What is Keratoconus?
Keratoconus is a progressive eye condition that affects the cornea, the clear front surface of the eye. The cornea becomes thinned and adopts a cone-like shape, instead of its normal round shape. This distortion of the cornea leads to blurred and distorted vision, and can reduce quality of life. While the exact cause of keratoconus is still unknown, it is believed to be a combination of genetic and environmental factors. Eye rubbing is a major environmental contributing factor and must be stopped immediately. Allergic eye disease and dryness are also treatable contributing risk factors.
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The symptoms of keratoconus
The symptoms of keratoconus usually begin to appear during adolescence or early adulthood. These symptoms can vary from person to person but often include blurred or distorted vision, increased sensitivity to light, difficulty seeing at night and frequent changes in eyeglass or contact lens prescriptions (particularly increases in myopia or short-sightedness and astigmatism). In some cases, keratoconus can progress rapidly, while in others it may progress more slowly over several years. Generally, but unfortunately not in all cases, the condition stabilizes by your early forties.
Diagnosing keratoconus involves a comprehensive eye examination, including a detailed medical history and various specialised tests to assess the shape and thickness of the cornea. At Eagle Eye Surgeons, we have the latest diagnostic corneal tomography technology to diagnose and manage this condition.
Managing keratoconus
Dr Erica is our subspecialist corneal surgeon at Eagle Eye Surgeons and has expertise in managing patients with keratoconus. While there is currently no cure for keratoconus, there are several options available to help stabilise the condition and improve the vision:
1. Prevent progression and ongoing damage to the eye: stabilisation.
We offer epithelium-off traditional and accelerated corneal collagen cross-linking protocols as well as customised treatments suited to treatment the severity of the keratoconus.
2. Improve the vision: visual rehabilitation.
In the early stages, glasses or soft contact lenses may be sufficient to correct vision. As the condition progresses, specially designed contact lenses, such as rigid gas permeable lenses or scleral lenses, may be required to provide better vision and support for the cornea. In more severe cases, surgical interventions like intrastromal corneal rings (INTACS) and corneal transplantation (DALK, PKP see corneal transplants section) may be recommended.
Keratoconus is a challenging eye condition that requires ongoing monitoring and management. Patients at risk for keratoconus should have regular eye examinations to ensure early detection and appropriate management of the condition.
What is Corneal Cross Linking?
Corneal cross-linking is a revolutionary treatment for many patients with keratoconus. At Eagle Eye Surgeons we offer this procedure that aims to halt the progression of the disease through application of a special chemical ‘Riboflavin’ that strengthens collagen fibers in the cornea. It reduces the chance of needing a more invasive treatment, such as corneal transplantation. By stabilizing the cornea, cross-linking can prevent further deterioration of vision and improve the quality of life for patients with keratoconus.
How long do the benefits of corneal cross linking last?
Once the cornea has been strengthened through the procedure, the results are generally permanent. This means that the need for further treatments or interventions is significantly reduced.
Corneal Cross Linking Procedure
The corneal cross linking procedure typically involves the following steps:
Anaesthetic eye drops
Anesthetic eye drops are applied to numb the eye and ensure comfort throughout the procedure.
Removal of the surface layer of the cornea
The surface layer of the cornea, called the epithelium, is gently removed to allow the cornea to absorb the specialised chemical.
Riboflavin eye drops
Riboflavin eye drops are applied to the cornea. These drops help in the formation of new cross-links within the collagen fibers.
Expose the cornea to ultraviolet light
The cornea is then exposed to ultraviolet light for a specific duration, which activates the riboflavin and strengthens the cornea. Where appropriate we will also perform oxygen activated cross-linking.
After the procedure
After the procedure, a protective contact lens is placed on the eye to aid in healing and reduce discomfort.
Recovery and Aftercare for Corneal Cross Linking
After undergoing corneal cross linking, it is normal to experience some discomfort, sensitivity to light and blurred vision. These symptoms typically subside within a few days to weeks. After the procedure you will be prescribed eye drops to prevent infection and promote healing. It is important to avoid rubbing or touching your eyes. We recommend protective eyewear, such as sunglasses, when outdoors.
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Frequently asked questions about Corneal Cross Linking
The success rate of corneal cross linking in halting the progression of keratoconus is high, with studies reporting success rates of over 90%.
The procedure itself is not painful as it is performed under local anesthesia. However, some discomfort, sensitivity to light, and blurred vision can be expected during the recovery period. We apply a comfort contact lens at the conclusion of the surgery to aid with pain relief and also appropriate pain medication to take at home during the first few days of recovery.
Yes, corneal cross linking can be performed on both eyes simultaneously, which can reduce the overall treatment duration and recovery time.
Although unusual, in some cases corneal cross linking may need to be repeated if the condition continues to progress. Dr Erica will continue to monitor your condition post cross-linking and will determine the best course of action in the unlikely event that your keratoconus continues to progress.
Whilst overall a relatively safe procedure cross-linking may be associated with the complications such as: continued progression, scarring, haze, inflammation and extremely rarely infection. During your consultation and informed consent process the potential complications will be discussed in detail and you will have the opportunity to ask any questions about the procedure.
