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Treatment of Keratoconus Health Feed

Keratoconus And Cross Linking - What Should You Know?

DNB Ophtalmology, MBBS
Ophthalmologist, Ludhiana
Keratoconus And Cross Linking - What Should You Know?

Corneal cross-linking refers to a treatment for an eye problem known as keratoconus. During this condition, the front portion of the eye known as the cornea becomes thin and gradually get weaker over a period of time. This makes it bulge into a cone shape, which could make one's vision totally distorted and make it very hard to see. During corneal cross-linking, doctors or ophthalmologists use special eye drops along with ultraviolet light to make the tissues lying in the cornea stronger. This prevents the bulge from getting worse.

It is known as cross-linking because it adds a special connection between the collagen fibers in one's eye. They work like support beams to help the cornea remain stable. At this point in time, it is the only treatment that can stop this condition from getting worse. It can also help people avoid going for a corneal transplant, which is major surgery.

Treatment Procedure -

An ophthalmologist can carry out this cross-linking procedure in his or her clinic. The procedure is described as follows:

  • First, the patient would receive drops that get the eyes numb along with a medicine to calm him or her down.

  • Then, the doctor would put in riboflavin eye drops, containing Vitamin B2, which allow the patient's cornea to absorb a light lot better.

  • For the remainder of the procedure, patients would simply lie back in a chair and look up at a light. There will be no pain as the eyes remain numb.

Types Of Cross-Linking -

There are two types of cross-linking:

  • Epithelium-off

  • Epithelium-on

Epithelium-off is when the doctor removes the epithelium before he or she puts the drop. Certain experts feel that this allows one’s eye to absorb the vitamins and light lot better but takes much longer to recover and has more risks as well.

During Epithelium-on, one’s epithelium is left alone. This means that patients will not have any pain and the recovery process will also be short.

Tips From Ophthalmologists - 

Let us look at the valuable tips from Ophthalmologists, with regard to this procedure of Cross-Linking, which patients undergo for Keratoconus. They include:

  • Cross-Linking is ideal for all those, who have recently got diagnosed with Keratoconus.

  • This procedure does not reverse the changes in the cornea, which have already taken place.

  • Patients must not wear contact lenses for a couple of weeks before undergoing this treatment.

  • Patients should also ask if there are restrictions with regard to certain foods or medicines during this time.

  • It is important not to wear any makeup, perfume or apply after-shave on the day of the procedure. One can have a light meal and take fluids before going for the treatment.

  • Once patients have undergone the cross-linking procedure, they might require new glasses or contact lenses.

1971 people found this helpful

Keratoconus - Things You Must Know About It!

Dr.Vinay Agrawal 87% (14ratings)
MBBS, DNB - Ophthalmology, MS - Ophthalmology, Cornea Fellowship
Ophthalmologist, Mumbai
Keratoconus - Things You Must Know About It!

Keratoconus is a progressive vision disorder which occurs when the normally round cornea becomes thin and cone-shaped, and bulges out, deflecting the light entering the eye leading to a distorted and blurry vision.

Causes of Keratoconus
Weakening of the collagenous fibre, which holds the cornea in its regular place, leads to its bulging out. Decreased levels of antioxidants in the cornea too cause the condition by damaging the fibre from external pollutants. It is also seen running into families, though there is no concrete evidence of it yet. Therefore, it can be stated that even though the exact cause of the condition is unknown, it seems to be affected by genetic, hormonal, and environmental factors.

Diagnosis of Keratoconus is easy, mainly from routine eye examination by an expert ophthalmologist.

Implications on Vision
Though Keratoconus itself does not lead to blindness, it causes poor vision by an unclear cornea which is unable to focus light properly on the retina, leading to a distorted, blurry vision and glare. It changes the shape of the cornea, leading to its thinning and scarring, making it lose its transparency. Keratoconus progresses very fast in young patients, and hence it is important that immediate medical help is sought. Some of the symptoms of the condition include eye pain and strain, sudden change of vision in one or both eyes, double vision with just one eye, sensitivity to light, glare, headaches, blurry and distorted vision, seeing halos or light streaks and inability to drive after dark.

