Keratoconus: causes, symptoms and treatments
Keratoconus is a condition that affects the front surface of the eye called the cornea. The cornea is the most important focusing component of the eye. Keratoconus causes the cornea to thin and become unstable in shape. It often becomes cone-shaped, which explains why the disease is also known as 'conical cornea'. This tends to happen during puberty and vision progressively becomes worse.
A healthy cornea has a rounded shape similar to that of a soccer ball. With keratoconus, the shape changes as it thins to look more like a football. It is this distorted shape that causes the blurred vision.
That's not all though...
It is very important to read the whole article as it is not all bad news.
Please understand that misinformation is abundant.
This is our promise... please read on and you will be all the wiser. If reading is not your thing, there are a couple of very informative videos that will get you up to speed on keratoconus and its nuances.
If you or your child has been diagnosed with keratoconus, it can be a challenging time.
Even though keratoconus is degenerative, especially under the age of 25, do not stress as there are many very successful treatments, both non-surgical and surgical that will allow you to do all the things that you felt were beyond your vision.
The biggest concern facing all patients when diagnosed is:
Can conical cornea cause blindness?
The answer is no.
No one goes blind from keratoconus if managed properly from the beginning. This is an eye condition that can cause huge amounts of stress and anguish.
This should not be!
When managed properly, virtually all patients are able to pursue their career and sporting choices.
Keratoconus does affect your vision, often significantly, but with the care of an experienced optometrist and the right treatment, there is no reason why anyone should lose their sight.
So here is the good news!
You will be able to lead a relatively normal and productive life. Understanding more about the disease can be very reassuring
See the video below as listen to what Dr Jim Kokkinakis has to say about keratoconus. He has been successfully managing this eye condition now for over 30 years.
How common is Keratoconus?
Keratoconus is not common, with only 1 in 2000 people being affected in a meaningful way. That said, more than 1 in 500 people have a very mild case of the disease. They may never have a definitive diagnosis, as they see quite well with or without glasses. There are many cases of forme fruste keratoconus that started to develop but for some reason stopped progressing.
Not sure what type you've got?
There are a number of related conditions – some more severe and some less severe. Click here for the complete guide to understanding keratoconus and its lesser-known cousins.
What are the Symptoms?
Patients often complain that their vision becomes distorted, blurry or hazy. Night vision is particularly affected. Depending on the severity of the disease, symptoms obviously will be worse. Eye strain also known as asthenopia can also be associated with conical cornea, as it is very common to squint to try and clear the vision. This puts enormous pressure on the focusing eye muscles, which translates into visual stress.
We have written another page that explains both the signs and symptoms of keratoconus.
What Causes this Eye Disease?
If you’re wondering what you did to deserve keratoconus, be reassured that family history (genetics) has a big role to play. While conical cornea is found in both males and females, and across the globe, it does tend to favour males, and those of Polynesian, Middle Eastern or African extraction.
The causes of keratoconus are still being investigated, but we now understand that allergy also plays a role, particularly by causing eye rubbing.
Stopping the cycle of itchy eyes and eye rubbing is an essential first step in successful managing, as the friction that can be applied on the fragile cornea can often cause significant progression in the eye disease.
When is this Eye Condition Diagnosed?
In most cases, you (or your child) will be diagnosed during puberty, late teens or early twenties, when vision starts to decline. This can be a very difficult and stressful time. This is a time where teens and young adults are gaining confidence and embracing life. They have so much to look forward to!
• getting their driver's license
• preparing to finish school and get started on their career
• the excitement of overseas travel
And sadly it is at this time that the diagnosis is abruptly delivered. It can seem, as if it is the end of your world and your life. Our vision is our most precious sense. The thought that we may lose it is very traumatic for all concerned.
Vision is affected regardless of whether the diagnosis is mild, moderate or severe and it can be debilitating. Getting treatment from the appropriate practitioner early is important. In many cases, patients are misdiagnosed and may see a number of doctors before they finally have a correct diagnosis. Often, a diagnosis of astigmatism or amblyopia (lazy eye) is given when in fact the patient has keratoconus.
We cannot stress enough how important it is to find a practitioner, who sees affected patients on a regular basis. It is with such a practitioner that an accurate diagnosis shall be made and the appropriate course of action taken.
Common fears after Diagnosis
Young people when diagnosed often worry about their future. For parents, the fears are endless. We all want our children to be happy and healthy. The thought of one of our children losing their vision is terrifying.
