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Keratoconus

Treatment of Keratoconus

Unlike the normal curvature of the cornea, those suffering from this degenerative disorder have structural corneal changes leading to the appearance of a thin conical shaped cornea. This further affects the vision leading to distorted images, multiple images and sensitivity to light. Our ophthalmologist can help restore the vision by carrying out surgical procedures, namely crosslinking. Customized wave front guided surface ablation can be performed in certain cases. For advanced keratoconus, we also offer corneal ring segment inserts or corneal transplant in order to restore the vision.

Signs and symptoms:

Initially, patients will experience blurring and distortion of vision, due to the progressive thinning of the cornea. This may be corrected with glasses during the early stages of the condition. Hard contact lenses can be used for moderate cases.

Treatment:

As keratoconus advances, the cornea becomes highly irregular and vision is no longer adequately corrected with spectacles. Rigid contact lenses are then required to provide optimal visual acuity. Soft contact lenses are usually not an option, as they cannot correct for the irregular astigmatism associated with the keratoconus. In about 15% of cases, the keratoconus progresses to the stage where corneal transplantation is required.

The latest revolutionary Keratoconus treatment is Corneal Collagen Crosslinking with Riboflavin. This treatment is performed in just 20 to 30 minutes. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light.

The cornea is first anaesthetized using drops. The mucous surface of the cornea (epithelium) is disrupted and then Riboflavin, (Vitamin B2) drops are placed in the eye every few minutes. In certain cases this procedure can be performed with no disturbance of the epithelium. The yellow pigment of the Riboflavin absorbs the Ultraviolet A light, increases the amount of collagen cross-linking in the cornea and strengthen the cornea. Once the procedure is completed, a soft bandage contact lens will be placed in the eye and antibiotics will be instilled.

The cornea increases in rigidity soon after the procedure although the process of cross linking continues on for a period of a few days afterwards.

Other treatments available include

  • Gas permeable contact lenses. If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment.
  • ClearKone hybrid contact lenses. (SynergEyes Inc., Carlsbad, Calif.) These hybrid contact lenses combine a highly oxygen-permeable rigid center with a soft peripheral "skirt." The ClearKone version was designed specifically for keratoconus and vaults above the eye’s cone shape for increased comfort.
  • Topography-guided conductive keratoplasty. While more study is needed, early results of a small study involving topography-guided conductive keratoplasty (CK) show this procedure might help smooth irregularities in the corneal surface. This treatment uses energy from radio waves, applied through tiny probes, to reshape the eye’s surface. A topographic “map” created through imaging of the eye’s surface helps create individualized treatment plans.
  • Corneal transplant. A corneal transplant may be needed when vision cannot be corrected satisfactorily using other procedures such as contact lenses and glasses, or if painful swelling cannot be relieved by medications. A corneal transplant, also known as a corneal graft, or as a penetrating keratoplasty, involves the removal of the central portion called a button (see left photo) of the diseased cornea and replacing it with clear healthy donor button.
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