Treatment of Keratoconus
Only prescription glasses are generally recommended to correct the vision in the early stages of Keratoconus. However, this is not a permanent solution because this condition rapidly progresses leading to further deterioration of the vision. In that case, one of the following treatments might be recommended by the ophthalmologist depending on the severity of the condition.

● Hybrid or rigid contact lenses can be prescribed to improve vision by masking the shape of the cornea. But, that does not prevent further deterioration of vision.
● When the vision is no longer correctable by using glasses or contact lenses, corneal ring segments are employed. These plastic segments are implanted into the cornea by a surgical procedure and they keep the shape of the cornea intact, leading to refractive correction of vision eventually.
● Corneal collagen cross-link stops the progression of the Keratoconus. In this procedure, the outer layer of the epithelial tissue on the cornea is removed. It is then enriched with riboflavin and collagen, which are activated by the application of ultraviolet light to strengthen the cornea by improving its rigidity significantly. It requires some weeks of care after the procedure.
● Keratoplasty or corneal transplantation is employed only when no other option works for an individual. It is a complex surgical procedure in which a donor cornea replaces the defective cornea. Eventually, corneal cells grow and fuse with the donor cornea during the process of recovery, which can take up to almost a year.

People with even a small degree of the condition should not opt for the LASIK as it may worsen the condition.

Urgent referral is not required in Keratoconus as the condition manifests itself slowly, generally over a span of months and years. However, symptoms should not be ignored and medical help should be sought as soon as possible.

2056 people found this helpful

Keratoconus - Know More About It!

DNB Ophthalmology, MD - Ophthalmology, MBBS
Ophthalmologist, Mumbai
Keratoconus - Know More About It!

Keratoconus is a progressive vision disorder which occurs when the normally round cornea becomes thin and cone-shaped, and bulges out, deflecting the light entering the eye leading to a distorted and blurry vision.

Causes of Keratoconus:

Weakening of the collagenous fibre, which holds the cornea in its regular place, leads to its bulging out. Decreased levels of antioxidants in the cornea too cause the condition by damaging the fibre from external pollutants. It is also seen running into families, though there is no concrete evidence of it yet. Therefore, it can be stated that even though the exact cause of the condition is unknown, it seems to be affected by genetic, hormonal, and environmental factors. Diagnosis of Keratoconus is easy, mainly from routine eye examination by an expert ophthalmologist.

Implications on Vision:

Though Keratoconus itself does not lead to blindness, it causes poor vision by an unclear cornea which is unable to focus light properly on the retina, leading to a distorted, blurry vision and glare. It changes the shape of the cornea, leading to its thinning and scarring, making it lose its transparency. Keratoconus progresses very fast in young patients, and hence it is important that immediate medical help is sought. Some of the symptoms of the condition include eye pain and strain, sudden change of vision in one or both eyes, double vision with just one eye, sensitivity to light, glare, headaches, blurry and distorted vision, seeing halos or light streaks and inability to drive after dark.

Treatment of Keratoconus:

Only prescription glasses are generally recommended to correct the vision in the early stages of Keratoconus. However, this is not a permanent solution because this condition rapidly progresses leading to further deterioration of the vision. In that case, one of the following treatments might be recommended by the ophthalmologist depending on the severity of the condition.

  1. Hybrid or rigid contact lenses can be prescribed to improve vision by masking the shape of the cornea. But, that does not prevent further deterioration of vision.

  2. When the vision is no longer correctable by using glasses or contact lenses, corneal ring segments are employed. These plastic segments are implanted into the cornea by a surgical procedure and they keep the shape of the cornea intact, leading to refractive correction of vision eventually.

  3. Corneal collagen cross-link stops the progression of the Keratoconus. In this procedure, the outer layer of the epithelial tissue on the cornea is removed. It is then enriched with riboflavin and collagen, which are activated by the application of ultraviolet light to strengthen the cornea by improving its rigidity significantly. It requires some weeks of care after the procedure.

  4. Keratoplasty or corneal transplantation is employed only when no other option works for an individual. It is a complex surgical procedure in which a donor cornea replaces the defective cornea. Eventually, corneal cells grow and fuse with the donor cornea during the process of recovery, which can take up to almost a year.

People with even a small degree of the condition should not opt for the LASIK as it may worsen the condition.

Urgent referral is not required in Keratoconus as the condition manifests itself slowly, generally over a span of months and years. However, symptoms should not be ignored and medical help should be sought as soon as possible.

