Keratoconus isn’t a widely known problem when it comes to eye care, but the issue is more common than you may think.
A non-inflammatory condition of the cornea, Keratoconus occurs in the clear dome-shaped structure that covers the colored part of the eye called the iris. Read on below to learn more about this issue, whether or not you may be at risk, and how Brill Eye Center provides expert Keratoconus treatment in Kansas City.
How Keratoconus Works:
Normally, the cornea is round or slightly oval-shaped. With keratoconus, a typically spherically-shaped cornea thins and starts to bulge from the inside and ends up being shaped similar to a cone on the external contour. As light passes through the conical part of the cornea, the optics do not form a clear image on the back of the eye as we would expect.
The distortion is so great that vision becomes poor and we’re unable to determine a proper glasses prescription. Keratoconus is generally bilateral, with one eye being more advanced than the other. The cone can form in the upper, lower, or central apically located area.
Typically, it’s difficult for people to notice whether they have Keratoconus. Pain and other symptoms aren’t noticeable until very late in the condition, when the cornea can eventually perforate because of extreme thinning associated with this condition. Also, many people make the issue worse by rubbing their eyes. Some symptoms you can look out for include:
- Blurry vision not correctable by glasses
- Halos around lights
- Night vision difficulty and glare
- Images doubling or overlapping
- Eyestrain and eye headaches
- Variable eyeglass prescriptions
- Itchy or dry eyes
- Systemic and ocular allergies
- The previous belief was that keratoconus was quite rare, only affecting roughly 1 in every 12,000 people. However, new research and better technology shows that figure might be as low as 1 in 200.
- Keratoconus also runs in families. If there is a family history of keratoconus, we recommend every family member receives a topographical analysis as young as six years of age.
- To professionally diagnose keratoconus, we’ll take a photograph of the corneal topography by using our Medmont Meridia advanced corneal topographer. This instrumentation allows us to accurately measure the level of distortion and the shape characteristics of your eye with micron-level accuracy one-thousandth of a millimeter).
- There are non-topographic methods to detect Keratoconus. These classic observations are by a careful examination of the corneal side profile of the cornea at the slit lamp microscope.
- Also, having a patient look downward and looking for “Munson’s sign”, aka an oval bulging of the lower eyelid, is another test. Retinoscopy of the eye will show a classic “scissors reflex” while manually attempting to determine a spectacle correction.
Treatment For Keratoconus:
It’s important to note that Keratoconus isn’t curable using these treatment methods. Rather, these treatment methods help make day-to-day life easier for patients. Brill Eye Center can help by providing comprehensive keratoconus treatment at our office in the Kansas City metro. Our knowledgeable, professional staff will run tests to determine the severity of your issue, and will work with you to determine the best course of action for treatment.
There are multiple methods we can utilize to treat Keratoconus, which include both non-surgical and surgical options:
- Glasses: Glasses may be utilized if they can correct vision to 20/40 or better. There are cases where your glasses prescription may not even be measurable by your doctor, or it might be so strong that a patent can’t tolerate it.
- Contact lenses: Contact lenses can help improve visual function while providing increased visual comfort. They can also be custom-designed using advanced technology to fit the diseased cornea. Options for contact lenses include soft, hybrid, smaller corneal gas permeable, larger scleral gas permeable, or piggyback lens designs (rigid over soft).
- There are a variety of different brands and designs of corneal contact lenses, mini-scleral lenses and larger scleral lenses that may work better for the different locations of the cone.
- The diameters of these lens designs can vary from the Rose K 2 lens at 8.5mm to the BostonSite lenses with up to 21mm in diameter. Particular characteristics of these specialty lenses involve the type of material & material characteristics, lens thickness, oxygen transmission, higher or lower vault over the cornea, as well as the capability to change the curves of the lenses.
- These changes occur in different quadrants and in the peripheral contours of the lens, as it transitions from the clear cornea to the white scleral portion of the conjunctiva.
- Scleral profile analyzers now exist to map the contour of the white part of the eye beyond 16mm. Studies of right eyes vs left eyes show that there are differences in the periphery part of the eye that need to be taken care of differently.
- If you are now trying to get your head around all these variations, it’s because the field of treatment of keratoconus is very complex to do correctly. Dr. Brill has the experience, judgment, and technology to sort through your personal manifestations of this sight-threatening disease.
- Intacs: These are a semi-circular piece of plastic surgically implanted in the middle thickness of the cornea. Ideally, these will flatten the cone-shaped portion of the cornea, but rarely offer a precise correction. They may make it actually more difficult to get a good contact lens correction.
