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Keratoconus

Keratoconus

Collagen Cross-linking and Intacs or Keraring implants. These new techniques can halt and reverse some of the effects of keratoconus. If you are affected by Keratoconus, contact the specialist team at Eye Institute to arrange an appointment.

What is Keratoconus?
Keratoconus is a condition in which the cornea (the clear front “window” of the eye) becomes weakened and develops an irregular shape. It generally affects both eyes although one eye may be much more affected than the other.

The cornea does most of the eye’s focusing - therefore irregularity of its shape causes blurring of vision. As this progresses, glasses become less effective at improving vision.

 

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Traditional Keratoconus Treatment
When glasses become ineffective, the next step is to try contact lenses to improve vision. These are usually hard (rigid gas permeable or “RGP”) lenses although soft lenses may be suitable, or even a combination of soft and hard. Your optometrist is the best person to help you with fitting these and follow-up advice.

For some people, it is impossible to get a good and comfortable contact lens fit. Traditionally, this has been an indication for a corneal transplant operation, something that around 20% of people with keratoconus eventually required.

Corneal transplantation is an excellent operation for those who need it, but it does have an element of risk for the eye and visual rehabilitation can be lengthy (12-18 months) with the possibility of still requiring a contact lens for good vision.


New Treatment Options for Keratoconus

  1. Corneal Collagen Cross-linking with Riboflavin (CXL, C3R)

    What?
    This procedure strengthens the cornea to slow or halt progression of keratoconus. It works by creating more chemical “links” or “bonds” within and between collagen fibrils, making the cornea more resistant to deformation.

    Why?
    Stopping progression of keratoconus, especially if it is carried out fairly early on, means that vision that you currently have is likely to be retained. In short, your eyes shouldn’t get worse. This means that people with keratoconus treated early should retain good vision with or without glasses; if treated later when you are contact lens dependent, it should stop worsening of keratoconus that could otherwise require a corneal transplant.

    Evidence shows that many people who have this treatment also benefit from mild flattening of the cornea over the next two years, a beneficial effect for people with keratoconus.

    Keratoconus - Collagen cross-linkingHow?
    The procedure involves painlessly removing some of the corneal surface (the epithelium) and applying riboflavin (Vitamin B2) drops for 30 minutes. Then a measured dosage of ultraviolet light is applied to the cornea for 30 minutes. A soft contact lens is applied during the initial four day healing phase and drops are used to help with healing and comfort. Vision may be a little blurry for the first two – three weeks as the eye completely settles.


  2. Intralase Intrastromal Corneal Ring Implants 
    (Intacs, Kerarings, Ferrara rings)


    What?
    These are tiny transparent semicircular implants that are precisely placed within the cornea to make its shape more regular and to flatten the central cornea, a beneficial effect for people with keratoconus. Precise placement is made possible with use of the Intralase femtosecond laser, most commonly used for creating very thin flaps in the cornea during the iLASIK refractive procedure.

    Keratoconus - Keraring implants - intacsWhy?
    The best use of intrastromal implants (Intacs, Kerarings, Ferrara rings) is for people with moderate keratoconus who require hard contact lenses for good vision. Problems with contact lens comfort are common due to worsening keratoconus, dry eye or allergy problems. Implants are likely to improve contact lens comfort. They typically also improve unaided vision and vision with glasses, and may make it possible to move from hard contact lenses into soft lenses. In addition, the implants may help to stabilise the cornea and delay or halt progression.

    Implant surgery should always be considered before proceeding to a corneal transplant operation.

    How?
    The procedure is carried out painlessly with local anaesthetic drops and takes about 20 minutes. The Intralase laser is used to create a precisely located circular channel within the cornea before your Doctor places the ring implants within this channel to change the shape of the cornea. Discomfort afterwards is typically transient and minimal. Vision takes about three months to stabilise.

The treatment of keratoconus has now entered an exciting phase with the development of these new techniques to halt and to reverse some of the effects of this visually debilitating condition.