Australia is the lucky country for many reasons. When it comes to keratoconus, however, misinformation abounds.
Many of the patients we see for the first time are wearing incorrect glasses, or have poorly-fitted contact lenses.
Some have been advised that they are likely to go blind later in life. This information can cause severe stress, leading to depression and the perception that quality of life will be poor now and into the future.
But is this how it should be? Absolutely NOT!
Even though there is no keratoconus cure, read on and find out about the 7 ways to treat keratoconus at present in Australia and how to make sure that these are approached in the right order to maximise your result.
The Eye Practice optometrists are experts in keratoconus diagnosis and treatment and are centrally located in Sydney CBD. We have been managing keratoconus patients for 30 years, so we know quite a bit about this important topic.
1. Monitoring keratoconus progression accurately
This is critical in making the correct choices going forward. Any corneal surgical intervention is never without risk. Seeing an experienced keratoconus optometrist (rather than a surgeon) is always preferable as they are less likely to go straight to a surgical treatment option. Surgery is the end-of-the-line treatment for keratoconus, but it is essential to exhaust less-invasive treatment options first, before jumping straight to an irreversible surgical procedure.
Your expert optometrist will not refer you for surgery when less invasive treatments can achieve the same results.
Neither will your optometrist hold you back from surgery when it IS indicated. Glasses and contact lenses are required in most cases of keratoconus irrespective of surgical intervention. In other words, even if you have a corneal graft, you will still need glasses or contact lenses afterwards so there is no reason for your optometrist not to refer you for surgical intervention at the appropriate time.
Sometimes the best treatment is NO treatment. If there is no progression and vision is adequate, there is often no reason to do anything.
2. Glasses for keratoconus
The main goal of keratoconus management and treatment is to maximise vision. If vision is reasonable and is not deteriorating, then further treatment is not meaningful. Prescribing glasses for keratoconus is very difficult, especially for the inexperienced practitioner. In fact it is assumed and documented in many inappropriately-conducted studies that keratoconus causes a short-sighted prescription.
The reality is that most people with this disease have mixed astigmatism. This type of glasses prescription is very different from short-sighted prescriptions.
Often we have seen patients, who can achieve highly functional vision using glasses but are incorrectly advised that they must have rigid gas permeable contact lenses.
3. Keratoconus Cross Linking
This surgical procedure has a very important role to play in halting or slowing down progression of keratoconus. Its role is very specific and it should not be used indiscriminately.
The best time to offer keratoconus cross linking (or collagen cross linking) is in the progressive phase of this eye disease (i.e. when it is getting progressively worse). This occurs during the ages of 15 and 25, although it can occur earlier and it also can progress (i.e. worsen) into ones thirties.
We have seen many thirty-year-olds who have been offered this procedure when their disease was no longer progressing. Exposing someone to the risks of eye surgery is not appropriate when there is little or no benefit to be gained.
4. Contact Lenses designed for keratoconus
Depending on how irregular the surface of the human cornea is, often some sort of contact lens will be required. This achieves an adequate level of vision to function efficiently and with confidence. Customised contact lenses are key to a successful outcome.
Contact lenses are still the mainstay of keratoconus treatment.
Contact lenses need to be fitted by a keratoconus-experienced optometrist. There are infinite possibilities when it comes to refining the fit to get the best result. It is a tragedy if contact lenses which could change someone’s life are fitted inappropriately. Not only does this withhold a viable life-enhancing product but also damages an already fragile cornea.
5. Laser Eye Surgery
In the past this was never offered as a viable treatment for keratoconus. This was because by definition the irregularity and blurriness that keratoconus causes to the vision is caused by a thinner than normal cornea, which loses its stability. Laser Eye Surgery only removes further corneal tissue, which will make it even thinner! If done indiscriminately it will nearly always make the keratoconus worse!
Of late, some ophthalmologists have started experimenting with keratoconus cross-linking followed by laser eye surgery to re-sculpture the shape of the eyes to achieve better vision.
There is no doubt that this procedure has a role to play, but at this early stage it is best reserved for patients that are not tolerant of keratoconus contact lenses.
6. Intacs and Implantable Lenses (ICL’s)
These two invasive procedures rarely have a role to play in the successful treatment of keratoconus. They involve placing small devices within your eye and, to date, haven’t been shown to give reliable results.
7. Partial- and Full-Thickness Corneal Transplants
There is no doubt that the ultimate, end of the line treatment for keratoconus is a corneal graft (or transplant). But it is essential to realise that this doesn’t give you a clean slate; it’s just a different slate.
Tissue from a donor cornea is grafted onto your own cornea, once the diseased section has been removed. This is a very invasive procedure and requires the new cornea to be sutured into place. The sutures normally remain in the eye for about a year, when they are then removed.
Your vision may be unstable during this time and require frequent changes in glasses. After sutures are removed, the vision is likely to be unstable again. At this stage, hard contact lenses may be required to provide functional vision. This is not well understood by many patients undergoing corneal transplant; the fact is you will almost certainly still need glasses and quite often hard contact lenses to see clearly after your graft.
The first graft will last on average 15 years, at which time you will need another graft, and this only lasts half as long as the first one.
As long as you have comfortable and functioning vision, it makes sense to delay having your first corneal transplant for as long as you possibly can.
Are you struggling in your keratoconus contact lenses? We succeed where others fail. Call The Eye Practice on (02) 9290 1899 or make an appointment online today.
(This article first appeared in Oct 2016 and has been updated for accuracy).