Keratoconus affects about one in 1000 people, but when this eye ailment strikes, serious distortion of vision can be experienced.The important thing to know is that although it can cause vision problems, you are not likely to go blind.

What happens when a person has Keratoconus?

How does it affect eyesight?  Jim Kokkinakis Optometrist, Sydney CBD, sees numerous patients with Keratoconus on a weekly basis.

In a nutshell, keratoconus is an irregularity which causes the eye’s cornea to bulge out or become dome-shaped. This can also be described as the warping of the cornea’s shape such that it becomes cone-like.

The cornea is a thin layer of tissue which is found in the anterior of the eye. This is responsible for focusing the light on the back of the eye called the retina.  This in turn sends and electrical signal to the brain’s visual cortex via the optic nerve. When the cornea is distorted, then it means that the brain will also wrongly interpret the message and the vision will be blurry and ghosted.

Progression of Keratoconus

Keratoconus usually begins to exhibit initial symptoms during the late teens or early 20s. The progression is relatively slow in many cases and it takes about 10 to 20 years before it manifests serious vision problems. Others though can have very quick degradation.  The spectrum of keratoconus is nearly infinite with every case having a unique twist.

The initial symptoms include blurriness or distortion of vision. The eyes may become extra sensitive to light too. Because the first symptoms are very mild, a lot of people simply dismiss this as something that is not too serious.

When the bulging of the cornea goes on, the eyesight would also become worse. During the latter stages of keratoconus, there is a tendency for the cornea to have sudden warping which may be accompanied by swelling. Since the cornea already has an irregular shape, cracks could appear on it too. It may take several days to a few weeks before the cracks heal. When they do, there could be scar tissue, which could also impair vision.  This late condition, which occurs infrequently, is called hydrops.

Testing for Keratoconus

The distortion of vision can happen very fast if the situation is not handled properly during the initial stages.  Because of this, it is important to have regular check up for the eyes to avoid progression of this visual ailment. At this early stage a procedure called collagen crosslinking will be recommended to slow down further progression.

Early and accurate management of keratoconus is critical to maximize outcomes.  Practitioners that specialise in keratoconus are far and few between.  This is because keratoconus is not common and the average eye care practitioner has little experience in this area.  Ideally you should see an optometrist, who routinely performs the following tests.  Among the tests for keratoconus are:

• Slit Lamp

  —Allows optometrists to have a magnified look at the cornea and associated structures.

• Corneal Topography

  —Focuses on the shape of the cornea.  If keratoconus progresses the corneal shape will also change.

• Corneal Pachymetry

  —This is done using computerized apparatus, which measures the corneal thickness in multiple locations.  As keratoconus progresses, the cornea will also become thinner and thinner.

• Retinal Examination

  – We need to also remember that just because the optometrist is monitoring keratoconus it does not mean that other structures of the eyes will not develop other eye conditions, which might also need prompt treatment. These can be totally unrelated to keratoconus.

Cure and Prevention of Progression of Keratoconus

Optometrists and Ophthalmologists will give recommendation when it comes time to remedy. This will depend on the severity of the visual impairment. Among the solutions for keratoconus include:

Eyeglasses or soft contact lenses

This is recommended for people who are still at the initial stages and are experiencing

Collagen Cross Linking.

This procedure is best implemented when progression is occurring, typically before the age of 25years of age.

Rigid gas permeable contact lenses.

For people whose cornea is significantly curved.  There are many different styles of lenses in this category.  Typically on an experienced optometrist will be able to fit the whole rang of options.

Intacs or Kera Rings.

These are small curved perspex rings that are implanted in the cornea to try and reduce the bulge. Often that are implanted in conjunction with using collagen cross linking. They are useful in a small sub group of patients.

Corneal transplantion.

This is ideal only for people who suffer serious visual impairment contact lenses have been proven to fail by experienced contact lens fitters. Even though it is a last resort corneal transplantation is a great option when performed by an experienced corneal ophthalmologist.

To try and minimize progression it is imperative to NOT rub your eyes and to have any contact lens fitted well.  Rubbing eyes and poorly fitted contact lenses have been shown to make keratoconus worse.

Keratoconus is a huge topic for more information make an appointment with Dr Jim Kokkinakis by calling (02) 9290 1899 or order our comprehensive manual on keratoconus.