Keratoconus Therapy Options: A Comprehensive Guide by an Ophthalmologist

Keratoconus Therapy Options: A Comprehensive Guide by an Ophthalmologist

Keratoconus is a progressive eye disorder that leads to blurry vision and heightened light sensitivity. While it can’t be cured, an early diagnosis and appropriate treatment can help manage its progression and even slow it down. This condition is quite common, affecting approximately one in every 2,000 individuals, as per Johns Hopkins’ data. Keratoconus usually starts during puberty and continues until the mid-30s. Eyeglasses can manage the early stages, but as it advances, a corneal transplant may be needed to restore sight.

Understanding Keratoconus
Typically, corneas are round and dome-shaped, but for those with keratoconus, the cornea becomes thin and forms a cone-like shape. This condition can affect one or both eyes and is most common in teenagers and young adults. The leading cause is imbalanced enzymes in the eye that weaken the cornea, leading to keratoconus. It is believed to be a hereditary condition that can affect multiple family members. Other potential causes include excessive sun exposure, ill-fitting contact lenses, and chronic eye infections or inflammation.

The cornea’s flexibility and strength come from collagen, which maintains its round shape. A healthy cornea can focus light, enabling clear vision. However, in keratoconus patients, the cornea thins and bulges into a cone shape, causing vision loss.

Risk Factors
Several factors can heighten the risk of developing keratoconus:

– A family history of keratoconus or certain systemic disorders like Down syndrome can increase the risk.
– Chronic eye rubbing can contribute to the condition’s development and progression.
– Chronic eye inflammation due to allergies or irritants can damage the corneal tissue, leading to keratoconus.

Keratoconus is typically diagnosed in the teenage years. Advanced cases in young patients may require surgical intervention as the condition worsens.

Treatments
Treatment for keratoconus primarily aims to correct vision and depends on the disease’s stage. Early detection allows for more conservative, less invasive treatment options. Eye doctors may recommend custom-made lenses (gas-permeable or hybrid soft) that neutralize astigmatism, improve vision, and stabilize corneal changes.

For advanced cases, corneal cross-linking (CXL) might be suggested. This intervention stabilizes and can even enhance the cornea’s shape, improving visual accuracy and contact lens fit. In the most severe cases, a corneal transplant may be required, replacing the diseased corneal tissue with healthy donor tissue.

Treatment by Stages
In the early stages, glasses can manage nearsightedness and astigmatism. As the disease progresses, glasses become insufficient, and patients may need hard contact lenses. If rigid lenses become uncomfortable, the doctor may suggest “piggybacking” a hard lens on top of a soft one.

During intermediate stages, progressive keratoconus is treated with corneal collagen cross-linking, an in-office procedure that applies a vitamin B solution activated by UV light to the eye. This process facilitates the formation of new collagen bonds to preserve some of the cornea’s shape and strength. While the cornea will not revert to its normal state, the procedure can prevent vision from deteriorating further and might even improve it.

In advanced stages, implantable, plastic, C-shaped rings (corneal ring) may be used to flatten the cornea’s surface and allow a better contact lens fit. Alternatively, a corneal transplant might be required.

Symptoms
Keratoconus often goes unnoticed, with slight vision blurring or progressively worsening vision being the earliest symptoms. Other signs may include glare and light halos, headaches, eye irritation and pain, difficulty seeing at night, increased sensitivity to bright lights, and sudden worsening or clouding of vision.

To learn more about keratoconus treatments and what to expect, please schedule an appointment for a consultation at Shankar Netrika Eye Centre. Visit https://shankarnetrika.com/ or call at 9920044620 or 24702640. Our address is G. D. Ambekar Marg, Kalachowky, Cotton Green, Mumbai.

Dr. Navin Kumar Gupta
http://shankarnetrika.com

Director, Shankar Netrika Medical Retina Specialist Retina Fellow, University of California, Irvine, USA (2008-2010) Research Fellow, Johns Hopkins Hospital, Baltimore, USA (2007-2008) Anterior Segment Fellow, Aravind Eye Hospital, Madurai (2004-2006) Affiliate of SEE International, Santa Barbara, USA Collaborator and Advisor of Phaco Training Program, Anjali Eye Center

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