What is Keratoconus?

Keratoconus (KEHR-uh-toh-KOH-nus) is a corneal disorder that results in progressive thinning of the cornea that can cause the development of a cone-like bulge. The majority of KC occurs in both eyes, but it often develops asymmetrically (more in one eye than the other). Highly irregular corneas result in visual distortions and aberrations that cannot be corrected with typical glasses and soft contact lenses.

In rare cases, the cornea can swell suddenly and start to scar. When the cornea has scar tissue, it loses its smoothness and vision becomes even more distorted and blurry. Keratoconus can result in significant vision loss and may lead to a corneal transplant in severe cases. Management depends on two main factors: progression and disease severity.

Diagnosing Keratoconus

Corneal topography or tomography is the best way to detect early signs of keratoconus and monitor for signs of progression. Symptoms of keratoconus can include but are not limited to:
–   Frequent prescription changes
–   Eye irritation, excessive eye rubbing
–   Difficulty seeing at night
–   Increased sensitivity to bright light and glare
–   Vision that cannot be fully corrected with glasses

Visual Rehabilitation

There are many options to optimize vision in keratoconic eyes, depending on the severity of the disease:
–   Eyeglasses or standard soft contact lenses
–   Custom soft contact lenses
–   Gas permeable (GP) contact lenses
–   Hybrid lenses (GP center with a soft ‘skirt’)
–   Scleral lenses

Arresting Progression

Younger patients are more likely to experience rapid progression and more significant complications than adults, but it is a highly variable and unpredictable disease. Eye rubbing is strongly associated with KC progression. Your doctor may refer you for Corneal Cross-Linking (CXL), a non-surgical procedure that strengthens the cornea, which can help prevent the disease from getting worse.

Surgical Management

When useful vision cannot be achieved due to advanced disease and/or scarring, surgical procedures are considered. While newer surgical procedures exist, many are not widely available. Your doctor will refer you to a corneal specialist if you may benefit from surgical intervention:
–   Corneal Transplant (e.g. DALK, PKP)
–   Corneal Tissue Addition Keratoplasty (CTAK)
–   Intrastromal Corneal Ring Segments (ICRS)