Keratoconus

WEAKENING AND DISTORTION OF THE CORNEA

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In this video, Prof Mohammed Muhtaseb explains what you need to know about keratoconus

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KERATOCONUS EXPLAINED

In these toggles we explain what you need to know about keratoconus

Keratoconus usually affects both eyes, although at differing points of onset and rates of progression.

In most people, keratoconus begins during their teenage years and progresses at varying rates until stabilising in their 30s or 40s.

Watch this video on keratoconus:

Keratoconus arises because of weakness in the layers of the cornea that leads to progressive thinning of the cornea.

Normal pressure within the eye causes the cornea to bulge into a cone-like shape progressively. This makes the eye more myopic and induces astigmatism (think of the cornea becoming shaped more like a rugby ball than a football). When this happens, you may notice blurring of vision and more frequent changes in spectacle prescriptions.

Normal activities, such as driving and reading can be challenging to perform.

We can diagnose and examine keratoconus by performing a comprehensive eye examination.

The tests include:

  • Eye refraction
  • Slit-lamp examination
  • Keratometry
  • Computerised corneal mapping

Treatment of keratoconus is aimed at stabilising corneal shape and improving vision.

The correct treatment for your eyes depends on many factors.

A full consultation with Prof Muhtaseb will be required to establish the precise clinical need and most appropriate care plan to produce the best outcome.

Glasses and contact lenses

Keratoconus is typically treated with contact lenses to improve vision. A proper lens fit is crucial to obtain adequate vision and wearing comfort. Poorly fitting or outdated contact lenses can be uncomfortable and lead to significant discomfort, corneal abrasions, scarring or infection.

If traditional methods aren’t possible, the interventions described below are successful in a high proportion of patients.

Corneal Collagen Crosslinking (CXL)

When the corneal shape is only mildly affected in early keratoconus, and the vision is still good, CXL can slow down or halt progressive distortion of the cornea by increasing its strength. It may also be possible to perform CXL in more advanced cases of keratoconus if the cornea is not too thin and the best corrected vision is still reasonable.

Watch this video on the Cross Linking:

INTACS (IntraCorneal Rings)

INTACS inserts are clear, thin prescription inserts placed in the periphery of the cornea during a brief procedure. INTACS inserts reshape the curvature of the cornea from within.

Intrastromal Corneal Ring Segments (ICRS)

When the corneal shape is more distorted, and the vision is reduced, ICRS can reshape the cornea and restore vision by improving the chance of success with a contact lens.

Watch this video on the Intrastromal Corneal Ring Segments (ICRS):

Implantable Collamer Lens (ICL)

When the corneal shape is stable, corrected vision with glasses is good, and there is a desire to reduce dependence on glasses, then ICL phakic lens implantation can provide functional visual rehabilitation. NB: this is an off-label treatment.

Combining treatments

ICRS + CXL

In some cases, there is a need to reshape the cornea and increase corneal strength. This produces a normalisation of corneal shape that is long-lasting and stable.

Additional ICL

When the cornea has undergone reshaping and become stable, ICL implantation can complete the visual rehabilitation by improving functional vision.

Corneal transplantation

Although keratoconus rarely results in blindness, 20% of all patients may at some time need to undergo a corneal transplant if the condition is left untreated. This can be either because of corneal scarring that prevents useful vision or because of intolerable side effects related to the use of contact lenses.

A corneal transplant, either full- or partial-thickness, can restore corneal clarity and improve vision.

However, corneal transplantation is a major undertaking with prolonged recovery time. Although the final result is often favourable in keratoconus, it should be considered a last resort.

Why have I developed keratoconus?

Keratoconus can be seen in isolation, or it may be associated with some medical conditions such as asthma, eczma, hay fever, Down syndrome, and others

Can keratoconus be cured?

No, keratoconus cannot be cured in terms of reversing the corneal changes. However, collagen cross-linking can strengthen the cornea and slow down that changes of keratoconus.

What is the best way to improve my vision if I have keratoconus?

Vision can be improved by using glasses, but if these don’t work then a specialist contact lens specially designed to fit over a conical cornea may provide a good improvement in vision.

Will keratoconus continue to get worse over my lifetime?

No, keratoconus generally stabilises by the time a patient enters their 40’s. However, the corneal changes that can occur in the meantime may be quite severe and cause a serious reduction in vision.

Therefore, it is important to seek a consultation with a consultant ophthalmologist with a special interest in keratoconus for advice on possible treatment options.

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R M, Refractive Surgery
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D R, Refractive Lens Exchange
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Mrs. A L, LASIK
“I would like to thank you for operating to remove my cataracts in both my eyes. It is the first time in my life that I'm able to see without glasses or contact lenses. I've been short-sighted since I was a child when I used to sit at the front of the class in school to see the blackboard. Once again thank you, I'm so grateful to you." ★★★★★
Mrs. W, Cataract surgery
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Mrs. A D, Refractive Lens Exchange
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Anonymous, Multifocal Piggyback Lens
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Mr. D, Cataract surgery
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Mr. A, Cataract surgery
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The NHS has compared laser eye surgery and lens replacement, and is worth a look. Click here for more information.

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Presbyopia is a condition that can make patients undergo a lens replacement – but what exactly is it? Click here for more information.

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ABOUT THE EXPERT

Prof Mohammed Muhtaseb, FRCOphth

Consultant Cornea, Cataract and Refractive Surgeon

iLase is the private practice of Consultant Ophthalmic Surgeon, Prof Mohammed Muhtaseb. Based in South Wales, he is one of the very few ophthalmologists working in the UK who is a fellowship-trained specialist in Cornea, Cataract and Refractive Surgery. He holds full specialist registration with the General Medical Council and was appointed as a Consultant in the NHS in 2006.

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