3135 people found this helpful

Age of my son is 8 years and he is wearing specs from last four years. Last year my son was diagnosed with keratoconus in right eye and posterior dystrophy in left eye. We have done pentacam test twice in six month but doctor has found no variation in report means it might be stabilize .but we need to change his glass every three month .his power is increasing by -0.5 in every check up our main concern is that if keratoconus is some how stabilize then why power is increasing. This time his power is - 4.75 in both eye.

MBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)
General Physician, Delhi
Age of my son is 8 years and he is wearing specs from last four years. Last year my son was diagnosed with keratoconu...
Usually, the progression of keratoconus occurs in the age of 40-45 years and then it gets stabilized. In some cases, the progression may even occur even after the age of 50. Fit is believed that progression of keratoconus usually occurs during the first 15-20 years after the onset of the disease. Once your keratoconus has been stabilized, contact lenses can be a great option to achieve your best corrected vision. You may discuss your issue in detail for further detailed consultation.
1 person found this helpful
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My child is diagnosed with keratoconus disease in right eye and posterior dystrophy in left eye from puberty. We are done pentacam thrice but doctor find no variation means it's stabilize but his power is increasing every three months -0.5 and we need to change the glass .my question is that why is this happening if keratoconus is stable.

MBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)
General Physician, Delhi
My child is diagnosed with keratoconus disease in right eye and posterior dystrophy in left eye from puberty. We are ...
When the fibers are weakened, they cannot hold their shape. This causes the cornea to change from a dome to more cone-like in shape. When the Collagen continues to weaken, the Keratoconus gets worse, and there are factors that contribute to this. Let's have a detailed discussion to ensure proper treatment.
1 person found this helpful
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Keratoconus - All You Should Know!

Dr.Vinay Agrawal 87% (14ratings)
MBBS, DNB - Ophthalmology, MS - Ophthalmology, Cornea Fellowship
Ophthalmologist, Mumbai
Keratoconus - All You Should Know!

Keratoconus is an eye problem where the cornea starts to thin and eventually its shape gets distorted. This disease is progressive in nature and can affect both the eyes. Due to this condition, your vision will get distorted, which can’t be corrected with prescription glasses. 

This condition mostly surfaces during one’s teenage years or early twenties. 

 What are the symptoms?

In this condition, the shape of the cornea is distorted. Due to this change in shape, you may face near-sightedness and astigmatism, in addition to blurred and distorted vision.

Another problem you may have is sensitivity to light and glare. Also, this condition can cause frequent fluctuations in your eyeglass prescription.

What causes it?

Earlier doctors did not know what caused Keratoconus. They were aware of the risk factors –

  • Rubbing one’s eyes in a vigorous manner.

  • A family history of keratoconus.

  • Certain conditions like hay fever, Down syndrome and retinitis pigmentosa can make your susceptible.

New research, however, has pointed towards enzyme imbalance in the cornea as the most likely cause. It has been found that an enzyme imbalance makes it susceptible to free radicals damage that can weaken the tissue of the cornea. 

Too much exposure to UV rays of the sun is also a risk factor of keratoconus.

Treatment

There are many ways to treat this condition. The exact method will be determined by your doctor based on how severe your condition. It will also depend upon how quickly the condition is progressing.

Mild versions of this condition can be treated with the help of contact lenses or eyeglasses. But if the disease progresses rapidly along with the shape of the cornea being significantly distorted then these treatment options won’t help. 

In such cases, you will have to turn to the following treatments – 

  1. Corneal crosslinking
    This procedure is used to strengthen the corneal tissue so that the eye surface does not bulge.
     
  2. Customized contact lenses
    There are specially designed soft contact lenses in the market for mild to moderate keratoconus. 
     
  3. Hard lenses
    Hard contact lenses (gas permeable) are an option if soft contact lenses don’t produce the desired results. They may appear uncomfortable initially, but once you get used to them you will be able to see very clearly. 
     
  4. Piggyback lenses
    If hard lenses are uncomfortable then the doctor might suggest piggybacking a hard lens on top of a soft contact lens.
     
  5. Hybrid lenses
    Hybrid lenses are also an alternative to hard contact lenses. They have a hard centre with a soft outer ring.
     
