Keratoconus Management Playlist

What is Keratoconus?

Keratoconus is a progressive eye condition that affects the shape and structure of the cornea.

The term “keratoconus” comes from the Greek words “kerato” (cornea) and “conus” (cone).

Prevalence and Demographics

Keratoconus is not a rare condition, but it’s not extremely common either.

Age of Onset

Keratoconus typically first appears in the late teens to early twenties.

Gender

There’s no significant difference in prevalence between males and females.

Ethnicity

Some ethnic groups appear to have a higher risk of developing keratoconus.

Family History

About 10-28% of people with keratoconus have a family history.

While non-surgical management options are often the first line of treatment for keratoconus, there are cases where surgical intervention becomes necessary. As the leading eye doctors in keratoconus care in Orange County, we are well-versed in the latest surgical techniques and emerging treatments.

When is Surgery Considered?

It’s important to note that the decision to pursue surgical treatment is always made on a case-by-case basis with your eye doctor, considering the individual patient’s needs, lifestyle, and overall eye health.

Surgery for keratoconus is typically considered in the following scenarios:

When non-surgical options no longer provide adequate vision correction

To halt the progression of the disease

In cases of severe corneal thinning or scarring

When contact lens intolerance develops

Corneal Collagen Cross-Linking (CXL)

Corneal collagen cross-linking is a minimally invasive procedure that has revolutionized keratoconus treatment by offering a way to halt the progression of the disease.

How CXL Works

The procedure involves applying riboflavin (vitamin B2) drops to the cornea and then exposing it to controlled ultraviolet (UV) light. This process creates new chemical bonds between collagen fibers in the cornea, strengthening and stabilizing it.

Types of CXL

Epithelium-off (epi-off) CXL

The epithelium (outer layer of the cornea) is removed before the procedure.

Epithelium-on (epi-on) CXL

The epithelium is left intact. It should be noted that (epi-on) CXL is not yet FDA approved.

Advantages of CXL

Halts or slows the progression of keratoconus
Can prevent the need for corneal transplantation in many cases
Minimally invasive with a relatively quick recovery time

Considerations

Best results are typically seen in younger patients with progressive disease
Vision may continue to fluctuate for several months after the procedure
Additional vision correction (glasses or contact lenses) is still usually required

Corneal Tissue Addition for Keratoplasty

Corneal Tissue Addition for Keratoplasty (CTAK) represents a cutting-edge development for treating keratoconus, a progressive eye disease that causes thinning and a cone-like protrusion of the cornea. Let’s break it down into simple, relatable terms.

How CTAK Work

CTAK utilizes custom laser-cut tissue inlays tailored specifically for each patient. These inlays are made from acellular corneal stromal tissue, sterilized using gamma irradiation for both safety and stability. The inlays are placed in the cornea to improve its thickness and reshape its contour naturally.

These personalized inlays not only enhance the cornea’s thickness but also create a more uniform and stable corneal shape. This innovative approach is like giving your cornea a perfect-fitting patch, crafted just for its unique curvature and needs.

Advantages of CTAK

CTAK replaces INTAC favoring CTAK because:

Improved Vision

In clinical trials, every single patient reported improved unaided distance visual acuity (UDVA).

Personalization

Each inlay is meticulously prepared based on patient-specific data, saving valuable time in the operating room and ensuring a tailored fit.

Gift of Donation

CTAK maximizes the potential of donated corneal tissue, honoring donors while giving recipients a life-changing opportunity.

Ease of Use

The inlays are pre-packaged, pre-sterilized, and ready to use, with a remarkable 2-year shelf life. This convenience means less stress for surgeons and more reliability for patients.

Considerations

CTAK isn’t a universal solution for every keratoconic patient. Here are some important points to keep in mind:

Not One-Size-Fits-All

The success of CTAK relies on precise topographic mapping and clinical data. It may not be suitable for cases with extensive corneal scarring or other severe abnormalities.

Continued Care

While CTAK improves corneal thickness and shape, some patients may still need corrective lenses for the best vision.

