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Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes and often begins during a person's teens or early 20s.
Complications of Keratoconus
In advanced keratoconus, your cornea may become scarred, particularly at the point of the cone. A scarred cornea causes additional vision disturbances, and can be corrected only with corneal transplant surgery.
Causes of Keratoconus
New research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward. Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses and chronic eye irritation.
Signs & Symptoms of Keratoconus
Keratoconus can be difficult to detect, because it usually develops slowly. However, in some cases, keratoconus may proceed rapidly. As the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may occur. Often, keratoconic patients experience changes in their eyeglass prescription every time they visit their eye care practitioner. It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is unfamiliar with the early-stage symptoms of the disease.
Diagnosis of Keratoconus
Your ophthalmologist can diagnose keratoconus during a routine eye exam, but more sophisticated tests may be done to determine the exact shape of your cornea. Tests to diagnose keratoconus include:
Treatments of Keratoconus
The treatment of keratoconus depends on its severity and rate of progression. Mild or moderate keratoconus can be treated with corrective glasses or contact lenses, but surgery may be necessary for advanced cases or scarring of the cornea.
If you're using rigid or scleral contact lenses, be sure that they're fitted by an eye doctor with experience in treating keratoconus, and that you go in for checkups and re-fittings. A poor-fitting hard contact lens can make keratoconus worse.
You may need surgery if you have corneal scarring, extreme thinning of your cornea, or you can't tolerate the contact lens options. Several surgeries are available, depending on the location of the bulging cone and the severity of the disease. Surgical options are:
Although this surgery can restore a more normal corneal shape and halt the progression of keratoconus, many people still need to wear corrective lenses following the procedure. However, the surgery makes it easier to fit and tolerate contact lenses. Since the surgery is reversible, some people try ICRS before considering keratoplasty.
During a keratoplasty, you may have a general anesthetic, or just your eye may be numbed with a local anesthetic. Your doctor removes a button-shaped portion of your cornea, replacing it with a similar-sized button from a donor cornea. Stitches and a soft lens are placed to protect your eye as it heals. Recovery after keratoplasty can take up to one year, and you will likely continue to need rigid contact lenses to have clear vision.
A new treatment for keratoconus, called collagen cross-linking, is showing promise. After having riboflavin drops applied to your corneas, you receive 30 minutes of exposure to ultraviolet A (UVA) light. The procedure hardens and stabilizes the corneas, with the goal of preventing further thinning or bulging. The treatment is still in its testing phase and additional study is needed before it's widely available.
Prevention of Keratoconus
Most cases of keratoconus are not preventable, but there are some steps you can take to be sure you don't cause it yourself:
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