Keratoconus cannot be cured, but it can often be slowed or halted in its tracks. Management of this eye disease centres on providing clear, comfortable vision to keep you out of a corneal transplant for as long as possible.
If managed properly, 95% of keratoconus patients will not need a corneal transplant.
Often, for mild to moderate keratoconus, the best treatment is a pair of properly prescribed glasses. Less experienced optometrists are often trigger-happy with prescribing hard contact lenses for mild keratoconus, which may involve a lengthy fitting process and which may be poorly tolerated by many patients. Meanwhile, an appropriate pair of glasses would have provided adequate vision for most activities. Look for an optometrist experienced in keratoconus to prescribe the best possible pair of glasses.
RGP contact lenses
If your keratoconus has developed to the stage that glasses are no longer giving you clear vision, soft contact lenses are unlikely to either. They may, however, be used in conjunction with hard (RGP) lenses to provide comfortable vision in a piggy-back set up. RGP (or rigid gas permeable) contact lenses are the most common treatment option for keratoconus. It is vital that they are fitted by an experienced keratoconus expert who has many fitting sets available to choose from. One of the worst scenarios for a keratoconus patient, is being prescribed poorly-fitting contact lenses, which may do a lot more harm than good. A common but very serious problem is a contact lens that is too flat and rubs against your delicate cornea at its thinnest point. RGP lenses require regular follow up and adjustments as your keratoconus develops.
Sometimes, even with the best practitioner, RGP lenses just don’t work. The vision might be fine but the discomfort is too much. This is why many keratoconus patients fail in RGP contact lenses. This is where scleral contact lenses come in. They are much larger than RGPs – which may sound scary at first. But the beauty of scleral lenses is that they vault the cornea’s delicate surface and only touch the much tougher and less sensitive white of your eye – the sclera. Scleral lenses are very well tolerated by many people who struggle with RGPs. The tricky bit is getting the right fit. Make sure you choose a practitioner who offers these lenses and is experienced at fitting them as they may be the key to clear, comfortable vision for you. Even better if they can provide 3D mapping of your sclera to guarantee the best contact lens fit.
Collagen Cross linking
Keratoconus is caused by a weakness in the structure of the cornea, resulting in progressive thinning and bulging of the centre of the cornea. It usually starts around the time of puberty and peters out by your thirties. A treatment called corneal collagen cross-linking uses UV light and riboflavin (vitamin B solution) to cross-link – or stabilise – the collagen fibres that make up the bulk of your cornea. This has the effect of slowing – or often halting – the progression of keratoconus in young patients. In order to be a good candidate for cross-linking, it needs to firmly established that you have progressive disease – i.e. your keratoconus is getting worse over time. This treatment is very effective and commonly used for keratoconus sufferers in their teens and twenties. Referral for this treatment can be arranged through your keratoconus expert.
When all else fails, we turn to corneal transplant as the end of the line treatment for keratoconus. The keys words here are WHEN ALL ELSE FAILS. Corneal transplant is a very serious undertaking and has many associated risks and side effects. Vision can take months to years to fully stabilise after a corneal graft, and eye drops are often required for several months – or longer. RGP contact lenses may still be required to provide adequate vision for day to day activities. The point is that, even though corneal transplant has come a long way and provides a great outcome for many patients, it should only be recommended when a keratoconus contact lenses expert has exhausted the options for clear comfortable vision with RGPs or scleral lenses. Corneal transplant involves the replacement of a section of your own cornea with donor tissue, unaffected by keratoconus. They typically last 15 to 20 years the first time, with subsequent grafts lasting for a shorter time. The longer you can put off the first graft, the better.