Treatment of Keratoconus
Goal: Improve Quality of Life
Unfortunately, there is no cure for keratoconus but treatment options are available. Like most other medical problems, the need for treatment of keratoconus depends on the severity of the condition.
Unfortunately, glasses are minimally effective for correcting vision in cases of keratoconus. Almost every glasses prescription has some degree of astigmatism correction which means that there is a certain prescription in the vertical part of the lens and a different prescription in the horizontal part of the lens with a gradual change in prescription between the two meridians. Keratoconus causes multiple and unpredictable curves in the prescription which cannot be plotted out in a glasses prescription resulting in persistent ghost images and blurred vision. However, glasses are often prescribed over scleral contact lenses to correct for any residual prescription.
Soft Contact Lenses
In very mild cases of keratoconus, soft contact lenses may be used to give some improvement in vision. However, similar to a glasses prescription, soft contact lenses cannot be manufactured to correct for the unpredictable astigmatism and ghost images caused by keratoconus.
Rigid Contact Lenses
RGPs have been the treatment of choice for many years until the development of scleral contact lenses. RGPs act to resurface the front of the eye but come in direct contact with the cornea which is highly innervated making them quite uncomfortable. Vision is often variable as the RGP will mold the cornea resulting in constant changes in prescription and vision. These lenses are also prone to popping out of the eye at random times.
Scleral Contact Lenses
Improve quality of life in keratoconus at any stage, scleral contact lenses have now become the treatment of choice. These contact lenses are slightly larger than standard lenses providing the advantage of “vaulting” over the entire corneal surface. This design gives the eye a spherical optical surface as it covers the bumpy and irregular corneal surface caused by keratoconus. As the name implies, scleral lenses rest on the sclera (white part of the eye) which has fewer pain receptors than the cornea. Since the lenses never touch the cornea, they are much more comfortable than the older style rigid gas permeable lenses which make direct and often painful contact with the cornea. In many cases the scleral contact lenses can fully correct the vision to maximum potential. However, in some cases a light glasses prescription may be worn over the scleral contact lenses to further sharpen the vision.
Corneal Cross Linking
This is a relatively new procedure that has shown good results in stabilizing keratoconus. Crosslinking involves soaking the cornea in riboflavin followed by exposure to infrared light. This encourages new collagen links to form which strengthen and stabilize the cornea. However, crosslinking does little to reverse keratoconus so other treatments options such as scleral lenses will still be necessary to insure optimal vision. Rendia embed for cross linking video
INTACS is a surgical procedure in which tiny plastic rings are inserted into the cornea in attempt to flatten the steep, cone shaped cornea. INTACS is usually performed when the cornea is too steep to allow for rigid gas permeable contact lens wear. Although INTACS is usually effective in flattening the cone, contact lenses are still required for clearer vision. Since new scleral lenses can often fit even the steepest corneas, INTACS is usually not needed if scleral contact lenses are used instead of rigid gas permeable contact lenses
This surgical procedure involves removing the diseased cornea and replacing it with a donor cornea from a person who has “passed on.” Corneal transplantation should be used only as a last resort in extreme cases of keratoconus. Recovery time can be several months or even years and the procedure may have to be repeated if the donor cornea is rejected. Scleral contact lenses are usually required to maximize vision after the transplant. Corneal crosslinking has shown significant benefit in stabilizing the cornea and avoiding corneal transplant.
LASIK, PRK, SMILE
LASIK, PRK, SMILE and other refractive surgeries cannot treat keratoconus and are absolutely contraindicated (don’t do it!) in keratoconus patients. Refractive surgery further thins and destabilizes the cornea which can make the keratoconus worse or cause a borderline keratoconus patient to develop full blown keratoconus.