Keratoconus is a progressive eye condition, typically diagnosed during puberty. It causes a normally dome-shaped cornea (the front of your eye) to become cone-shaped and bulge.
As the condition progresses, vision is distorted, but with the right treatment, vision should be maintained.
This diagnosis raises so many questions. Here we try to answer some of the more concerning questions that we encounter:
Does Keratoconus lead to blindness?
Keratoconus does not lead to blindness, when treated appropriately. The condition does however affect vision, presenting as mild, moderate or severe. Either way, this eye disease should not lead to blindness, assuming you are seeing an optometrist, who is an expert in Keratoconus management.
As with all conditions, it is best to have a diagnosis of this condition as soon as possible. Regular eye tests are required during puberty, as this is the time the condition usually is diagnosed.
If a parent has Keratoconus, then it is imperative that children have their vision checked regularly (at least every two years) in order to diagnose at the earliest stage.
In mild cases, patients are able to wear a pair of glasses just like anyone else to correct their vision. They are able to work and participate in sports just like everyone else.
In moderate cases, rigid contact lenses may be required to correct vision. When fitted correctly, vision is near perfect and again should not affect work or lifestyle.
In more severe cases of this disease, a corneal graft may be required, if specialised contact lenses fitted cannot provide adequate vision. In the hands of an expert, quality of life is not affected, and vision and eyes stay healthy.
Keratoconus can be inconvenient, but can it make you go blind? The answer is no, assuming the right people looking after you.
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How common is Keratoconus?
Keratoconus is a rare condition on average affecting 1 in 2000 people.It is often underdiagnosed and could possibly affect up to 1 in 400 people in its mildest form.
The incidence of this condition varies considerably due to a number of different factors:
1. Family history of Keratoconus will increase the risk of having this condition.
2. Geographic location may also affect the numbers of people affected by Keratoconus. For example, countries such as India and the Middle East where the weather is typically hotter, have a higher prevalence of this condition compared to countries such as Finland, Japan and Russia, where the temperatures are cooler and there is less sunshine.
3. Genetic Factors – reports have indicated a prevalence of up to 7.5 times greater for Indian, Pakistani and Bangladeshi subjects compared to Caucasian. Most of these Asian subjects were predominantly Muslim with a higher prevalence of consanguinity, which is usually associated with a high rate of genetic conditions.
4. In our anecdotal experience, we have found in our practice an over-representation of patients from Middle Eastern and New Zealand backgrounds to be affected with Keratoconus.
How does a person see with Keratoconus?
With the onset of the condition, vision starts to change. This can happen gradually or change rapidly depending on the severity of the condition. When suffering from this condition, patients often describe their vision as being blurry, distorted or even causing double vision.
Other times it is described as hazy or ghosting around lights, particularly at night, making night driving difficult. Light sensitivity is another a common symptom with the onset of this eye disease, creating glare issues.
This eye disease usually does get worse at the early stages of the condition. It is during this progression that patients and their families are most distressed.
Keratoconus does not however progress for very long and usually stabilises around the age of 25-30. There are cases however that deteriorate more, and this is usually due to poorly-fitting contact lenses, or continual eye rubbing.
Keratoconus can be corrected with eye glasses in the early stages of the condition. This eye disease presents as mild, moderate or severe.
In mild cases, patients usually will be prescribed glasses to correct their vision and never move on to Contact Lenses.
Prescribing a spectacle prescription for this condition is not simple and often patients are fitted with contact lenses when in fact they are able to achieve 20/20 vision with glasses. It is imperative that an optometrist that is highly experienced in keratoconus prescribes the glasses.
If this eye disease progresses to a moderate or severe stage then glasses will not correct vision and contact lenses need to be prescribed. In cases where the disease becomes very advanced, a corneal transplant (or graft) may be required.
Please see below a chart showing the different stages of Keratoconus and how it is best treated.
There are no natural treatments for this eye disease. However, a healthy lifestyle and vitamins can protect the eyes and possible slow down the progression of the disease.
Daily exercise, healthy diet and no smoking will all contribute to better eye health.
Including antioxidants in diet will help reduce the rate of cell damage but will not address this eye condition specifically. Antioxidants are found naturally in foods like:
• Kale
• Spinach
• Brazil Nuts
• Tuna
• Almonds
• Banana
• Eggs and many more foods.
Any dietary changes will help generally with eye health and general well-being but as mentioned, will not treat or cure Keratoconus. Consultations with a qualified optometrist who understands your needs, and is able to treat the condition appropriately is essential, to maintain good vision.
Should I have a Corneal Transplant/Graft?
A corneal transplant should not be your first option for Keratoconus. When a patient is diagnosed with this condition, the best option is to start with glasses for vision correction, followed by contact lenses, as the condition progresses.
A corneal transplant should only be performed when the condition has progressed to a stage where optical appliances are no longer giving suitable vision correction, or when then cornea has become so thin that it cannot support contact lenses any further.
Vision after a corneal graft can vary dramatically between patients. For some, vision may start out as poor but over a few months improve and yet for others vision may instantly be improved but may deteriorate slightly over the next few months.
Generally speaking, after a corneal transplant, vision, can take up to a year to settle and become stable. The most improvement in vision is for patients at the most severe stages of keratoconus, as the bulging, distorted cornea is replaced with a smooth, dense cornea.
Sutures, or stitches, are left in place for up to a year. Vision tends to stabilise most, after sutures have been removed. At this stage, most patients will still require either glasses or contact lenses to achieve the best possible vision. That said, there are cases after a graft, there is no need for glasses or contact lenses.
What is also very important to understand is that corneal transplants do not last forever. On average 50% of corneal grafts fail within 15 years, so it is likely most patients will require a second and even a third graft if they are done too early. Once a fourth graft is performed the immune system tends to be very aggressive and rejection becomes common. Where possible avoiding a transplant is the best option.
At The Eye Practice, we see many patients who are diagnosed with this condition on a daily basis. Each and every patient is different and requires their own unique solution.
