Keratoconus

Keratoconus is a disease of the cornea affecting approximately 1 in 1000 people. A direct translation of the word is 'cone-shaped cornea'. In keratoconus, the cornea becomes thin and weak and bulges forward in the middle causing stretching. It can make a person's vision irregular and distorted as the cornea is responsible for two-thirds of the eye's ability to focus. Keratoconus sufferers may also experience sensitivity to light and see multiple overlapping images. Both eyes are usually affected to varying degrees.

What Is Keratoconus?

Watch Mr CT Pillai, Founder/Medical Director at Advanced Vision Care, explain what Keratoconus is, and how it affects those who suffer with the condition:

 

Video Transcript

"Keratoconus, we would say is a non-inflammatory degenerative condition of the cornea. People are born with it or it will develop in the early childhood. The cornea gets weaker so it becomes thinner and thinner as the age progresses. Because it is getting thinner the patient will increasingly become more astigmatic or more shortsightedness. They need glasses that won’t help them; they need contact lenses to get a good vision."

Mr CT Pillai, Founder/Medical Director at Advanced Vision Care

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The Causes & Symptoms Of Keratconus

There is no known cause for keratoconus but doctors suggest that it could be associated with eye rubbing, allergies and could be passed down through genetics. It can be more common in people of a certain race and those with certain medical conditions such as Down's syndrome.

Symptoms usually start to occur during puberty or adolescence. Patients can initially experience symptoms of any refractive error and acquire glasses and/or contact lenses to help them with reading and/or driving.

Mr CT Pillai, Founder/Medical Director at Advanced Vision Care, describes the common symptoms of keratoconus and how it is diagnosed:

 

Video Transcript

"Warning signs are if the patient needs frequent change of glasses or contact lenses, or they use contact lenses and the lens is not fitting properly, or their prescription is changing quite rapidly. Their shortsightedness or astigmatism changes quite rapidly, or they do a lot of rubbing their eyes. These are the early warning signs of Keratoconus. Most opticians will be able to recognize it and diagnose it. There are also a lot of machines now that can do mapping of the cornea, can diagnose this condition at a very early stage."

Mr CT Pillai, Founder/Medical Director at Advanced Vision Care

END


The Treatments Available For Keratoconus

Traditionally, corneal grafts (in more advanced keratoconus) was the mainstay of treatment. Contact lenses - soft, rigid, hybrid, are used to improve a keratoconic patient's vision, but not cure or treat the disease. The condition typically progresses and eventually stabilizes, but the rate will vary from patient to patient. Advances in technology, corneal collagen cross-linking, have allowed to halt the progression of keratoconus.

Watch Mr CT Pillai, Founder/Medical Director at Advanced Vision Care, describe the available treatments for keratoconus:

 

Video Transcript

"Ten years ago the options were the patient probably wore glasses or contact lenses or special corrective corneal contact lenses. If it is not fitting properly then the corneal transplant was the only option. That was 15 years ago, now there’s a very innovative well-standardized technique called cross-linking which stops the progression of the disease. It doesn’t cure it; it stops the progression, makes the refraction, we call them prescription, much better. So people don’t need a corneal transplant. There is also a technique called Intacs, which are plastic tubes we put in the cornea that can flatten the cornea.

Also, in advance, we do implantable contact lenses for these patients who have stabilized prescription. It’s a thin, miniature contact lens which is put inside the eye. The patient will be able to see without any glasses or contact lenses.

So there are three options now, Cross-Linking, Cross-Linking with Intacs, or Cross-Linking with implantable contact lenses. So these patients can be visually rehabilitated now, they don’t need a corneal transplant; there’s no doom and gloom for these patients."

Mr CT Pillai, Founder/Medical Director at Advanced Vision Care

END


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Cross-Linking

Cross-Linking was first developed twenty-five years ago in Switzerland and Germany. It uses an ultraviolet light (UVA) applied to a photosensitising solution (riboflavin) in the form of eye drops to stiffen the cornea. This combination creates additional linkages between the cornea's collagen fibres and provides increased strength to the structure.

keratoconus

Patients over forty may not require this treatment as their keratoconus has typically stabilized.

The procedure can last up to an hour (around thirty minutes for the light and thirty minutes for the eye drops). When the treatment is complete, a contact lens is placed on the eye for protection and to allow it to heal. One eye is treated at a time to enable the patient to still see out of their other eye whilst recovering.

Following the procedure, patients are given eye drops to use at regular intervals. This is to prevent infection and lessen inflammation. Pain-relief tablets will also be prescribed and an eye-shield should be worn to prevent the patient from rubbing their eye.

There is usually some moderate to high discomfort following the procedure, which can last up to a day or two. A week later the patient will have a follow-up appointment to ensure that the eye is healing and that there is no infection.

Depending on the aftercare package offered by the clinic, more follow up appointments will be scheduled to monitor the patient's progress.

Other treatment options include:

Corneal Transplant

If the cornea is too thin for cross-linking to have any affect, it can be replaced by way of a transplant. This requires a donor cornea to be grafted to the existing eye tissue with sutures that dissolve over time. The operation is performed under general anaesthetic. Because there are no blood vessels in the cornea, blood type does not have to be matched as it would do in most other forms of transplant. However, there is still risk of rejection from the donated cornea however 97%+ of corneal transplants are successful.

Some patient will require a corneal graft where by parts of the patient's cornea is removed and replaced by a donor cornea. This operation is typically done under general anesthesia. Because the cornea does not have any blood vessels, blood types do not have to be matched as in other forms of transplant, and therefore the risk of rejection is low.

Intacs

Intacs are ring segments that are placed into the eye to improve BCSVA in glasses and contact lenses by helping to reduce the prescription.

The surgeon will place anaesthetic drops onto the eye and may give the patient an oral sedative. They will then create a small tunnel between the layers of the corneal stroma where the intac rings will be placed. These rings vary in thickness so the appropriate size will be chosen and inserted. This results in the flattening of the cornea.

It only takes around fifteen minutes and the patient can go home straight afterwards. It will take at least twenty four hours to notice any improvement in vision.

Mini Ark Surgery

Mini ARK surgery uses a diamond blade to create incisions on the edge of the cornea in order to flatten it. There are a lot of reports of halos and glare after this procedure and it is not one of the most popular forms of eye surgery in the UK because many people feel that it is senseless to cut into an already thinning cornea. There are discussions and debates on this subject available on the internet. (See below for more information.)


The Cost Of Treating Keratoconus

Costs vary from clinic to clinic and will depend on the surgeon and also the aftercare available but as a general guide, it costs around £2500 for cross-linking surgery and £3300 for a corneal transplant. Intacs cost around £1500 per eye.

Can Keratoconus Be Treated On The NHS?

Whether the NHS will help fund the operation will depend entirely on your specific circumstances and what funding is available in your NHS catchment area. For more information on whether or not you could be entitled to support and funding through the NHS please visit your local GP.

Because keratoconus can be treated in many ways, it's best to see your GP or an eye specialist for a thorough examination in order to find out what will be the best treatment for you and what support is available.

 

Video Transcript

Yes, there are some centers, they are well-trained surgeons in the NHS but the awareness is not there in truth in the NHS. But yes it can be treated in the NHS, yes.

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Further Information

There are lots of forums, online resources as well as communities dedicated to supporting keratoconus sufferers, many of which you'll find listed below:

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