Keratoconus

Keratoconus affects about 1 in every 2,000 people, often starting in adolescence. But what happens when your vision begins to blur in ways that glasses or contact lenses can no longer fix? Keratoconus, a condition that causes the cornea to thin and change shape, is the culprit. It’s progressive, unpredictable, and can be life-altering. The good news? There are treatments that can slow it down or even improve vision. So, let’s break it down. What exactly is keratoconus? How can you spot it early? And what’s being done to treat it? Read on to get the answers you need to understand and manage this condition.

What Is Keratoconus?

Keratoconus is a condition that causes the cornea—the transparent, dome-shaped front part of your eye—to thin and bulge out into a cone-like shape. This abnormality distorts the way light enters the eye, leading to blurry or distorted vision. The condition often begins in the teenage years and typically progresses until the person reaches their 30s.

While it’s not life-threatening, keratoconus can significantly impact daily life, especially as it worsens. Vision changes rapidly, and simple tasks like reading, driving, or using a computer become more challenging. But don’t worry—early diagnosis and treatment can help manage the symptoms and prevent further damage.

Symptoms You Shouldn’t Ignore

The signs of keratoconus can be subtle at first, but they worsen as the condition progresses. If you’re experiencing any of the following, it’s time to see an eye care professional:

• Blurry or Distorted Vision: One of the earliest symptoms. As the cornea changes shape, your vision will become increasingly blurry, even with the best glasses or contacts. Straight lines may appear wavy, and night vision may become difficult.

• Frequent Changes in Prescription: If you’re constantly updating your prescription for glasses or contacts, it could be a sign of keratoconus. People with this condition often find that their vision fluctuates rapidly.

• Halos and Glare: As the cornea’s shape becomes more irregular, bright lights can cause halos or glare, especially when driving at night.

• Eye Irritation: Because of the corneal changes, some people experience a feeling of grittiness or constant irritation, like there’s something stuck in their eye.

• Double Vision: In more advanced cases, keratoconus can cause double vision or multiple images, making it difficult to focus.

How Is Keratoconus Treated?

While keratoconus can’t be cured, there are several treatment options available to manage the condition and slow its progression. Treatment depends on how severe the condition is and how much it affects your daily life. Let’s take a closer look at some of the most common options.

1. Glasses and Contact Lenses

• For early-stage keratoconus, glasses or soft contact lenses might help. However, as the condition progresses and the cornea becomes more irregular, these lenses may no longer provide clear vision.
• In those cases, rigid gas permeable (RGP) lenses are often the next step. These hard lenses create a smooth surface over the cornea, improving vision.
• Scleral lenses, larger lenses that sit on the white part of the eye (the sclera), are particularly useful for advanced cases where other lenses aren’t effective.

2. Corneal Cross-Linking (CXL)

• Corneal cross-linking is a groundbreaking procedure that strengthens the cornea and prevents further deterioration. It involves applying riboflavin (vitamin B2) drops to the cornea, followed by ultraviolet (UV) light. This process increases the collagen bonds in the cornea, making it more rigid and stable.
• This procedure is most effective in the early stages of keratoconus and can slow or even stop the progression of the condition. It can also improve vision in some patients, offering hope for a better quality of life.

3. Intacs (Corneal Ring Segments)

• Intacs are small, crescent-shaped rings that are surgically inserted into the cornea to flatten the steep, cone-like shape. This can improve vision and reduce the need for a corneal transplant.
• Intacs are particularly effective for people in the early to moderate stages of keratoconus. The procedure is reversible, and the rings can be removed if necessary.

4. Corneal Transplant (Keratoplasty)

• In severe cases of keratoconus, where other treatments have failed, a corneal transplant may be necessary. This involves replacing the damaged cornea with a healthy donor cornea.
• There are two main types of corneal transplants: penetrating keratoplasty (PK), which replaces the entire cornea, and deep anterior lamellar keratoplasty (DALK), which only replaces the front layers of the cornea. The choice of procedure depends on the severity of the disease and the specific needs of the patient.

5. Medications

• While there isn’t a medication that can cure keratoconus, several options can help manage symptoms:
  • Lubricating eye drops can help reduce dryness and irritation caused by the irregular corneal shape.
  • Anti-allergy medications like Olopatadine (Patanol) can help manage allergic reactions that might lead to eye rubbing, preventing further damage.
  • In some cases, topical steroids like fluorometholone can reduce inflammation in the cornea, but these should only be used under the supervision of an eye care provider due to the risk of side effects.