World Keratoconus Day is an opportunity to raise awareness of the disease and this year it is celebrated on November 10. Keratoconus is a disease of the cornea that is progressive but not inflammatory. Keratoconus is caused by the weakening of the collagen fibers that would normally maintain the cornea’s dome shape. With this disease, the weakened cornea begins to thin, changes shape, and protrudes outward. This bulging and thinning causes the cornea to take on a gradual cone shape that can seriously affect vision.
An initial sign of keratoconus is usually a change in prescription. Additionally, many patients experience visual disturbances such as glare, halos, and double vision due to the cornea changing shape. Over time, keratoconus patients notice that their vision begins to distort and become blurry, and since it is a progressive disease, these visual symptoms worsen. Many keratoconus patients tend to be very myopic with a high level of astigmatism. Initially, glasses and contact lenses may help with visual changes, but as the disease worsens, glasses and contact lenses lose their helpful effects. Opticians tend to refer a patient to an ophthalmologist if these signs begin to occur and worsen, the ophthalmologist will then diagnose the condition and prescribe a treatment plan.
Keratoconus can occur for many reasons, but the cause is still unknown. The disease can be hereditary and can develop from a young age, so it is recommended that children’s eyes be checked by an ophthalmologist if the disease is hereditary. It can also develop at a later age due to; chronic eye rubbing or laser eye surgery (called ectasia), for example. There are also some other medical conditions where a patient may be more likely to develop Keratoconus such as; retinitis pigmentosa, Ehlers-Danlos syndrome and Down syndrome.
Treatment for keratoconus varies depending on the severity of the disease. As mentioned above, glasses or soft contact lenses are recommended initially to help with visual changes, but as the disease progresses, switching to hard or other specialized contact lenses may be helpful for better vision. These types of contact lenses must fit properly and follow-up is essential to monitor vision and the condition of the cornea. If glasses and different types of contact lenses don’t work, and as the disease continues to develop, a corneal doctor may recommend a procedure called corneal collagen cross-linking. This procedure, now recommended by the National Institute for Health and Care Excellence (NICE), helps slow or stop the progression of the disease. It works by using ultraviolet light and riboflavin (vitamin B2), to help build and straighten weakened collagen fibers by creating more cross-links between the fibers in the cornea, making it stronger and rougher. Corneal collagen crosslinking can be performed in both children and adults and is rapidly becoming the procedure of choice for ophthalmologists to treat keratoconus due to its safety and efficacy. Other options to treat keratoconus may also include corneal ring implants, which help maintain the natural shape of the cornea, and phototherapeutic keratoplasty (PTK) may also be suggested. If the disease is too advanced and severe, the above treatments may not help, and the only option may be for the patient to have a corneal transplant, which can be a partial or full thickness transplant and is only used as last resort if other treatments can’t help.
Keratoconus is a serious eye disease and can cause blindness if not properly controlled and treated. There are currently no cures for the disease and the only treatment to help slow or stop keratoconus is corneal collagen cross-linking. It is recommended that patients, adults and children, with keratoconus or suspected keratoconus attend their follow-up appointments and follow the advice of their optician or ophthalmologist.
