Keratoconus

Diagnosis

Your eye doctor will examine your eyes, go over your medical and family history in order to diagnose keratoconus. To learn more about the shape of your cornea, more tests could be performed. To diagnose keratoconus, tests consist of:

• Eye refraction.Specialized equipment is used in this test to measure your eyesight. You might be required to look through a phoropter, which is a device with wheels that hold various lenses. This tool assists in determining which combination results in the clearest vision. To examine the eyes, some doctors may utilize a portable device named retinoscope.
• Slit-lamp examination.In this test, the eye’s surface is exposed to a vertical light beam, and the eye is examined under a low powered microscope. The ophthalmologist assesses the form of your cornea and searches for additional possible issues within the eye.
• Keratometry.This examination entails directing a circular beam of light onto the cornea and assessing the reflection, which helps determine the fundamental contour of the cornea.
• Computerized corneal mapping. Specific photographic examinations, such corneal tomography and corneal topography, capture pictures in order to produce an intricate form map of the cornea. The cornea’s thickness can also be determined by corneal tomography. Often, this kind of testing can identify keratoconus signs in their early stages before a slit-lamp examination reveals the condition.

Treatment

The course of treatment for keratoconus is determined by the severity of the ailment and its rate of progression. In general, there are two methods for treating keratoconus: reducing the disease’s progression and enhancing vision.

Corneal collagen cross-linking may be necessary to halt or stop the worsening of keratoconus, if it is progressing. The goal of this treatment is to stabilize the cornea’s structure. It might lessen corneal bulging and improve eyesight when wearing contact lenses or glasses. Additionally, this treatment may keep you from ever needing a corneal transplant.

The degree of keratoconus determines how much vision can be improved. Contact lenses or spectacles can be used to treat mild to moderate keratoconus. This will probably be a long-term procedure, particularly if cross-linking or time cause the cornea to stabilize.

In certain cases of advanced keratoconus, the cornea becomes scarred. For some, it becomes challenging to wear contact lenses. For these individuals, corneal transplant surgery may be required.

Lenses

• Eyeglasses or soft contact lenses.In early keratoconus, distorted or hazy vision can be corrected using glasses or soft contact lenses. However, when the curvature of their corneas changes, people frequently need to adjust their prescription for contacts or glasses.
• Hard contact lenses.When treating more advanced cases of keratoconus, hard contact lenses are frequently the next step. Gas permeable, rigid lenses are examples of hard lenses. Although many people find wearing hard lenses irritating at first, they will usually adjust with time obtaining exceptional vision. Your corneas can be fitted with this kind of lens.
• Piggyback lenses.Your eye doctor could advise “piggybacking” a hard contact lens on top of a soft one if rigid lenses cause you discomfort.
• Hybrid lenses.For enhanced comfort, these contact lenses include a softer ring surrounding the rigid center. Hybrid lenses may be preferred by those who cannot wear hard contact lenses.
• Scleral lenses.When you have advanced keratoconus, these lenses can help with very erratic shape changes in your cornea. Scleral lenses sit on the white portion of the eye, known as the sclera, and vault over the cornea without touching it, in contrast to conventional contact lenses that rest on the cornea.

Make sure the eye doctor fitting your rigid or scleral contact lenses has experience treating keratoconus. Additionally, in order to make sure the lenses still fit properly, you’ll need to get regular examinations. A poorly fitting lens may cause corneal injury.

Therapies

• Corneal cross-linking.During this process, UV light and riboflavin eye drops are applied to the cornea. Cross-linking of the cornea results from this, stiffening the cornea to stop additional morphological changes. By stabilizing the cornea at an early stage of the disease, corneal cross-linking may help lower the chance of progressive vision loss.

Surgery

If you are unable to wear any kind of contact lenses, have severe corneal thinning, have poor vision even with the strongest prescription lenses, or have corneal scarring, you may require surgery. The following surgical procedures are available, depending on the location of the bulging cone and the severity of your condition:

• Intrastromal Corneal Ring Segments (ICRS).For mild to moderate keratoconus, your eye doctor can advise placing tiny artificial rings in your cornea. By helping to flatten the cornea, this procedure may enhance vision and facilitate a better fit for contact lenses. This process is occasionally used with corneal cross-linking.
• Cornea transplant (keratoplasty).You will probably require a corneal transplant if you have severe thinning or corneal scarring. Your eye doctor may advise replacing all or a portion of your cornea with healthy donor tissue, depending on your particular circumstances.

A cornea transplant for keratoconus typically results in excellent outcomes. Graft rejection, infection, astigmatism, and poor vision are possible complications. Re-wearing hard contact lenses is frequently an option for managing astigmatism following a cornea transplant.