Surgical Precision Matters

The procedure depends on accurate placement and skilled hands, emphasizing the importance of experienced surgeons.

Topography-Guided PRK

Topography-guided Photorefractive Keratectomy (PRK) is a laser procedure that can be used to regularize the corneal surface in some cases of keratoconus. Note that this procedure is not yet FDA approved.

How Topography-Guided PRK Works

Using detailed corneal topography maps, the excimer laser ablates the cornea in a precise pattern to reduce irregularities and improve the overall shape.

Advantages

Can improve the regularity of the corneal surface
May improve contact lens tolerance and fit
Can be combined with CXL for a dual approach (known as the Athens Protocol)

Considerations

Only suitable for mild to moderate cases with adequate corneal thickness
Risk of further corneal thinning
Generally performed in combination with CXL to prevent progression

Deep Anterior Lamellar Keratoplasty (DALK)

DALK is a partial-thickness corneal transplant procedure that replaces the front and middle layers of the cornea while leaving the innermost layer (endothelium) intact.

How DALK Works

Advantages of DALK

Lower risk of graft rejection compared to full-thickness transplants

Preserves the patient’s own endothelial cells

Stronger wound healing at the surgical site

Considerations

Technically challenging procedure

Not suitable if there’s significant scarring extending to the endothelium

Post-operative visual recovery can take several months

Penetrating Keratoplasty (PK)

Penetrating Keratoplasty, also known as a full-thickness corneal transplant, involves replacing the entire cornea with donor tissue.

When PK is Considered

In very advanced cases of keratoconus
When there’s significant scarring throughout all layers of the cornea
If DALK is not possible or has failed

Advantages of PK

Can significantly improve vision in advanced cases
May be the only option in cases of severe corneal scarring

Considerations

Higher risk of graft rejection compared to DALK
Longer recovery period
Lifelong need for careful monitoring and sometimes long-term steroid use

Bowman Layer Transplantation

This is a relatively new surgical technique for advanced keratoconus that’s not suitable for DALK or PK.

How it Works

The Bowman’s layer from donor corneal tissue is isolated and transplanted into the recipient’s cornea, creating a form of natural corneal inlay.

Advantages

Can flatten the cornea and reduce ectasia

May improve contact lens tolerance

Less invasive than full-thickness transplantation

Considerations

Still an evolving technique with limited long-term data

Not widely available

May not be suitable for all cases

Emerging Treatments

The field of keratoconus treatment is constantly evolving, with several promising treatments on the horizon.

CRISPR Gene Editing

Researchers are exploring the use of CRISPR technology to correct genetic mutations associated with keratoconus.

Stem Cell Therapy

Early research is investigating the potential of using stem cells to regenerate corneal tissue.

Novel Cross-Linking

New techniques include pulsed-light accelerated CXL and customized CXL tailored to the patient’s cornea.

AI in Treatment Planning

AI algorithms are being developed to predict disease progression and optimize treatment plans.

Combination Therapies

Increasingly, combination approaches are being used to maximize treatment effectiveness.

CXL Plus

This involves combining CXL with other treatments, such as:

CXL + ICRS: To both stabilize the cornea and improve its shape
CXL + Topography-Guided PRK: The Athens Protocol, which aims to regularize the cornea and halt progression

Sequential Treatments

In some cases, a planned sequence of treatments may be recommended. For example:

CXL to stabilize the cornea
Followed by ICRS once stability is confirmed
Potentially followed by PRK for further visual improvement

Novel Cross-Linking

New techniques include pulsed-light accelerated CXL and customized CXL tailored to the patient’s cornea.

Post-Surgical Management

Regardless of the surgical intervention chosen, post-operative care is crucial for optimal outcomes.

Key Aspects of Post-Surgical Care

Adherence to prescribed medication regimens
Regular follow-up appointments
Monitoring for signs of complications
Gradual return to contact lens wear when appropriate

Visual Rehabilitation

After surgery, patients may need to be refitted with contact lenses or may require updated spectacles. In some cases, Advanced contact lenses like scleral lenses may provide the best visual outcomes even after surgery.