- Corneal-Crosslinking: This process involves scraping and softening the cornea before applying a riboflavin solution. Surgeons then cured the eyes with ultraviolet light to stiffen the cornea.
- This is not for the correction and improvement of vision. It is designed to make the cornea less amenable to continuous degradation and thinning of the cornea. The normal aging process and daily exposure to ultraviolet light acts to stiffen the corneal naturally. Specialty contact lenses will still be necessary to optimize the optics of the eye and correct vision better.
- Corneal transplants: deceased donors who still have healthy corneas and a proper tissue match make Transplants possible. A transplant involves removing a small button of the central diseased cornea and replacing it with a new healthy button from the donor using a cookie-cutter-like device called a trephine. In order to perform the transplant, the donor must have the proper tissue type. Corneal transplants are the last-ditch effort to remediate keratoconus. Contact lenses are the mainstream correction for keratoconus.
- Patients with Keratoconus often are not aware that they have this condition. In fact, many doctors do not screen for keratoconus by doing routine corneal topography on their patients. Keratoconus of the lower corneal topography that does not affect the central portion of the apex of the eye often goes undetected.
- It is not until vision is difficult to correct that eye care providers even think that there could be a disease issue that affects correctable vision. Often, doctors may call this difficulty is correcting vision Amblyopia.
- Once we make a proper diagnosis of Keratoconus using our methods, it will be necessary to have a discussion of what the future prospects of vision will be like if left unattended. Contact lenses are the go-to answer to improve vision when glasses are not feasible.
- These contact lens fits are difficult because we are dealing with an irregularly shaped surface, both of the clear cornea and the bulbar conjunctiva. The skill and experience of the provider is most important here, as well as the availability of the lenses and fitting software technology. Dr. Brill has 42 years of experience doing this type of specialty care.
- Once we fit the specialty lenses, patients need to manage their lenses. This involves ensuring that they continue to do their job of providing clear vision and not impinge on the cornea or conjunctiva adversely. This can happen over time because of further advancement of the keratoconus condition.
- Careful use of cleaning and disinfection solutions is mandatory to keep lenses clean and healthy. We will instruct handling procedures of application and removal. We’ll also schedule follow-up visits at regular intervals to assure continued success.
Frequently Asked Questions
How does Keratoconus occur?
Generally, keratoconus occurs in families. Allergies and associated eye rubbing is strongly implicated in the development of weakening of the corneal collagen structure. There are hereditary diseases involving collagen disorders that typically have an associated keratoconus component.
Can you cure Keratoconus completely?
At this point, there is no cure for keratoconus. Just like other chronic and progressive conditions, keratoconus needs ongoing management and monitoring.
At what point is surgery recommended?
Surgery is the last-ditch treatment. A penetrating keratoplasty involves a full-thickness replacement of the central cornea of the recipient’s cornea with a donor cornea.
In this procedure, a corneal technician will trephine or “cookie-cutter” out a button from the donor a full-thickness portion of the central cornea. These donor corneas are kept at a local “cornea bank”. When properly tissue-matched, the recipient can have a new lease on vision.
Deep anterior lamellar keratoplasty (DALK) is a more modern version of corneal keratoplasty that preserves the critical rear-most portion of the cornea called the endothelium. Healthy endothelium actively pumps out extra fluid called edema from the cornea to maintain its clarity.
How can Brill Eye Center treat my condition compared to other clinics?
Brill Eye Center has the experience and technology to assess the severity of the keratoconus condition. Dr. Brill and his staff can answer your specific questions regarding specialty contact lenses and their appropriate management. Our office has the compassion to listen to your concerns and work with you towards your personal success.
How will treatment improve my daily life?
Treatments are designed to make your altered lifestyle as normal as possible with the use of a customized plan for your ongoing success. We are on your side and your partner in this disease process over your lifetime.
Contact Brill Eye Center Today for a Keratocnus Evaluation
If you suspect that you may have keratoconus, we highly encourage you to visit our office in the Kansas City metro. This is a serious eye issue that gets progressively worse, and it’s to not mess around with amateur treatment experimentation.
Make Brill Eye Center the destination for your specialized care and get a definitive diagnosis and promptly start treatment to optimize your outcome. Schedule an appointment today and join the thousands of people who’ve regained their active lives with our cutting-edge treatments.
For over 38 years, Brill Eye Center has remained at the forefront of innovative eye care. Our wealth of experience, combined with advanced technology and personalized care, allows for a rewarding experience that produces lasting results for our patients. We pride ourselves on putting the “I care” back in eye care, and we won’t rest until you’ve achieved your ideal visual outcome.