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Keratoconus Treatment
Keratoconus is a progressive eye disease characterised by thinning and protrusion of the cornea, the transparent front layer of the eye. Normally, the cornea is shaped like a rounded dome; in keratoconus, however, it takes on a cone-like shape. This prevents light from focusing properly on the eye, leading to vision problems and making activities such as driving, typing on a computer, watching television or reading difficult.
The disease progresses between the ages of 20 and 40 and enters a stable phase after the age of 40. Although the exact cause of keratoconus has not been determined, it has been proven that genetic inheritance, exposure to ultraviolet rays, the use of hard lenses, environmental factors, connective tissue weaknesses, and trauma such as eye itching due to allergies are effective. Furthermore, having certain systemic and genetic disorders such as Down Syndrome, Marfan Syndrome, and Osteogenesis Imperfecta also constitutes a risk factor for the disease.
What Is Keratoconus?
Keratoconus is a progressive eye disease that affects the cornea, the clear front surface of the eye. Normally, the cornea has a smooth dome shape that helps focus light onto the retina. In keratoconus, however, the cornea gradually becomes thinner and bulges forward into a cone-like shape. This irregular curvature prevents light from focusing properly, resulting in blurred or distorted vision.
The disease usually begins in adolescence or early adulthood, progressing between the ages of 20 and 40. After the age of 40, the condition often stabilizes, though the damage it causes can remain permanent if not treated in time. Keratoconus can affect daily activities such as driving, reading, using a computer, or watching television, reducing overall quality of life.
Causes of Keratoconus
The exact cause of keratoconus remains unclear, but researchers have identified several contributing factors:
- Genetic predisposition: Family history of keratoconus increases the risk.
- Eye rubbing: Frequent or forceful rubbing of the eyes, especially due to allergies, may accelerate progression.
- Environmental factors: Excessive exposure to UV rays or oxidative stress may weaken corneal tissue.
- Connective tissue disorders: Patients with Marfan syndrome, Down syndrome, or osteogenesis imperfecta have a higher risk.
- Chronic irritation: Poorly fitted contact lenses or persistent eye allergies can contribute.
Most likely, keratoconus results from a combination of genetic, environmental, and biochemical factors.
Symptoms of Keratoconus
Symptoms vary depending on the severity and stage of the disease. Common signs include:
- Blurred or distorted vision.
- Increased sensitivity to light and glare (especially at night).
- Frequent changes in eyeglass prescriptions.
- Double vision or ghost images in one eye.
- Eye irritation or discomfort with contact lens wear.
In advanced stages, scarring of the cornea may develop, leading to significant vision loss that cannot be corrected with glasses or soft lenses.
Types of Keratoconus
Keratoconus can present in different patterns:
- Nipple Cone: A small, central cone-shaped protrusion of the cornea.
- Oval Cone: A wider, oval-shaped bulge located in the lower portion of the cornea.
- Globus Cone: A rare, advanced form where more than half of the cornea is affected.
Identifying the type helps determine the severity and the most appropriate treatment plan.
Diagnosis of Keratoconus
Early diagnosis is essential for slowing disease progression. Common diagnostic methods include:
- Corneal topography: Maps the shape and curvature of the cornea to detect irregularities.
- Pachymetry: Measures corneal thickness.
- Slit-lamp examination: Allows the doctor to observe corneal thinning, scarring, or swelling.
- Wavefront analysis: Evaluates how light travels through the eye to measure distortion.
Patients at risk, especially those with a family history or frequent prescription changes, should undergo regular eye check-ups.
Treatment Options for Keratoconus
1. Glasses and Contact Lenses
In early stages, glasses or soft contact lenses can correct vision. As the disease progresses, rigid gas-permeable (RGP) lenses or scleral lenses may be required for better visual clarity.
2. Corneal Cross-Linking (CXL)
3. Intrastromal Corneal Ring Segments (ICRS)
4. Corneal Transplant (Keratoplasty)
In advanced cases with severe scarring or thinning, a partial or full-thickness corneal transplant may be necessary. This replaces the diseased cornea with a healthy donor cornea.
Surgery Process for Advanced Keratoconus
When surgical intervention is required, the procedure is performed under local or general anesthesia depending on the case:
- CXL or ring segment implantation is minimally invasive and typically takes less than 1 hour.
- Corneal transplantation takes longer, usually 1–2 hours, and may require stitches.
Modern techniques have significantly improved success rates, with most patients regaining functional vision after recovery.
Recovery After Keratoconus Surgery
Recovery depends on the treatment type:
- CXL: Patients may feel discomfort for a few days. Vision stabilizes within weeks.
- ICRS: Recovery is faster, with improved vision noticeable within a few weeks.
Corneal transplant: Healing is longer, usually 6–12 months, as stitches need to be monitored and removed gradually.
Precautions After Keratoconus Treatment
For the best results and to prevent recurrence:
- Follow the doctor’s medication instructions carefully.
- Avoid excessive eye rubbing or pressure.
- Maintain good eye hygiene and avoid dusty environments.
- Protect the eyes from UV light with sunglasses.
- Maintain a healthy lifestyle with balanced nutrition and no smoking.
These steps help stabilize the condition and ensure long-term vision improvement.
The Journey of Keratoconus Surgery in Turkey
Initial Consultation
Travel and Accommodation
Procedure
Post-Operative Care
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