The Importance of Customized Treatment Plans

As keratoconus eye doctors, we understand that every patient’s eyes are unique. What works well for one person may not be the best solution for another. Our approach involves:

Thorough evaluation of the patient’s corneal shape, thickness, and overall eye health

Consideration of the patient’s lifestyle, visual needs, and personal preferences

Discussion of all available options, their potential benefits, and risks

Collaborative decision-making with the patient

Living with Keratoconus

Keratoconus is a chronic condition that can significantly impact a person’s daily life. However, with proper management and support, individuals with keratoconus can lead fulfilling lives and pursue their goals.

Understanding the Emotional Impact

Keratoconus can bring emotional challenges such as anxiety about potential vision loss, future career prospects, and treatment procedures. Many patients experience frustration adapting to fluctuating vision or contact lenses while explaining the condition to others who may not understand. The overwhelming nature of the diagnosis and grieving the loss of “normal” vision can lead to feelings of depression.

To cope, seek support through keratoconus groups or counseling, and educate yourself to reduce anxiety and feel empowered in decision-making. Communicate openly with loved ones and your care team, and prioritize self-care activities to promote overall well-being and stress reduction. With the right strategies, you can navigate the challenges and focus on improving your quality of life.

Adapting to Daily Life

Living with keratoconus often requires some lifestyle adjustments. Here are some strategies for managing daily activities:

Work and School

Inform relevant parties: Consider discussing your condition with employers or educators to ensure appropriate accommodations.
Optimize your workspace: Adjust lighting, use larger fonts, or utilize assistive technologies as needed.
Take regular breaks: To reduce eye strain, follow the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds).

Driving

Be cautious with night driving: Keratoconus can cause increased glare sensitivity, making night driving challenging.

Use anti-reflective coatings: These can help reduce glare on glasses.

Consider yellow-tinted lenses: These may help improve contrast for night driving.

Sports and Recreation

Choose appropriate eyewear: For contact sports, consider protective goggles over contact lenses.
Be mindful of water activities: Take precautions to avoid losing contact lenses in water.
Manage outdoor activities: Wear sunglasses and a hat to reduce glare and UV exposure.

Managing Contact Lens Wear

For many keratoconus patients, contact lenses are a crucial part of their vision correction. Here are some tips for successful lens wear:

Hygiene and Care

Follow cleaning instructions: Proper lens care is crucial for eye health and comfort.
Replace lenses as scheduled: This helps prevent complications and ensures optimal vision.
Practice good hand hygiene: Always wash hands thoroughly before handling lenses.

Comfort Strategies

Use lubricating drops: These can help alleviate dryness and improve lens comfort.

Build up wearing time gradually: If you’re new to lenses or switching types, increase wear time slowly.

Be prepared: Carry a lens care kit and backup glasses for emergencies.

Troubleshooting

Address discomfort promptly: If you experience persistent irritation, remove lenses and consult your eye care provider.
Monitor vision changes: Report any significant changes in vision to your eye doctor.

Our Expertise in Keratoconus Care

At our practice, we pride ourselves on offering state-of-the-art care for patients with keratoconus. Our team of world class eye doctors has extensive experience in managing this complex condition, from early diagnosis through advanced treatment options. We are proud to be the top rated advanced contact lens practice in Orange County, and we are referred for Keratoconus from Santa Ana, Huntington Beach, Irvine, Orange, and across Orange County.

Our Technology

We invest in cutting-edge technology to provide the best possible care for our keratoconus patients:

Advanced Corneal Topography and Tomography

For precise mapping of corneal shape and thickness.

Optical Coherence Tomography (OCT)

For detailed imaging of corneal structure.

Wavefront Aberrometry

To measure higher-order aberrations that impact vision quality.

Corneal Biomechanics Assessment

To evaluate the strength and elasticity of the cornea.

Kerasoft Ic And Novakone Lenses For Patients With Keratoconus Pellucid Marginal Degeneration And Other Corneal Irregularities

Frequently Asked Questions

CAN KERATOCONUS BE CURED?

