Keratoconus

Keratoconus is typically treated with contact lenses to improve vision. A proper lens fit is crucial to obtain adequate vision and wearing comfort. Poorly fitting or outdated contact lenses can be uncomfortable and lead to significant discomfort, corneal abrasions, scarring or infection.

If traditional methods aren’t possible, the interventions described below are successful in a high proportion of patients.

When the corneal shape is only mildly affected in early keratoconus, and the vision is still good, CXL can slow down or halt progressive distortion of the cornea by increasing its strength. It may also be possible to perform CXL in more advanced cases of keratoconus if the cornea is not too thin and the best corrected vision is still reasonable.

Watch this video on the Cross Linking.

INTACS inserts are clear, thin prescription inserts placed in the periphery of the cornea during a brief procedure. INTACS inserts reshape the curvature of the cornea from within.

When the corneal shape is more distorted, and the vision is reduced, ICRS can reshape the cornea and restore vision by improving the chance of success with a contact lens.

Watch this video on the Intrastromal Corneal Ring Segments (ICRS).

When the corneal shape is stable, corrected vision with glasses is good, and there is a desire to reduce dependence on glasses, then ICL phakic lens implantation can provide functional visual rehabilitation. NB: this is an off-label treatment.

ICRS + CXL

In some cases, there is a need to reshape the cornea and increase corneal strength. This produces a normalisation of corneal shape that is long-lasting and stable.

Additional ICL

When the cornea has undergone reshaping and become stable, ICL implantation can complete the visual rehabilitation by improving functional vision.

Corneal transplantation

Although keratoconus rarely results in blindness, 20% of all patients may at some time need to undergo a corneal transplant if the condition is left untreated. This can be either because of corneal scarring that prevents useful vision or because of intolerable side effects related to the use of contact lenses.

A corneal transplant, either full- or partial-thickness, can restore corneal clarity and improve vision.

However, corneal transplantation is a major undertaking with prolonged recovery time. Although the final result is often favourable in keratoconus, it should be considered a last resort.

Keratoconus can be seen in isolation, or it may be associated with some medical conditions such as asthma, eczma, hay fever, Down syndrome, and others

No, keratoconus cannot be cured in terms of reversing the corneal changes. However, collagen cross-linking can strengthen the cornea and slow down that changes of keratoconus.

Vision can be improved by using glasses, but if these don’t work then a specialist contact lens specially designed to fit over a conical cornea may provide a good improvement in vision.

No, keratoconus generally stabilises by the time a patient enters their 40’s. However, the corneal changes that can occur in the meantime may be quite severe and cause a serious reduction in vision.

Therefore, it is important to seek a consultation with a consultant ophthalmologist with a special interest in keratoconus for advice on possible treatment options.