Keratoconus
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Keratoconus is a progressive disease of the cornea (The front transparent layer of the eye) characterised by thinning and buldging of the cornea.
How keratoconus affects your vision?
When you have keratoconus, your vision becomes blurred. This is because the keratoconic cornea is irregular and is unable to project a clear image onto the retina. This affects the focus of your eye causing short sight (myopia) and astigmatism.
In advanced stages of keratoconus, some patients may develop scarring in the cornea, which can make their sight blurred by reducing the amount of light which can enter the eye. A small number of patients may experience a sudden, painful loss of vision if fluid from the eye enters a very thin cornea. This is called hydrops.
What causes keratoconus?
The exact cause of keratoconus is not known, but multiple factors including genetic and environmental play a role. Keratoconus is seen more often in people having allergies like asthma or eczema. In recent times it has been proposed that there is also a link between constant eye rubbing and keratoconus.
Who gets keratoconus?
Incidence of keratoconus varies depending upon geographic location and ethinicity. Surveys indicate a prevalence 4.4 and 7.5 times greater for Asian (Indian, Pakistani, and Bangladeshi) subjects compared with white Caucasians. In Central India the incidence of keratoconus is as high as 2.3%.
How can keratoconus be diagnosed?
If you have a high cylindrical power in your glasses or your refractive error (spectacle prescription) is changing frequently you need to visit your ophthalmologist. Blurring of vision with frequent change in cylindrical prescription is one of the symtoms of keratoconus.
You would need a refraction and slit lamp examination and might also have a corneal topography scan. This is a quick, painless imaging procedure which checks in detail the shape and thickness of your cornea to diagnose keratoconus at an early stage.
What treatment is available?
Keratoconus cannot be treated with eye drops or medication.
In the early stages, some patients will simply need glasses to see well, but many patients eventually require contact lensesfor better vision. The contact lenses are usually small hard lenses (rigid gas permeable lenses) but some people may wear soft (hydrogel) lenses and some need special lenses made specifically for keratoconus eyes. Contact lenses do not make keratoconus worse or better, they just improve your vision while you are wearing them. In very advanced cases, where contact lenses fail to improve vision, a corneal transplant (‘graft’) may be needed.
Corneal collagen cross-linking (CXL)
CXL is a well established FDA treatment that can halt the progression of keratoconus. Also known as C3R, it uses ultraviolet light(UVA) and vitamin B2 (riboflavin) drops to stiffen (and strengthen) the cornea. It is effective in over 90% of patients with a single 30-minute outpatient procedure. It is only suitable for some people with progressive keratoconus who present at an early stage.
Is CXL Safe?
CXL is a relatively safe procedure with few known complications. But there are always certain rare but possible risks such as – Infection, Scarring, Sterile corneal ulceration and in rare cases corneal melt.