Keratoconus Treatment: Contact Lenses, Cross-Linking and Referral

Keratoconus is an eye condition that affects the shape and structure of the cornea, the clear front part of the eye. The normal shape of the cornea is curved and dome-shaped, but if you have keratoconus, the size of the cornea becomes irregular, i.e., thin or bulging outward into a cone-like shape.

This abnormal shape and thinning of the cornea cause blurred or distorted vision; this eye condition is keratoconus. Keratoconus normally begins in the late teens or early 20s and is progressive; it can affect one or both eyes.

Finding an effective solution to restore clear vision is important for individuals living with keratoconus. The recent advancements in scleral lens technology have brought renewed hope and improved quality of life for keratoconus patients. In this blog, we talk about abnormal shaping, and thinning of the cornea, which cause vision issues, and effective treatment options for your condition.

What is the Fleischer ring in Keratoconus?

A Fleischer ring is a yellowish or brownish ring that appears on the outer edge of the cornea and is seen in some individuals living with keratoconus. It is ideally seen, when hemosiderin, a form of iron storage protein, is deposited in the epithelial cells of the cornea.

Several surgical and non-surgical Keratoconus treatment options are available today that can be ideal for your case since the cornea bulges outward like a cone, and light rays hitting the retina cannot focus back at the back of your eye indicating blurry vision.

Imagine how severe the condition can get if left untreated. From blurring of vision to halos around bright light, the increased sensitivity can indicate the risk of vision loss. That is why you need to consult a keratoconus specialist near you immediately to monitor your case and prevent it from progressing.

There is no exact cure for keratoconus, but certain treatment options can help improve your vision and slow the progression of the symptoms.

Early-stage treatments of Keratoconus

In the early stages of keratoconus, the following treatments can be effective in correcting the vision of your eyes:

1. Eyeglasses

Eyeglasses may be sufficient in the mild form of keratoconus. The irregular corneal shape degrades image quality, so patients take visual acuity tests at regular intervals.

2. Soft contact lenses

Soft contact lenses can be a more comfortable option for vision correction than eyeglasses for those living with early keratoconus. However, one can also use other lenses, like rigid gas permeable (RGP) contact lenses, piggyback lenses, and hybrid lenses, to ensure good central vision.

Advanced-stage treatment options for Keratoconus

Can you get LASIK with keratoconus? The answer still is that LASIK is not the ideal surgical procedure to treat keratoconus. Let’s learn about the advanced-stage treatment options and the best medical device for keratoconus.

1. Scleral Contact Lens Keratoconus Treatment

Scleral lenses, also known as ScCLs, are specialized contact lenses that vault over the entire corneal surface and rest on the sclera, the white part of the eye. Unlike traditional contact lenses that sit directly on the cornea, scleral lenses create a tear-filled vault that helps to neutralize irregularities caused by keratoconus, providing a smoother optical surface for improved vision.

One of the most significant advancements in scleral lens technology has been the development of high-oxygen permeable materials, such as fluorosilicone acrylate. This has reduced the risk of complications like corneal edema and ensured greater comfort during extended wear of scleral lenses for those living with keratoconus.

Keratoconus scleral lenses are highly effective with their large-diameter lenses that rest over the sclera, unlike conventional lenses that rest on the cornea. There is a space created between the cornea and the lens when you wear scleral contact lenses.

These large-diameter contact lenses rest on the white part of your eye (sclera) and vault over the cornea. They are a good option for people with advanced keratoconus who cannot tolerate RGP lenses.

2. Rigid gas permeable (RGP) contact lenses:

Rigid gas permeable (RGP) contact lenses are hard contact lenses for keratoconus, that pose rigid forms over the irregular corneal surface of the eyes. RGP lenses provide sharp and clear vision, and these are highly breathable, ensuring optimal eye health in an individual.

A thin layer of tear between the RGP lens and cornea provides a smooth refractive surface, which is how these lenses provide superior vision correction. Once adjusted, the RGP lens is comfortable for long-term wear. There is a less likely chance that the RGP lenses irritate the cornea.

3. Intracorneal ring segments (ICRS)

These are tiny, arc-shaped implants that are inserted into the cornea to help flatten it. ICRS may be combined with other treatments, such as RGP lenses.

In severe cases of keratoconus, a corneal transplant may be necessary. The diseased cornea is removed and replaced with a healthy donor cornea. Unlike this, it implants to reshape the cornea, ICRS aims to reduce the irregular astigmatism and visual distortions associated with keratoconus.

The effectiveness of ICRS depends on several factors, including the implant’s thickness, diameter, and precise placement within the cornea. ICRS has emerged as a valuable treatment modality where, intacs, a pair of tiny clear plastic impacts are used for your vision correction.

4. Corneal collagen cross-linking (CXL)

Corneal collagen Cross-Linking (CXL) is a minimally invasive procedure used to slow down the progression of keratoconus. a condition that weakens and thins the cornea, the clear dome at the front of your eye.

An eye drop solution containing riboflavin (vitamin B2) is applied to the cornea. Ultraviolet light is applied to the cornea after riboflavin application. The UV light activates riboflavin, which then triggers the formation of new cross-links between collagen fibers.

