Advanced Treatments for Managing Keratoconus

Keratoconus Treatment: A Comprehensive Overview

Keratoconus is a progressive eye condition where the cornea, the clear front part of the eye, thins and bulges into a cone shape. This distortion causes blurred vision and sensitivity to light. As the condition progresses, the vision may worsen, making routine tasks like reading, driving, or using a computer difficult. Fortunately, advancements in eye care offer several effective treatments that can slow or halt its progression and improve visual function.

Early Detection and Diagnosis

Early detection is key in managing keratoconus. Eye care professionals use several tests, such as corneal topography, to map the cornea’s shape. Other diagnostic tools include slit-lamp examinations and pachymetry, which measures the thickness of the cornea. Once diagnosed, patients can explore treatment options based on the stage of the condition.

Contact Lenses for Keratoconus

One of the earliest treatment methods for keratoconus involves the use of special contact lenses. In the initial stages, soft contact lenses may correct mild vision issues. However, as the cornea becomes more irregular, rigid gas permeable (RGP) lenses are often prescribed. These lenses provide a smooth surface over the distorted cornea, offering clearer vision.

Another option is hybrid contact lenses, which combine a hard center with a soft outer ring, providing the comfort of soft lenses and the visual clarity of hard lenses. Scleral lenses, larger than RGP lenses, rest on the sclera (the white part of the eye) and vault over the cornea. These lenses create a tear-filled chamber between the lens and the cornea, reducing discomfort and improving vision for advanced keratoconus patients.

Corneal Cross-Linking (CXL)

Corneal cross-linking (CXL) is a minimally invasive procedure that has revolutionized keratoconus treatment. This technique strengthens the corneal tissue to stop the progression of the disease. The procedure involves applying riboflavin (vitamin B2) drops to the eye, followed by exposure to ultraviolet (UV) light. The UV light activates the riboflavin, forming new bonds between collagen fibers in the cornea, making it more stable and less prone to bulging.

CXL can halt the progression of keratoconus, especially when performed in the early stages. There are two types of cross-linking procedures: the standard “epi-off” technique, where the epithelial layer of the cornea is removed before applying riboflavin, and the “epi-on” technique, where the epithelial layer remains intact. Both methods are effective, but the choice depends on the individual case and the surgeon’s recommendation.

Intracorneal Ring Segments (ICRS)

Intracorneal ring segments (ICRS) offer another treatment option for keratoconus. These tiny, crescent-shaped implants are placed in the cornea to flatten its cone shape. ICRS can improve vision by reshaping the cornea and reducing irregularities.

The procedure is typically quick and can be performed under local anesthesia. ICRS do not halt keratoconus progression, but they can delay the need for more invasive treatments, like corneal transplants, by improving vision and providing structural support to the cornea.

Customized Laser Surgery

Laser procedures, such as photorefractive keratectomy (PRK), can be an option for certain keratoconus patients, though they are not suitable for everyone. PRK reshapes the cornea to improve vision, but this treatment is usually only recommended for those with mild or moderate keratoconus. In more severe cases, laser surgery may be combined with other treatments like CXL to enhance results.

Corneal Transplant

In advanced stages of keratoconus, when vision deteriorates significantly and other treatments fail, a corneal transplant may become necessary. This procedure, also known as penetrating keratoplasty (PK), replaces the damaged cornea with healthy donor tissue. The success rate of corneal transplants for keratoconus is high, and many patients regain functional vision after the procedure.

There is also an option for partial-thickness corneal transplants, known as deep anterior lamellar keratoplasty (DALK). This technique preserves more of the patient’s natural corneal tissue, reducing the risk of complications while improving visual outcomes.

There are two main types of corneal transplants:

• Penetrating Keratoplasty (PK): A full-thickness transplant where the entire cornea is replaced.
• Deep Anterior Lamellar Keratoplasty (DALK): A partial-thickness transplant where only the outer and middle layers of the cornea are replaced, preserving the inner layers. DALK offers a lower risk of rejection compared to PK.

Conclusion

While keratoconus is a challenging condition, a wide range of treatments offers hope to patients. Early diagnosis allows for timely intervention, which can slow or stop the progression of the disease. From contact lenses and corneal cross-linking to surgical options like intracorneal ring segments and corneal transplants, each treatment is tailored to the patient’s unique needs. By working closely with an eye care specialist, individuals with keratoconus can manage the condition effectively and maintain a good quality of life.