General Description:

Keratoconus is a progressive eye disease in which the normally round, dome-shaped cornea (the clear front surface of the eye) thins and begins to bulge into a cone-like shape. This change leads to blurred vision, distortion, and increased sensitivity to light because the light is no longer correctly focused on the retina. Keratoconus typically appears in adolescence or early adulthood and can worsen over time. The treatment aims to slow the progression of the disease, stabilize the cornea, and improve vision.

Indications:

Treatment for keratoconus is indicated for:

  • Progressive Keratoconus: Patients whose corneal shape is deteriorating and whose vision is increasingly impaired.
  • Vision Loss or Deterioration: Patients experiencing significant vision deterioration due to the disease.
  • Intolerance to Glasses or Contact Lenses: Patients who cannot achieve adequate vision correction with traditional glasses or contact lenses due to the irregular corneal shape.
  • Early Stages of Keratoconus: To slow the progression of the disease and prevent more severe changes in the cornea.

Methods:

  1. Description:
    There are various treatment options for keratoconus, chosen based on the severity of the disease and the patient’s individual needs. The most common treatments include glasses and contact lenses, corneal cross-linking (CXL), intracorneal ring segments, phakic intraocular lenses, and corneal transplants.
  2. Procedure:
    • Glasses and Contact Lenses:
      • Glasses: In the early stages of keratoconus, glasses can be used to correct vision, especially if corneal deformation is minimal.
      • Soft Contact Lenses: For mild keratoconus, soft contact lenses can correct vision by evenly covering the eye.
      • Rigid Gas Permeable (RGP) Contact Lenses: These lenses provide a regular surface over the irregular cornea, helping to focus light correctly on the retina and improve vision.
      • Hybrid Contact Lenses: A combination of a rigid center and a soft outer ring for better comfort and vision correction.
      • Scleral Contact Lenses: Larger lenses that rest on the sclera (the white part of the eye) and create a smooth surface over the irregular cornea, improving vision.
    • Corneal Cross-Linking (CXL):
      • Epithelium-off CXL: This method involves removing the outer layer of the cornea (epithelium) before applying riboflavin eye drops (Vitamin B2) and then activating them with UV light. This process strengthens the collagen fibers in the cornea to stop thinning and stabilize the cornea.
      • Epithelium-on CXL: In this less invasive method, the epithelium remains intact while riboflavin and UV light are used to strengthen the cornea. This method may be less painful but might have reduced effectiveness in stabilizing the cornea.
    • Intracorneal Ring Segments (ICRS):
      • These small, arc-shaped plastic segments are surgically implanted into the cornea to reshape it and improve refractive power. They can stabilize vision and reduce dependence on contact lenses.
    • Phakic Intraocular Lenses (PIOL):
      • These specialized lenses are implanted in the eye without removing the natural lens. They correct visual acuity, especially in patients with high astigmatism or myopia caused by keratoconus.
    • Corneal Transplantation:
      • Penetrating Keratoplasty: A full-thickness corneal transplant, replacing the entire damaged cornea with a healthy donor cornea. This method is used in advanced cases of keratoconus when other treatments are ineffective.
      • Lamellar Keratoplasty: A partial corneal transplant that replaces only the affected layer of the cornea. This method has a shorter recovery time and fewer rejection risks compared to full transplantation.
  3. Advantages:
    • Variety of Treatment Options: Patients can choose from various treatments tailored to their specific needs and the severity of their condition.
    • Slowing Progression: Procedures like corneal cross-linking can stop or slow the progression of keratoconus, preventing the need for corneal transplantation.
    • Improvement of Vision: Many treatments, including contact lenses, ring segments, and PIOLs, can significantly improve vision.
    • Preservation of the Cornea: Some treatments, like corneal cross-linking and intracorneal ring segments, allow for preserving the natural cornea and improving its function.
  4. Disadvantages:
    • Possible Side Effects: Some treatments, especially surgical procedures, can carry risks such as infection, inflammation, scarring, and vision loss.
    • Cost: Some treatments, especially surgical procedures and specialized contact lenses, can be expensive and may not be fully covered by insurance.
    • Recovery Time: Some procedures, like corneal transplants, require a long recovery time and can take several months to restore full vision.
    • Required Adjustments: Many treatments require regular adjustments and follow-up care to ensure optimal results and avoid complications.

Conclusion:

Keratoconus treatment offers various options to slow disease progression, improve vision, and enhance patients’ quality of life. From non-surgical solutions like specialized contact lenses to surgical procedures like corneal transplants, there is a suitable treatment for most patients. A thorough consultation with an ophthalmologist is crucial to choosing the best treatment strategy and understanding the individual risks and benefits of the different procedures.