Keratoconus management

Keratoconus is a progressive, degenerative disorder characterized by thinning of the Cornea. The dome shaped cornea starts to bulge out and becomes cone-like. The function of the cornea is to refract and focus light rays onto the retina. So, any abnormality in its shape leads to visual distress, eg- blurred vision and difficulty to focus distant objects or those in close-up.

This process of thinning and re-shaping of Cornea is called ‘Corneal Ectasia’. Keratoconus is a type of corneal ectasia.

Cause

The causative factor of keratoconus is not completely known, but a genetic factor is thought to be involved.

Keratoconus is most common in children with chronic eye allergy who have a habit of rubbing their eyes vigorously. It normally starts between 10-15 years of age and presents with frequent change of glass power with increasing cylindrical power. If such symptoms are present, the child should be immediately taken for check-up. Early detection is important. It left unaddressed, it progresses very fast and causes maximum damage by 20 years of age.

Diagnosis of Keratoconus

Early diagnosis of Keratoconus is possible only through sophisticated investigations like Corneal Topography, Aberrometry and anterior segment OCT (Optical Coherence Tomography). The progressive nature of the disease can be established by repeating the investigations at an interval of 4-6 months.

Keratoconus Treatment

Treatment of Keratoconus has the following goals:

  • Visual rehabilitation
  • Retarding the progression of the disease
  • Restoring the normal shape of the cornea
  • Replacing the scarred cornea

Visual Rehabilitation

In early stages, vision can be improved by changing the glasses.

In relatively advanced cases, when glasses become ineffective, rigid/scleral contact lenses may help.

In majority of the severe cases, satisfactory visual rehabilitation cannot be achieved via glasses or contact lenses.

Retarding the Progression of disease

In cases of progressive Keratoconus, a process known as Collagen Cross-linking is employed to slow down the progress. In this process, the cornea is stained with a chemical called Riboflavin and is then exposed to UV rays of a particular wavelength.

Restoring the normal shape of Cornea

In certain cases, as the cornea becomes conical, implantation of semi-circular rings within the cornea (intra-corneal rings) helps in bringing back the shape towards normal and hence improves the vision.

Femto 2nd laser technology is best suited for the purpose.

Replacing the scarred cornea

In very advanced cases, the cornea becomes scarred (opaque). Replacing such corneas (either full or partial thickness) with healthy donor corneas (Corneal Transplantation/ Keratoplasty) is required.

Right from early detection to final stage management, MPEH is fully equipped for the management of Keratoconus. Highly sensitive tools like iTrace, Orb Scan, Anterior segment OCT, FS-200 (most acclaimed Femto 2nd laser technique, for intra-corneal ring implantation and corneal transplantation), premiere tools for collagen cross-linking  — all processes are available under one roof.

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