The following are all very real and frightening questions:
Will I go blind?
Is the diagnosis correct?
What are the treatment options?
Is there a cure?
An experienced practitioner will be able to put your mind at ease regarding all of these common questions.
Other questions include:
Can I drive with Keratocnus?
Will I be able to pursue the career I have always dreamed of?
Will I be able to look after myself?
The answer to these 3 questions is yes!
Place yourself in the care of a practitioner who knows Keratoconus and knows it well. A practitioner who liaises with other specialists in this area and who understands the difficulties faced with this eye disease.
There is no reason why you cannot do everything you want to do.
Treatment – What are the options?
Keratoconus Treatment can involve both surgical and non-surgical interventions. Don't miss our dedicated Keratoconus Treatment page.
Non-Surgical Management includes glasses, contact lenses and allergy management.
When it comes to this eye disease, it is hugely beneficial to see an optometrist who specialises in advanced contact lens fittings.
Hard contact lenses, are after all, the foundation of managing this eye disease. More on contact lens options for keratoconus can be found under our contact lenses category from the main menu above.
Designs include rigid gas permeable (RGP), hybrids (hard centre with a soft skirt) and scleral contact lenses (which vault over the entire cornea and rest on the white of the eye). Fitting these types of customised contact lenses is complex. It requires multiple contact lens trial sets and sophisticated technology like corneal topography to get good results.
The Eye Practice fits all types of contact lenses to manage this eye disease.
Surgical management includes corneal collagen cross linking, Intacs, and even laser eye surgery is being attempted.
Ultimately, a corneal transplant can be considered if all else fails. This can be in the form of deep lamellar or full thickness penetrating.
We like to keep our patients out of a corneal transplant for as long as possible – preferably for good.
With a comfortable pair of contact lenses, you should be able to live a normal life.
Corneal transplant / graft is something to be avoided if at all possible. Grafts don’t last forever and each subsequent graft only lasts half as long as the one before. The older you are having your first one – the better.
Latest clinical research
In early 2017, the results of the latest study on keratoconus were published in Cornea medical journal. This study comes out of the USA, where the data for over 20,000 patients with the disease was examined. The results were very revealing:
The incidence of corneal graft for keratoconus has decreased, particularly since 2009. This is believed to be due to substantial improvements in contact lens technology, allowing more patients with the disease to lead normal lives without having surgery. In 2005, over 6% of patients with keratoconus had a corneal graft, compared to less than 3% in 2010, just five years later.
Keratoconus cure – is there one?
There is no cure for this condition. It is not something that you can treat and be healed.
Ongoing research may one day deliver the Holy Grail, but to date a cure is still elusive. Although this eye condition can have a large impact on your life, it can be managed successfully, when an experienced optometrist is on the case.
It can be hereditary, so patients should always have their children and siblings checked for the condition. Maybe one day, genetic intervention will be able to change to the course or even cure this condition.
What if I failed in contact lenses in the past?
Failing in contact lenses is very common when an inexperienced practitioner is attempting the fitting of a complex cornea, such as in keratoconus.
The average optometrist might see one or two cases per year. It is thus very difficult to develop a skill set for this condition.
Many people with this eye condition get to the stage where they find their glasses no longer give them satisfactory vision.
As a result of this, optometrists and ophthalmologists from around NSW and Australia-wide, refer patients with this eye condition to The Eye Practice for specialist contact lens fitting.
We pride ourselves on restoring distorted vision, using the latest contact lens designs and materials.
Keratoconus Treatment at The Eye Practice
This is not a common condition and as such many optometrists may only ever see one or two keratoconus patients per year. When treating any condition, the doctor needs to see many patients in order to gain the experience required to provide the best possible treatments available.
At The Eye Practice there is not a day that goes by where we do not see a new case of this condition. There are many options that we have at our disposal that other optometrists have not even heard of. This is because we live and breathe this eye disease.
Dr Jim Kokkinakis of The Eye Practice is a Fellow of the International Society of Contact Lens Specialists (ISCLS) and can help you with your contact lens fitting no matter how complicated your prescription may be.
Jim is also a Senior Lecturer at the Optometry School at the University of NSW and teaches keratoconus management and fitting for the Advanced Contact Lens Studies course.
He also regularly lectures to both optometrists and ophthalmologists in Australia and around the world.
To learn more, download our free eBook on Keratoconus, read our blog or book an appointment online now.