A riboflavin solution is applied to the cornea, followed by ultraviolet light treatment in CXL. The ultraviolet light activates riboflavin, which strengthens the collagen fibers in the cornea.

What is keratoconus topography?

Keratoconus topography is a crucial diagnostic tool that involves the use of specialized instruments that create detailed maps of the corneal surface. Keratoconus topography is a non-invasive imaging technique that gives clues about the eye disorder with the correct assessment of the cornea.

Corneal topography helps to detect keratoconus before even the symptoms arise. It helps to evaluate if there are any signs of rapid progression and track changes in the corneal surface. Besides, it helps in attaining the inferior and superior halves of the cornea and the mean toric keratometry (MTK) index to understand the degree of corneal astigmatism, if any.

Keratoconus topography helps eye care professionals optimize your case, with potential signs of visual improvement and customized treatment plans, like the placement of ICRS or the application of CXL. The unique pattern of corneal irregularities can be monitored with further corneal response and management strategies, to preserve vision loss from keratoconus.

Keratoconus self-care: Living with the eye disorder

Avoid eye rubbing. Do not self-start medicated drops; ask an eye-care professional about safe lubrication or allergy management. Follow prescribed contact-lens hygiene and seek urgent care for pain, redness or sudden vision change.

Besides corneal topography, corneal hysteresis (CH) and a corneal resistance factor (CRF) also help understand the cornea’s stiffness, elasticity, and deformation. In these tests, the biochemical properties of the cornea are measured.

The results show that the forme fruste keratoconus eye has lower CH and CRF values compared to a normal eye. Also, those with forme fruste keratoconus have rather weak and less stiff corneas.

What are the risk factors for keratoconus?

Patients with a family history of keratoconus or with certain systemic disorders, such as Down syndrome, are at a higher risk of developing keratoconus. Chronic eye inflammation may also be a risk factor for developing keratoconus.

If you get keratoconus at an early age, surgical intervention can prevent disease progression, so get access from doctors, on the urgency of any sort of destruction of corneal tissue. For keratoconus,

American basketball point guard Steph Curry has Keratoconus and it is likely to be a genetic disease. Under the survey, the familial occurrence of keratoconus in his brother, Seth Curry, who also plays in the NBA, gives hints of a genetic link in their cases.

Keratoconus is certainly not a disability, as it can be treated. In many cases, people only have a mild form of keratoconus and can attain good vision with corrective lenses like eyeglasses or soft contact lenses.

What is acute hydrops?

Acute hydrops is a serious complication that can be associated with individuals having keratoconus. This condition indicates a sudden buildup of fluid within the cornea, in the clear front part of the eye.

Acute hydrops occur when a tear develops in Descemet’s membrane of the cornea. This tear might move from the inner eye to leak into the corneal stroma (middle layer), causing bulgy eyes. It can have a link to seasonal allergies, but the fact that it indicates advanced keratoconus cannot be denied. So, taking a comprehensive eye exam, including a slit-lamp examination, helps you track the eye disease.

Is keratoconus a rare disease?

Keratoconus is a relatively rare condition, you can say that, but advancement in diagnostic tools signifies that most cases of keratoconus are still to be discovered. Earlier studies suggested a prevalence of around 1 in 2,000 individuals.

However, modern corneal topography types and imaging techniques have detected early and mild cases. It now proposes the possibility of keratoconus in 1 in 400 people. The good news is that the ongoing K-MAP study is working to study the true global prevalence of keratoconus, its causes, and risk factors.

How much does a keratoconus surgery cost in Nepal?

Nepal offers relatively affordable options compared to many other countries. The cost of keratoconus surgeries can vary depending on the procedure, facility, and surgeon’s expertise.

Keratoconus procedure costs vary by diagnosis, facility, surgeon, investigations and technique. Obtain a current written estimate from the treating specialist after assessment.

To date, Nepal has made significant advancements in corneal care, with experienced ophthalmologists and well-equipped eye hospitals. They provide a range of surgical and non-surgical treatments for keratoconus and other corneal conditions.

Specialist corneal services are available in Nepal, but availability and current case volumes should be confirmed directly with the treating hospital.

Conclusion

Nepal has made significant progress in eye surgery, including advanced corneal surgeries and treatments for keratoconus. It is a relatively rare condition, but the availability of advanced corneal topography and imaging techniques has now monitored the surgical landscape in Nepal.

Treatment depends on disease stage, corneal measurements, progression, visual needs and specialist assessment. Options may include properly fitted spectacles or contact lenses, corneal cross-linking, intracorneal ring segments or transplantation in selected cases; none is a universal cure.

Corneal transplantation may be discussed for selected advanced cases when other options do not provide adequate function. A corneal specialist determines suitability and explains risks and expected outcomes.

Authoritative Keratoconus Reference

For patient information about keratoconus, see the National Eye Institute corneal dystrophies guide. Glasses or contact lenses may improve vision but do not replace medical monitoring of progression or an ophthalmologist’s treatment decision.