Keratoconus Education and Treatment

Keratoconus is a progressive non-inflammatory disorder of the cornea (the front surface of the eye) that causes the cornea to become thinner and steeper. In almost all cases, the cause of this condition is genetic. Keratoconus usually appears in the early or late teen years and has an active period of about 5 years. After this active period, the effects of keratoconus begin to stabilize or to slow down. With a condition like a keratoconus, each eye can be affected differently. In the later stages of keratoconus, a dramatic reduction in a person’s uncorrected visual acuity can take place. Eyeglasses and conventional contact lenses may not be able to provide a keratoconus patient with functional vision.

New research shows that keratoconus is more common today than was previously thought. Years ago keratoconus was thought to occur in 1 in 2000 people. Today, however, due to new diagnostic instruments, it appears that the incidence of keratoconus occurs in 1 out of 500 people. Eyeglasses and soft contact lenses may correct mild cases of keratoconus where the patient’s nearsightedness and astigmatism are minimal. In more advanced cases, these options will not be able to provide a keratoconus patient with functional, comfortable vision.

With today’s contact and scleral lens technologies, very few patients will ever need to undergo corneal transplant surgery. Corneal transplant surgery carries with it very real risks of ocular infection and corneal rejection. In addition, the healing period after a corneal transplant may be as long as one year. Also, the anti-rejection medications that corneal transplant surgery patients must use can cause glaucoma and cataracts.

The best option for vision improvement in patients who have lost quality vision as a result of keratoconus is a scleral lens. The ocular surface in eyes with advanced keratoconus is extremely compromised. Conventional contact lenses are not well tolerated by this type of cornea. Scleral lenses have the advantage of providing excellent vision while not touching the corneal surface. Instead, these lenses vault over the cornea and come to rest on the white portion (the sclera) of the eye. A liquid reservoir exists between the back surface of the lens and the front surface of the cornea. In other words, the compromised, irritated and often dry corneal tissues are always in a liquid environment.

Vision and comfort are almost always excellent. Scleral lenses are made from special highly oxygen rigid polymers that are thousands of times more oxygen permeable that any soft contact lens.

Very often keratoconus patients will ask “how do I know if my keratoconus is progressing?”. The answer is to have sequential corneal topographies done at regular intervals using the same corneal topographer and having this procedure done by the same operator. Each corneal topographer is different and each uses a separate algorithm or software which can provide misleading information. In addition, please understand that change is normal and change in a computerized topographic image does not necessarily mean progression or regression. If a photo was taken of you today and compared to a photo taken 5 or 6 years ago, change may be noted. However, you cannot imply that you are better or worse just because a normal change has occurred.