Keratoconus is a progressive eye disease, where your cornea becomes a very thin, cone-like shape. This can often begin in the late teenage years to early 20s. You’ll notice increased light-sensitivity, some eye pain, and the need to frequently change your eyeglass prescription. With a wide range of symptoms, keratoconus is hard to diagnose. A highly-trained doctor can use a slit lamp and inspect your cornea at a microscopic level to determine if you have this.
New research shows this weakening of the corneal tissue with keratoconus might be due to an imbalance of enzymes in the cornea. This imbalance leads to susceptibility to oxidative damage from free radicals, causing the cornea to weaken and puff up. A genetic disposition is also considered as one of the causes, which explains why more than one member of your family may experience keratoconus. Overexposure to UV rays, a history of poorly-fitted contacts, or excessive eye rubbing can also be the causes.
Eyeglasses or soft contact lenses may help mild forms of keratoconus. Since it is a progressive disease, glasses or regular contact lenses won’t help when your symptoms worsen. Possible keratoconus treatments are listed below, and please see an eye doctor in order to determine is one of the solutions will be right for you.
- Corneal cross-linking (CXL). This procedure strengthens corneal tissue in order to stop the bridging of your cornea in keratoconus. There are two types of corneal cross-linking: epithelium-off and epithelium-on. This has recently been approved, so your trained eye doctor can treat this in office reducing the need for a corneal transplant.
- Custom soft contact lenses. Lens manufacturers have recently introduced soft contact lenses that are specifically designed to correct mild-to-moderate keratoconus. These are made-to-order, following your specific prescription, have a wide range of fitting parameters, and are wider in diameter that regular contact lenses to ensure greater stability on the keratoconus eye.
- Gas permeable contact lenses. While normal contact lenses may not help, switching to gas permeable contacts might be the solution. Although they can be less comfortable, these lenses vault over the cornea, replacing the dome with a uniform refracting surface.
- "Piggybacking" contact lenses. Although generally not recommended, wearing two lenses can help. By placing a soft contact lens over the eye, and then placing a rigid, gas permeable lens over that, fitting the lens combination requires experience on the part of the lens fitter. An eye doctor can confirm if wearing two contact lenses allows enough oxygen to be delivered to the eye.
- Hybrid contact lenses. These lenses are a combination of a highly oxygen-permeable rigid center with a soft peripheral “skirt.” Specifically designed for keratoconus, the center vaults over your cone-shaped cornea and provides comfort.
- Scleral and semi-scleral lenses. These lenses have a wider periphery than a typical contact lens, and the wider base covers the cornea, thus alleviating eye pain related to keratoconus (see here for more information about sclera).
- Intacs. Surgically approved corneal inserts can help reshape the cornea, providing better vision. If a corneal transplant is the desired route, intacs might delay, but not prevent this from happening.
- Topography-guided conductive keratoplasty. Early results of this study show this treatment might help smooth the irregularities on the corneal surface. In fact, a study done by the American Journal of Ophthalmology reported that 15 of 21 patients who had topography-guided CK saw more corneal symmetry.
- Corneal transplant. This last remedy is the solution if rigid contact lenses or other forms of therapy don’t provide any alleviation.
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