Introduction:

Keratoconus is a relatively rare but significant eye condition that affects the cornea, the transparent outer layer of the eye. It causes the cornea to progressively thin and bulge into a cone-like shape, leading to distorted vision and potential visual impairment. Early detection and timely treatment are crucial for managing the progression of keratoconus and preserving a patient’s vision. In this blog post, we will delve into how keratoconus is detected and explore the innovative treatments that offer hope and improved vision to those affected by this condition.

Detection of Keratoconus

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   Credit: Edouard Spooner, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons

   Comprehensive Eye Examination: The first step in detecting keratoconus is a comprehensive eye examination conducted by an eye care professional. This examination includes a detailed medical history review, family history analysis, and an assessment of any existing eye conditions or vision-related symptoms.

2. Visual Acuity Test: The ophthalmologist will conduct a visual acuity test to determine how well the patient can see at different distances. This helps identify any potential vision abnormalities caused by keratoconus.
3. Refraction Test: A refraction test is performed to measure the patient’s refractive error and determine the appropriate prescription for corrective lenses. In the early stages of keratoconus, frequent changes in prescription or an inability to achieve clear vision with glasses may raise suspicion.
4. Slit lamp examination: The slit-lamp biomicroscope is a powerful tool used to examine the front structures of the eye, including the cornea. By magnifying the cornea’s surface, the ophthalmologist can identify thinning and structural changes that indicate keratoconus.
5. Corneal Topography: One of the most critical diagnostic tools for keratoconus is corneal topography. This non-invasive imaging technique creates a detailed map of the corneal surface, highlighting any irregularities and providing valuable information about the shape and curvature of the cornea. Steepening of the corneal surface as the cornea progresses to transform into a conical elevation is seen on this test.
6. Pachymetry: Pachymetry measures the thickness of the cornea. In keratoconus, the cornea tends to be thinner than usual, especially in the area of the cone.

Treatment Options for Keratoconus

1. Prescription Eyewear: In the early stages of keratoconus, glasses or soft contact lenses may be prescribed to correct mild astigmatism and improve vision. However, as the condition progresses, these options may become less effective.
2. Rigid Gas Permeable (RGP) Contact Lenses: RGP lenses are a preferred option for many keratoconus patients. They are custom-made to provide a smooth and regular corneal surface, offering better vision by compensating for the cornea’s irregular shape.
3. Scleral Contact Lenses: Scleral lenses are larger gas-permeable lenses that vault over the cornea and rest on the white part of the eye (sclera). These lenses provide improved comfort and visual acuity for individuals with advanced keratoconus.
4. Cross-Linking (CXL) Treatment: Corneal collagen cross-linking is a non-invasive procedure used to strengthen the cornea and halt the progression of keratoconus. During the procedure, riboflavin drops are applied to the cornea, followed by exposure to ultraviolet light. This encourages collagen fibers to form new cross-links, increasing the cornea’s rigidity and stability.
5. Intracorneal Ring Segments (ICRs): ICRs are small, semi-circular devices implanted within the cornea to reshape its curvature and improve visual acuity. They are particularly useful for patients who cannot tolerate contact lenses or those with mild to moderate keratoconus.
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   Credit: Megor1, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

   Corneal Transplantation: In advanced cases of keratoconus, where visual impairment cannot be sufficiently corrected with glasses, contact lenses, or other interventions, corneal transplantation may be recommended. During this procedure, the damaged cornea is replaced with a healthy cornea from a donor. Advanced surgical techniques, such as deep anterior lamellar keratoplasty (DALK), have improved outcomes and reduced recovery times. DALK is a partial thickness corneal transplant where only the front of the cornea is replaced with a donor graft. A full thickness corneal transplant may be required in some cases.

Conclusion

Keratoconus is a challenging eye condition that can significantly impact an individual’s quality of life. Early detection is vital, as it allows for timely intervention and better outcomes. With advancements in technology and treatments, there is hope for those affected by keratoconus to maintain clearer vision and lead fulfilling lives. If you suspect any changes in your vision, do not hesitate to consult an eye care professional, as prompt detection and treatment are key to managing keratoconus successfully.

Top image Credit: William Charles Caccamise, Sr, MD, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons