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What Is Keratoconus?

Definition of Keratoconus: The word keratoconus is derived from Greek and Latin. Kerato means cornea and conus means cone shaped. It is a bilateral, progressive, asymmetric, non-inflammatory thinning and ectatic condition of the cornea, resulting in a high degree of irregular myopic astigmatism.

Prevalence: Keratoconus is estimated to occur in 1 in every 2000 people in the general population. There appears to be no significant preference for males or females.

What is the average age of onset of keratoconus?

The onset of keratoconus is between the ages of 10 and 30. Changes in the shape of the cornea usually occur slowly over several years.

Symptoms: Symptoms depend on the severity of the disease. The most common symptoms include:

• Blurred vision.

• Distortion of vision.

• Photophobia.

• Shine.

• Eye irritation and itching.

• Constantly changing power scene.

• Inability to wear contact lenses.

Reasons:

The cause of keratoconus remains unknown, although recent research seems to indicate that possible causes include:

• Keratoconus is thought to be caused by a defect in collagen, the tissue that makes up most of the cornea.

• Keratoconus has a genetic component and studies show that about 8% of patients have affected relatives.

• It occurs more often in people with certain medical problems, including certain allergic conditions.

• Some think that constant excessive eye rubbing can cause keratoconus.

Classification:

(A) Based on keratometry reading:

1. Mild: Keratometric readings are less than 45D in both meridians.

2. Moderate: Keratometric readings are between 45D and 52D in both meridians.

3. Advanced: Keratometric readings are between 53D and 62D on both meridians.

4. Severe: keratometric readings are in both meridians above 62D.

(B) Based on morphologic form:

1. Nipple Cones: Characterized by their small size (5 mm) and steep curvature. The optical center is usually central or para-central and displaced inferonasally.

2. Oval Cones: Which are larger (5-6 mm), ellipsoid and usually displaced inferonasally.

3. Globus Cones: Which is the largest more than 6mm and can cover more than 75% of the cornea.

Clinical Characteristics:

1. In the early stages, visual impairment in one eye is due to progressive Irregular myopic astigmatism with high keratometry readings.

2. Scissor reflex in retinoscopy.

3. Ophthalmoscopically shows an “Oil droplet reflex”.

4. Munson sign-Bulging of lower lid in lower view.

5. Fleischer Ring-Epithelial iron deposits at the base of the cornea. The mechanism of iron deposition is not clearly understood. Tears may be unevenly distributed.

6. Progressive Central or paracentral stromal thinning with low apical protrusion.

7. Vogt striae-Fine deep vertical stromal folds that disappear temporarily with digital pressure.

8. Rizutti sign-conical reflection of the nasal cornea when light shines from the temporal side.

9. Prominent corneal nerves.

10. Acute Hydropes-Corneal edema resulting from tears Due to ruptures of descemet`s membrane and acute penetration of aqueous humor into the corneal stroma and epithelium. These breaks usually heal within 6-10 weeks and the edema gradually subsides.

11. Variable corneal scarring, depending on the severity of the disease.

Associations: Ocular and systemic associations with keratoconus include:

Ocular:

• Vernal conjunctivitis.

• Blue sclera.

• Aniridia.

• Ectopia Lentis.

• Retinitis Pigmentosa.

• Leber congenital amaurosis.

Systemic:

• Down syndrome.

• Ehlers-Danols syndrome.

• Marfan syndrome.

• Atopic dermatitis.

• Osteogenesis imperfecta.

Exams and Tests:

• Visual acuity test: Visual acuity is an indicator of the clarity or clarity of a person’s vision. It is a measure of how well a person can see.

• Refraction: A refraction test is an eye exam that measures a person’s prescription for eyeglasses or contact lenses.

• Slit Lamp Review: A slit lamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light on the eye. The slit lamp examination provides a stereoscopic magnified view of the eye’s structures in detail, enabling anatomical diagnoses to be made for various eye conditions such as keratoconus.

• Topography of the cornea: Corneal topography, also known as photokeratoscopy or video-keratography, is a non-invasive imaging technique for mapping the curvature of the cornea’s surface. A three-dimensional map is an invaluable aid. It is also used to diagnose and treat many conditions; to plan refractive surgery such as LASIK and evaluate its results; or to assess the fit of contact lenses or to diagnose keratoconus.

