Keratoconus: All About The Eye Condition In Which The Cornea Begins To Thin And Fold
Keratoconus is an ectatic corneal degenerative disease in which the cornea begins to weaken. “It further begins to thin and stiffen (bending) causing visual disturbances but not blindness,” says Dr. Sridevi Haldar, Ophthalmologist/Ophthalmic Surgeon, Ortho Vision Clinic, Noida.
The expert added that, as its name suggests, the spherical cornea in keratoconus takes a conical shape, hence the name “keratoconus” – (kerato -meaning cornea and conus -meaning conical). “The clear, transparent cornea focuses the light beam on the retina. Any abnormality in its shape causes visual disturbances,” she explained.
What causes keratoconus?
It generally begins around adolescence and progresses until the age of 35-40. Researchers have not been able to discern the exact cause of the disease, although a number of associated risk factors have been fairly well identified.
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Major risk factors include childhood eye allergies such as VKC (vernal keratoconjunctivitis), intense rubbing of the eyes, long-term use of steroid eye drops and sometimes also genetic components.
“These patterns lead to a progressive sharpening or curvature of the cornea and central cornea thinning followed by sudden rupture of the Bowman’s membrane of the cornea. This leads to acute hydrops leaving behind a central corneal scar greatly reducing vision,” she said. indianexpress.com.
Any cylindrical power >1.25 D should be carefully assessed for early detection of this disease.
If one changes glasses frequently and does not feel entirely comfortable with the quality of vision, keratoconus may be the case.
Increase cylindrical power can also be a sign of keratoconus.
Sudden blurred vision during pregnancy can also occur due to hormonal effects. It can also sometimes lead to keratoconus.
“The management of keratoconus depends on the stage of the disease. In the early stages of keratoconus, refractive error can be corrected with glasses, but in later stages vision may not be very clear with them,” Dr. Haldar said.
That’s when, she said, one may need special contact lenses called rigid/hard contact lenses. These lenses come in different types, depending on the extent to which cornea is accentuated:
• RGP (rigid gas permeable lenses)
• Miniscleral lenses
• Pink K lenses
• Scleral lenses.
Corneal collagen cross-linking (C3R)
• Corneal crosslinking is a procedure that can be done in mild to moderate cases of keratoconus with documented evidence of progression over a year (increasing the slope by 1D)
• This involves treating the cornea with riboflavin eye drops for 20-30 minutes (priming procedure), followed by a UVA radiation exposure to the beam for 10 to 30 minutes to fortify and strengthen the cornea so that it does not bend further.
• In advanced asymmetrical cones (as seen on corneal topography), intracorneal intacs or segments are placed in the cornea to regularize the shape of the cone so that contact lenses fit better and visual quality is improved. improved. They do not completely correct the existing refractive error but only change the shape of the cornea.
Cornea transplant (keratoplasty)
• In advanced keratoconus, such as post-hydrops scars where Bowman’s membrane the corneal layer is already broken due to too much thinning of the cornea, leaving behind a scar in the center of the cornea thus obstructing the visual axis
• Corneal surgeons can perform a partial-thickness or full-thickness corneal transplant to replace the scarred cornea with a clear donor cornea.
• The donor corneal graft is sutured to the host corneal rim with 16-20 fine sutures which are then removed after 8-9 months until the donor cornea is fully integrated into the host rim. However, one can start doing routine activities just after a week.
These are the best options available for keratoconus with a few changes in every procedure to maximize the visual outcome in our patients.
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