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 specialists in keratoconus care in Orange County, we are well-versed in the latest surgical techniques and emerging treatments.
This section will explore these options in detail.
When is Surgery Considered?
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
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.
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.
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
Intrastromal Corneal Ring Segments (ICRS)
ICRS, such as Intacs® or Keraring®, are small, clear, semicircular implants that are inserted into the cornea to reshape it.
How ICRS Work
These segments are placed in the periphery of the cornea, flattening the central cornea and reducing the cone-like bulge characteristic of keratoconus.
Advantages of ICRS
- Can improve vision and potentially reduce dependence on contact lenses
- Reversible procedure
- May delay or prevent the need for corneal transplantation
Considerations
- Not suitable for all cases of keratoconus
- May still require contact lenses for optimal vision
- There’s a small risk of complications such as segment extrusion or infection
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.
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
The diseased layers of the cornea are removed and replaced with healthy donor tissue. The patient’s own endothelium is preserved.
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
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, specialty contact lenses like scleral lenses may provide the best visual outcomes even after surgery.
The Importance of Customized Treatment Plans
As keratoconus specialists, 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:
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.
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 doctor.
Our Specialized
Keratoconus
Practice and FAQs
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 specialists has extensive experience in managing this complex condition, from early diagnosis through advanced treatment options. We are proud to be the top rated specialty 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.
Orange County’s Trusted Experts 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 specialists in keratoconus, we’re dedicated to giving you the best possible outcomes. Whether you need advanced contact lenses, non-surgical treatments, or expert 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 experts 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!
Frequently Asked Questions
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.
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.
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.
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.
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.
While you can’t prevent keratoconus entirely, there are steps you can take to potentially slow its progression:
- Avoid rubbing your eyes
- Manage allergies effectively
- Consider corneal cross-linking if you’re a suitable candidate
- Attend regular check-ups to monitor the condition
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.
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.
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.
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.
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.
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.
