What is Keratoconus?
In keratoconus the cornea bulges forward and become thinner causing irregular astigmatism
Keratoconus is a progressive disease of the cornea shape and generally affects both eyes (usually one more than the other). The underlying problem is weakness of the supporting collagen fibers in the cornea. This makes the cornea structurally and biomechanically “weak”. As a result, the cornea assumes a more conical shape with resultant irregular astigmatism or what is defined as an “irregular rugby ball shape”.
Keratoconus is a common disease and its incidence has been estimated for the age 10-44 at 1/1750 in white European and 1/440 in Asians.
Learn more about Keratoconus
What are the symptoms of keratoconus?
Keratoconus symptoms include substantial distortion of vision (astigmatism), with multiple images, blurry vision and sensitivity to light (photophobia). Initially most people can correct their vision with glasses. But as the astigmatism progressively gets worse patients may need to be managed with specially fitted rigid contact lenses to reduce the distortion and provide better vision. In 20% of patients, the condition is progressive and requires surgical intervention.
How does keratoconus affect vision?
The cornea is the main optical lens of the eye. The cornea helps focus images onto your retina at the back of the eye. As the cornea begins to bulge in keratoconus the regular optics of the cornea are distorted and therefore becomes difficult to focus a clear image onto the retina. This can result in distortion, ghosting and multiple image formation. As keratoconus progresses, it is more difficult for spectacles to correct vision. Most keratoconus patients achieve their best vision with a rigid contact lens which works by arching over the bulging cone of cornea and creating a new artificial smooth spherical surface.
What can happen if keratoconus is not treated?
Keratoconus tends to begin during teenage years and continues to progress up to the late 30’s, after which it tends to slow down and usually remain stable. In youth, the cornea is more elastic and has a layered structure. These layers can become stretched due to genetic characteristics, pressure within the eye or eye rubbing. The progression of Keratoconus can be quite variable but the rule is the younger the patient the higher the progression. A genetic predisposition to keratoconus has been observed, with the disease running within families in more than 10% of all cases. Unfortunately, if the condition isn’t treated early on with
collagen cross linking, patients are left with an abnormal shaped cornea that requires a contact lens to see well. Keratoconus is a very variable disease and can be very mild in one person and not progress very much, whilst being severe and rapidly progressive in other cases.
How is keratoconus diagnosed?
The diagnosis of Keratoconus is based on the patient’s history and a complete ophthalmological examination including sophisticated corneal imaging such as the pentacam corneal three-dimensional scanning tomography that allows to grade keratoconus and check for progression with serial scans comparisons. The
pentacam is the industry standard device for measuring the corneal shape accurately in three dimensions. At your first consultation, pentacam scanning will help us determine the most appropriate initial treatment. Subsequently, pentacam scanning will be used to ensure that your corneal shape is stable by comparing scans between visits. Please bring an USB flash drive so that we can give you your pentacam files to keep. For accurate scans, you should not use rigid contact lenses for two weeks prior to review visits.
How to stop Keratoconus?
Until recently, there were no treatments available to stop keratoconus getting worse. Patients were given rigid contact lenses once spectacles were no longer effective, and corneal transplantation when contact lenses were no longer tolerated. The two fundamental aims in modern keratoconus treatment are: stopping progression (Shape stabilisation) and restoring good vision. Since 2000,
Corneal Collagen Cross-linking (CXL) has emerged as a safe and effective method to halt keratoconus progression preventing further corneal shape deterioration.
How to treat Keratoconus?
Corneal Collagen Cross-linking (CXL) is the only way to stop keratoconus progression in early cases preventing further vision deterioration. Newer treatments for shape improvement and visual rehabilitation that have become available and can be used in selected cases include:
intracorneal ring segment (ICRS) implantation,
Visian implantable toric contact lens (ICL) implantation and
custom topographic and wavefront guided laser treatments (topography and wavefront guided No Touch LASEK). Current aims of keratoconus treatment are much more proactive and aim to stop disease progression and restoring good vision.
Why choose Vincenzo Maurino for your keratoconus treatment?
Vincenzo Maurino has been a Consultant Eye Surgeon at Moorfields Eye Hospital with specialist expertise in cornea, lens and laser eye surgery since 2002 and has a wealth of expertise and experience in cornea diseases in general and keratoconus specifically. He is Professor of Corneal Surgery at the prestigious University “Tor Vergata” in Rome. He has performed more than thirty thousand eye operations in his career and his results are second to none. Due to his experience and expertise he can offer the widest choice of customised treatments to serve his patient best.
