At The Eye Practice, we don’t just treat the disease, we treat the patient, and no two patients are alike. Our goal with all keratoconus treatment is to achieve clear, comfortable vision with the minimum intervention. First-line treatment is non-surgical (with the exception of corneal collagen cross linking). Surgical treatment also plays an important role, when necessary.
In the early stages of this condition, glasses usually work quite well to correct vision. If the condition remains mild, patients find that glasses are all they ever require for vision correction. However, this is not usually the case. Keratoconus is a progressive disorder, with the progression happening during the early years. (It does stabilise, usually in the mid to late 20's).
Finding the right pair of glasses can be harder than you might think. Many people go around in a blur because they just haven’t been given the right prescription. Measuring the eyes for glasses is an art form with this eye disease. You are much more likely to achieve success with a keratoconus specialist who is used to dealing with the high amounts of irregular astigmatism you will have.
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As the disease gets worse, you will need contact lenses for vision correction and this is where expertise and experience are key. There are a number of different contact lens options available and it is not a case of one-size-fits-all. Different options include custom soft lenses, rigid gas permeable (RGP), piggy back contact lenses, hybrid lenses (Synergeyes) and scleral contact lenses. Find out more about the full range of contact lenses available for keratoconus.
All eyes are different. What may work for one person may not work at all for another. It takes time and very specific diagnostic equipment to measure and customise the perfect contact lens to give you the best possible vision AND the most comfort.
If you are wearing badly-fitting contact lenses, you can find yourself not only in a lot of pain, but with more damage to your cornea. Depending on the extent of the damage, a corneal transplant may be required. This is nearly always avoidable with properly-fitted lenses.
There are some important considerations regarding contact lens solutions too: not all contact lens solutions are the same. The preservatives present in many contact lens cleaning systems are unsuited to your fragile corneas and must be avoided to give yourself the best chance of success.
Reducing eye rubbing
If you have keratoconus it is quite likely that you also have allergies. Ezcema, hay fever and asthma are commonly associated with this eye disease. With these conditions come itchy eyes. You may rub your eyes even if you don’t have allergies. One of the most important things to know about keratoconus is that aggressively rubbing your eyes can make it worse. It can even cause it in the first place. So, stopping the rubbing is one of the best possible treatments for this disease.
There are some very effective eye drops available to treat itchy eyes caused by hayfever and other allergies. Your specialist can prescribe preservative-free versions of these for you.
What if eye drops are not enough?
One of the most common times to want to rub your eyes is straight after removing your contact lenses at the end of the day, when the itch can be unbearable. If you are already using the anti-allergy drops prescribed by your contact lens practitioner, try adding a cold pack to the area as soon as you remove your lenses. You will love it!
Rubbing eyes with contact lenses is a disaster and can lead to further thinning and even scarring and ulceration of your cornea, so controlling the itch is essential to successful contact lens wear.
Decreasing eye rubbing cannot be overstated. You need to stop and you need to stop now.
The procedures that follow are performed by a corneal surgeon in a day-surgery facility. We are fortunate to work closely with some of the best corneal surgeons in the country and part of our keratoconus management program is to provide referrals for these procedures where appropriate.
Corneal Collagen Cross Linking
One of the most exciting things to come out of the last 15 years of research into keratoconus is a treatment called corneal collagen cross linking (or CXL).
This once-only treatment works by strengthening the links between the collagen fibres that make up your cornea. This slows or completely stops the progression or worsening of your keratoconus. Even though the procedure is not without risk, and can take up to a year to achieve clearest vision, it is very appropriate to consider as it has been shown to reduce the risk of corneal transplant.
Intacs (intra corneal ring segments)
Intacs for keratoconus have been relatively popular now for roughly 15 years. This procedure was a failure for correction of myopia or near-sightedness and was resurrected as a treatment for conical cornea. The principle is that by implanting some small arcuate Perspex splints in the affected cornea, it is possible to reshape in a way that can improve vision.
This treatment has had limited success. Even though the shape of the eye is theoretically improved it does not mean that any extra vision is achieved to make one independent of contact lenses. In fact, contact lenses are often more difficult to fit after this treatment.
If all else fails, a corneal transplant (or graft) is a sight-saving procedure and can help keep many advanced keratoconus sufferers seeing well enough to live a full life. But surgery should not be taken lightly! Transplant should only be considered when an experienced, expert keratoconus contact-lens specialist has failed to achieve a healthy, comfortable fit.
Like all surgery there are risks involved so where contact lenses are still suitable, it is best to continue with them, as contact lenses are often required even after a cornea replacement. Properly fitting contact lenses will nearly always provide far better vision than can be achieved with cross-linking, intra-corneal rings or a corneal transplant.
Find out about the latest research and findings on keratoconus here.