can be a great result, keep in mind that the purpose of CXL is to stop your keratoconus from progressing, not to reverse its effects. Don’t expect your vision to improve, but see it as a happy side effect if it does happen.

Overall, CXL has a great success rate. Over 93% of corneal crosslinking patients saw a reduction or a stop in their keratoconus progression. While it doesn’t cure keratoconus, corneal crosslinking is a great way to keep the symptoms to a minimum.

Is Corneal Crosslinking the Right Choice for Your Keratoconus?

Corneal crosslinking has a proven record of success. Especially for patients who get treatment early, it can slow or stop the progression of keratoconus to protect your vision.

Keep in mind that even without CXL, only a fraction of people with keratoconus will develop symptoms severe enough to warrant a corneal transplant. However, depending on how your condition is progressing, CXL can be a great way to keep your symptoms at bay so you may still have adequate vision with glasses or contacts.

At the end of the day, your eye doctor is the only person who can determine if you’re a candidate for CXL or another keratoconus treatment. To find out if it can help you, contact our corneal crosslinking experts for a consultation. If you’re a current patient, schedule your appointment online.

Everything You Need To Know About Keratoconus?

There is a common misconception that eyeballs do not grow after we are born. Our eyes do grow as the rest of our body grows, but at a slower pace than any other part. Different parts of the eye may grow at a different pace; if your cornea starts to grow and become more thin and out of shape, you may have trouble with your vision and experience the symptoms of Keratoconus.

What Is Keratoconus?

Keratoconus occurs when the cornea starts to thin out and the center of the cornea bulges out. This bulging causes a cone-like shape.

 

The cornea is important to our eyes for a variety of reasons. It is the outermost layer of the eye, and contains five layers of membranes that each have different functions. All five layers help to protect the rest of the eye from dirt, bacteria, and other substances that our eyes might come into contact with throughout the day.

 

Our corneas also focus 65-75% of the images that we see. Without this refractive process, the images that we see may become blurry. When the cornea becomes thin and misshapen, light cannot be reflected as effectively. This is why keratoconus can cause distorted vision and become an issue for patients. Everyday tasks like driving, reading, or typing can become difficult for patients with keratoconus.

What Are the Symptoms of Keratoconus?

Symptoms of keratoconus include:

  • Blurry vision
  • Double vision
  • Nearsightedness
  • Astigmatism
  • Sensitivity to light

 

Not all of these symptoms automatically point to keratoconus. If you are worried that you have keratoconus, call up your eye doctor for a regular eye exam. During this exam, your eye care professional will measure the shape and size of your cornea.

What Causes Keratoconus?

Eye care professionals do not know for sure what causes keratoconus. There are a handful of theories that point to enzyme imbalances and exposure to UV rays as possible causes for keratoconus. Excessive eye rubbing is also associated with keratoconus (if you have been diagnosed with keratoconus, be careful to not rub your eyes. Rubbing your eyes can cause further damage to the cornea.)

 

Similar patterns have been found in patients with keratoconus. If you have a parent that has keratoconus, for example, you might be at a higher risk of getting keratoconus. One in ten cases of keratoconus are genetic. Keratoconus is a corneal dystrophy that affects both eyes. This condition affects 1 in 2,000 people.

 

Symptoms usually appear in the late teenage years, and may continue to progress throughout the patient’s lifetime. This process happens more quickly for some patients than others.

How Is Keratoconus Treated?

Keratoconus symptoms range from mild to severe. When patients are first diagnosed with keratoconus, they may be able to address the problem with eyeglasses. Mild cases of keratoconus can be corrected with soft contact lenses, but as the condition progresses, contact lenses may no longer be a viable option.

 

If the condition becomes more severe, treatments are available to correct the cornea’s cone-like shape. Keratoconus treatments typically do not eliminate the need for glasses or contact lenses to obtain perfect vision. Options for patients with keratoconus include:

Specially Designed Contact Lenses

There are many different types of contact lenses that patients with keratoconus can use to address their symptoms. If you have been diagnosed with keratoconus, talk to your eye care professional about:

  • Custom soft contact lenses
  • Gas permeable contact lenses
  • “Piggybacking” contact lenses (two types of lenses in the same eye)
  • Hybrid contact lenses
  • Scleral and semi-scleral contact lenses
  • Prosthetic contact lenses

Intacs

In some cases of keratoconus, contact lenses will not be able to correct vision problems or adjust to the curvature of the cornea. Intacs, or intrastromal corneal ring segments, are inserts that are surgically placed into the periphery of the cornea. The inserts reshape the eye and have been proven to improve vision by two lines on a standard eye test.

 

Intacs can be the sole treatment needed to fix keratoconus. The inserts are also removable or exchangeable. If keratoconus continues to worsen with intacs, the inserts can only delay the time in which patients will have to get a corneal transplant.

 

Corneal Transplants

When keratoconus continues to progress and contact lenses or intacs are no longer a solution, eye care professionals may recommend a corneal transplant. Corneal transplants replace diseased or affected corneas with a healthy and safe cornea donated by humans after their death. Depending on the severity of keratoconus, a corneal transplant may involve replacing one or more layers of the cornea. The entire cornea may be replaced if the keratoconus is severe.

Corneal Crosslinking

Corneal crosslinking is the newest treatment for keratoconus. This process involves dropping Vitamin B2 into a patient’s eye and exposing the cornea to UV rays. The combination of B2 and UV rays forms a chemical reaction that hardens the cornea and stops the keratoconus from becoming more severe. The process will not bring the cornea back to its original rounded shape, but it has been proven to halt the progression of keratoconus in 94% of patients.

 

Corneal crosslinking has only been around for 10 years, but provides a less invasive alternative to traditional treatments for severe keratoconus. Like other treatments, patients will still have to wear glasses or contact lenses in order to see with optimal vision.

Which Keratoconus Treatment is Right For Me?

If you are looking to correct keratoconus, you have a lot of options for treatment. Before you move forward with a treatment, talk to an eye care professional about your options and hear their recommendations. Some treatments, like the corneal transplant surgery, are more invasive than others, but are one of the few options available for more severe keratoconus. Cost may also play into which treatment is best for you; newer treatments like corneal crosslinking are more expensive due to the fact that they are new on the market.

 

If you want to learn more about treating keratoconus, reach out to the experts at Focal Point Vision. We have the sole corneal crosslinking device in San Antonio that has been approved by the FDA. Over 160 patients have gone through corneal crosslinking in our office and enjoyed better vision.