Treatment:

Optical:

Views: In the early stages of keratoconus, glasses are often successful in correcting the myopia astigmatism associated with keratoconus. But in severe cases it does not provide good quality of vision due to high amount of corneal toricity.

Contact lenses:

1. Soft contact lenses: In the early stages of keratoconus soft contact lenses help. Because soft contact lenses provide good comfort. But in advanced stages, soft contact lenses cannot correct irregular astigmatism. Therefore, soft contact lenses are not useful in advanced stages of keratoconus.

2. Rigid Gas Permeable contact lens (RGP): As the condition progresses, the cornea becomes irregular and vision is no longer adequately corrected with eyeglasses and soft contact lenses. Hard gas permeable contact lenses are necessary to provide optimal visual acuity. The rigid gas permeable lens is able to vault the cornea, replacing the irregularities of the cornea by filling the tears between the cornea (front surface of the eye) and the back surface of the RGP lens with a smooth , uniform refracting surface to improve vision.

3. Piggy back contact lenses: A good fit of a rigid gas permeable contact lens over a cone-shaped cornea is sometimes not possible. To get a good fit and good visual results some practitioners use piggyback contact lenses. This procedure involves placing a soft contact lens, such as one made of silicone hydrogel, over the eye and then fitting an RGP lens over the soft contact lens.

4. Rose-K Lenses: The Rose-k lens was introduced by Dr Paul rose in 1995. This lens is the most frequently prescribed gas permeable lens in the world for keratoconus. This lens has a complex geometric design. Here are the six different curves on the back surface of the lens and the reduction of the optic zone as the base curve gets darker. The lens material is Boston.

5. Boston sclera contact lenses: In advanced cases of keratoconus to delay surgery Boston sclera contact lens is very helpful. It is made of material that allows oxygen to pass through the eye, larger diameters (15 to 24mm), the edges are on the sclera or white part of the eye and the central optic zone (12mm) is designed to fully vault of the irregular. shaped cornea. These large lenses are also more durable than conventional gas permeable contact lenses.

Operation:

Penetrating Keratoplasty: In about 15% of cases, keratoconus progresses to the stage where a corneal transplant is necessary to achieve better vision.

Corneal Collagen Cross-linking with Riboflavin (C3-R): A new, minimally invasive procedure called Corneal Collagen Cross-linking with Riboflavin (vitamin B) and ultraviolet-A (UVA 365nm) is called C3-R.

The treatment is performed in the operation theater under completely sterile conditions. Usually one eye is treated in one sitting. The treatment is done using anesthetic eye drops. The surface of the eye (cornea) is treated using Riboflavin eye drops for 30 minutes. The eye is then exposed to UVA light for 30 minutes. The combination of Riboflavin drops and ultra violet light reacts with the tissues of the cornea, strengthening it by creating more ‘cross-linking’ between them. The resulting increased hardness and rigidity of the cornea, stabilizes corneal ectasia. Therefore, the treatment takes one hour per eye. After treatment, antibiotic eye drops are applied; a contact lens bandage can be used, which is removed after a few days.

However, one should understand that Collagen cross-linking treatment is not a cure for keratoconus, rather, it aims to slow down the progression of the condition. But following the cross-linking treatment it makes the patient more comfortable to wear contact lenses.

Complications of keratoconus:

• Patients with even borderline keratoconus should not have laser vision correction. Corneal topography is performed before laser vision correction to prevent people with this condition.

• There is a risk of rejection after corneal transplantation, but the risk is lower than other organ transplants.

When to Contact a Medical Professional?

Young people whose vision cannot be corrected to 20/20 or 6/6 with glasses should be examined by an eye doctor experienced in keratoconus.

Does keratoconus affect both eyes?

Yes, keratoconus usually affects both eyes. Keratoconus is a bilateral condition; the degree of development of the two eyes is usually not the same.

Does keratoconus cause blindness?

Keratoconus does not cause complete blindness. However, this can lead to significant vision impairment resulting in legal blindness.

Prevention:

There are no preventive measures. Some specialists believe that patients with keratoconus should be aggressively treated for their eye allergies and should be taught not to rub their eyes.

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