Currently, there is no cure for keratoconus. However, with modern treatment options like corneal cross-linking, we can often halt the progression of the disease. Additionally, various vision correction methods can significantly improve visual acuity and quality of life for keratoconus patients.

WILL I GO BLIND FROM KERATOCONUS?

With proper management, blindness from keratoconus is extremely rare. While the condition can cause significant vision impairment if left untreated, modern treatments and vision correction options can help maintain good functional vision in the vast majority of cases.

CAN I WEAR SOFT CONTACT LENSES WITH KERATOCONUS?

In early or mild cases of keratoconus, soft lenses (especially those designed specifically for keratoconus) may be an option. However, as the condition progresses, rigid gas permeable (RGP) or scleral lenses often provide better vision correction.

IS LASIK AN OPTION FOR CORRECTING VISION IN KERATOCONUS?

LASIK is generally not recommended for patients with keratoconus, as it can further weaken the cornea and potentially worsen the condition. However, other refractive surgery options, such as PRK combined with cross-linking, may be considered in certain cases.

HOW OFTEN SHOULD I HAVE MY EYES CHECKED IF I HAVE KERATOCONUS?

We typically recommend check-ups every 6 to 12 months for stable cases. However, more frequent visits may be necessary if your condition is progressing or if you’re adapting to new treatment.

CAN I PREVENT KERATOCONUS FROM GETTING WORSE?

While you can’t prevent keratoconus entirely, there are steps you can take to potentially slow its progression:

Attend regular check-ups to monitor the condition
Avoid rubbing your eyes
Manage allergies effectively
Consider corneal cross-linking if you’re a suitable candidate

ARE THERE ANY ACTIVITIES I SHOULD AVOID WITH KERATOCONUS?

Generally, you can maintain an active lifestyle with keratoconus. However, you should protect your eyes during contact sports and be cautious with activities that might lead to eye rubbing. Always discuss specific concerns with your eye care provider.

WILL MY CHILDREN INHERIT KERATOCONUS?

While there is a genetic component to keratoconus, it doesn’t follow a clear inheritance pattern. Having a parent with keratoconus does increase the risk, but it doesn’t guarantee that a child will develop the condition. Regular eye exams for family members can help with early detection if the condition does develop.

CAN I WEAR MAKEUP IF I HAVE KERATOCONUS?

Yes, but with some precautions. Avoid applying makeup too close to the eye, and be gentle when removing it. If you wear contact lenses, insert them before applying makeup and remove them before taking makeup off.

HOW LONG DOES IT TAKE TO ADAPT TO SCLERAL LENSES?

Most patients adapt to scleral lenses within a few weeks. Initially, you may need to gradually increase your wearing time. Our team will provide detailed instructions and support throughout the adaptation process.

IS CORNEAL CROSS-LINKING PAINFUL?

The procedure itself is not painful as your eyes will be numbed. Some patients experience discomfort, sensitivity to light, and watery eyes for a few days after the procedure, but this is typically manageable with prescribed medications.

HOW SUCCESSFUL IS KERATOCONUS TREATMENT?

The success of keratoconus treatment varies depending on the stage of the condition and the specific treatment used. However, with modern management strategies, the majority of patients achieve good functional vision and quality of life. Corneal cross-linking, for instance, is successful in halting keratoconus progression in over 90% of cases.

Orange County’s Trusted Eye Doctors in Keratoconus Care

At Insight Vision Center Optometry, we are proud to serve the diverse communities of Orange County, California. Our conveniently located practice in Costa Mesa offers easy access for patients from nearby areas like Newport Beach, Huntington Beach, Irvine, Santa Ana, and beyond.

As Orange County’s leading eye doctors in keratoconus, we’re dedicated to giving you the best possible outcomes. Whether you need advanced contact lenses, non-surgical treatments, or eye doctors advice, our team is here to help you see the world clearly again.

Don’t wait to address your keratoconus. Schedule a consultation with the trusted eye doctors at Insight Vision Center Optometry today. Call (714) 942-1361 to book your appointment. Let us help you achieve better vision and a brighter future!

Insight Vision Center Optometry is a proud member of Vision Source, the premier network of private practice optometrists.

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