What is keratoconus?
Keratoconus is a common bilateral corneal condition, occurring in more than 1 in 1000 people. The condition typically starts in adolescence and early adulthood. Usually one eye is involved more than the other. Infrequently it may occur only in one eye.Keratoconus is a disease with an uncertain cause, and its progression following diagnosis is unpredictable. It is more common in people with allergies or those who rub a_imagetheir eyes frequently. If afflicting both eyes, the deterioration in vision can affect the patient’s ability to drive a car or read normal print. Further progression of the disease may lead to a need for surgery. Despite its uncertainties, keratoconus can be successfully managed with a variety of clinical and surgical techniques, and often with little or no impairment to the patient’s quality of life.
Common risk factors of keratoconus
This is usually done by an ophthalmologist with a detailed eye examination. Diagnosing early keratoconus can be tricky, since mild disease often does not show any identifiable signs on slit-lamp examination; however, recent and a more definitive diagnosis can be obtained using corneal topography, in which an automated instrument projects an illuminated pattern onto the cornea and determines its shape from analysis of a digital image. The topographical map reveals distortions or scarring in the cornea, with keratoconus revealed by a characteristic steepness of curvature which is usually below or around the centre of the cornea. The topography record of the degree and extent of the deformation is used for assessing its rate of progression. Unilateral cases tend to be uncommon. Sometimes it’s a mild condition in the better eye, below the limit of clinical detection. It is common for keratoconus to be diagnosed first in one eye and not until later in the other.
Diagnostic techniquest for keratoconus
Phacoemulsification through a smaller incision of around 1 mm with a sleeveless phaco tip and irrigation through a separate side port provides an advantage of speedy recovery, faster healing and lesser surgery induced astigmatism. The surgery involves insertion of a rollable lens of 5.5mm dia which can be inserted through 1.2 mm incision (The microincision). At Kiran Lasik Laser & Eye Care hospital we have facilities for the latest and most advanced imported intraocular lenses at reasonable prices and millions of satisfied patients who have opted for the same.
How can keratoconus be treated
Treatment of mild keratoconus is geared towards eliminating or reducing the myopia and astigmatism.
Temporary:
• Contact Lenses
Permanent:
New modality of treatment:
• Corneal Collagen Crosslinking with Riboflavin (C3-R®*), CXL, New CSO-Vega.
Role of Contact Lenses
Initial management is tried with rigid contact lenses by our contact lens specialist. In very early stages of keratoconus, spectacles can suffice to correct minor astigmatism. As the treatmentcondition progresses, spectacles may no longer provide the patient with a satisfactory degree of visual acuity, and most doctors will move to managing the condition with contact lenses.
Rigid gas permeable contact lenses for keratoconus improve vision by means of tear fluid filling the gap between the irregular corneal surface and the smooth regular inner surface of the contact lens, thereby creating the effect of a smoother cornea.
Many specialized types of contact lenses have been developed for keratoconus, and our contact lens expert helps you with the best fit. The irregular cone needs expertise to produce a contact lens with optimal contact, stability and steepness. Some trial-and-error fitting might be necessary.
Traditionally, contact lenses for keratoconus have been the ‘hard’ or rigid gas-permeable variety, although manufacturers have also produced specialized ‘soft’ or hydrophilic contact lenses. A soft contact lens has a tendency to conform to the conical shape of the cornea, thus diminishing its effect. These do not however prove effective for every patient.
Some patients also find good vision correction and comfort with a “piggyback” contact lens combination, in which gas permeable rigid contact lenses are worn over soft contact lenses, providing clarity of vision and comfort.
Precaution with contact lenses: There is a small risk of infection when wearing contact lenses and the risk becomes much greater if the contact lenses are not kept clean, so it is important to strictly follow the hygiene instructions given when the contact lenses are fitted.
A NEW PERMANENT NON SURGICAL TREATMENT: CORNEAL COLLAGEN CROSSLINKING WITH RIBOFLAVIN (C3-R®*), CXL, CSO-VEGA.
So far there has been not one successful way to stop the progression of keratoconus.With current methods using rigid contact lens or intra corneal ring segments, only the refractive error (spectacle numbers) can be corrected, but it has very little effect on the progression of keratoconus. It is estimated that eventually 21% of the keratoconus patients require surgical intervention to restore corneal anatomy and eyesight. A new non surgical, non invasive treatment, based on collagen cross linking with Ultraviolet A (UVA, 365nm) and riboflavin (Vitamin B 2), a photosensitizing agent is now available. This changes the intrinsic biomechanical properties of the cornea, increasing its strength by almost 300%. This increase in corneal strength has shown to arrest the progression of keratoconus in numerous studies all over the world.
What is collagen cross-linking?
A new treatment for keratoconus which has shown great success is Corneal Collagen Crosslinking with Riboflavin (C3-R®*), a one-time application of riboflavin eye drops to the eye. The riboflavin, when activated by approximately 30 minutes illumination with UV-A light, augments the collagen cross-links within the stroma and so recovers some of the cornea’s mechanical strength.C3-R®*, developed at the Technische Universität Dresden, Germany has been shown to slow or arrest the progression of keratoconus, and in some cases even reverse it, particularly when applied in combination with intracorneal ring segments.
How does Cross Linking cure keratoconus?
Until recently, there was no method to change the integrity and strength of the cornea itself for keratoconus patients. The non-invasive treatment C3-R®* (corneal collagen cross-linking riboflavin) treatment has been proven to strengthen the weak corneal structure in keratoconus. This method works by increasing collagen cross-linking, which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular (which is the cause of keratoconus).
The figures above show the parallel corneal layers (white) and the collagen cross-linking (red) which increased after C3-R®* treatment.
Benefits of CROSS LINKING?
CROSS LINKING is Permanent
Simple- Single- one hour treatment
No follow up sittings required
No need for admission
Stops the progress and causes regression of disease
Does not need eye donation as in corneal transplant
No major precautions
No injections or stitches
No incisions as in Intacs or Corneal ring segments
Quick recovery with short follow up
CXL, CSO-Vega has advantage of having in-built monitor and software programmes for increased accuracy of the procedure.
Our Services
Take your first step towards brilliant vision with the region-renowned laser eye surgery expert Dr. Karan Sarwal
at Kiran Lasik Laser & Eye Care Centre on Bathinda Chandigarh Highway, Rampura.
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