  6. Scleral lenses
    In very advanced cases, scleral lenses are preferred because they sit on the sclera (white part of the eye) instead of the cornea. The lens vaults over the cornea without making direct contact.
     
  7. Surgery
    If all methods fail then the doctor may recommend surgical methods like corneal inserts or a corneal transplant

In the first method, inserts are placed in the cornea to flatten the bulge and support the structure of the cornea to improve vision. 

A corneal transplant involves replacing the affected tissue with the donor tissue. This procedure is only recommended in cases of extreme corneal thinning.

1768 people found this helpful

Know In Detail About Keratoconus And Cross Linking!

MBBS, MS - Ophthalmology, Fellow in Cornea and Refractive surgery
Ophthalmologist, Ahmedabad
Know In Detail About Keratoconus And Cross Linking!

Corneal cross-linking refers to a treatment for an eye problem known as keratoconus. During this condition, the front portion of the eye known as the cornea becomes thin and gradually get weaker over a period of time. This makes it bulge into a cone shape, which could make one's vision totally distorted and make it very hard to see. During corneal cross-linking, doctors or ophthalmologists use special eye drops along with ultraviolet light to make the tissues lying in the cornea stronger. This prevents the bulge from getting worse.

It is known as cross-linking because it adds a special connection between the collagen fibers in one's eye. They work like support beams to help the cornea remain stable. At this point in time, it is the only treatment that can stop this condition from getting worse. It can also help people avoid going for a corneal transplant, which is major surgery.

Treatment Procedure -

An ophthalmologist can carry out this cross-linking procedure in his or her clinic. The procedure is described as follows:

  • First, the patient would receive drops that get the eyes numb along with a medicine to calm him or her down.

  • Then, the doctor would put in riboflavin eye drops, containing Vitamin B2, which allow the patient's cornea to absorb a light lot better.

  • For the remainder of the procedure, patients would simply lie back in a chair and look up at a light. There will be no pain as the eyes remain numb.

Types Of Cross-Linking -

There are two types of cross-linking:

  • Epithelium-off

  • Epithelium-on

Epithelium-off is when the doctor removes the epithelium before he or she puts the drop. Certain experts feel that this allows one’s eye to absorb the vitamins and light lot better but takes much longer to recover and has more risks as well.

During Epithelium-on, one’s epithelium is left alone. This means that patients will not have any pain and the recovery process will also be short.

Tips From Ophthalmologists - 

Let us look at the valuable tips from Ophthalmologists, with regard to this procedure of Cross-Linking, which patients undergo for Keratoconus. They include:

  • Cross-Linking is ideal for all those, who have recently got diagnosed with Keratoconus.

  • This procedure does not reverse the changes in the cornea, which have already taken place.

  • Patients must not wear contact lenses for a couple of weeks before undergoing this treatment.

  • Patients should also ask if there are restrictions with regard to certain foods or medicines during this time.

  • It is important not to wear any makeup, perfume or apply after-shave on the day of the procedure. One can have a light meal and take fluids before going for the treatment.

  • Once patients have undergone the cross-linking procedure, they might require new glasses or contact lenses.

4067 people found this helpful

Keratoconus - Know More About It!

MBBS, DNB - Ophthalmology, Fellowship In Glaucoma, FRCS - Ophthalmology
Ophthalmologist, Pune
Keratoconus - Know More About It!

Keratoconus is the thinning and bulging of the cornea due to weakening of the bonds between the collagen layers in its structure. The normally round cornea becomes thin and cone-shaped, and bulges out, deflecting the light entering the eye leading to a distorted and blurry vision. While it has a genetic tendency in some instances, it can also be produced by vigorous and long term eye rubbing especially in people with chronic eye allergy.

The diagnosis is suspected on clinical examination by an ophthalmologist and confirmed on corneal topography.

Implications on Vision:

It is commonly associated with high astigmatism type of spectacle power and frequent change of glasses and unclear vision despite glasses. Poor vision is only associated with advanced keratoconus. A tear in the deeper layers of the cornea sometimes occurs due to excessive thinning and may be associated with sudden drops in vision with pain. Rarely scarring will occur leading significant compromise of vision. Keratoconus can progress very fast in young patients

Treatment of Keratoconus:

Treatment in initial stages is glasses. When glasses cannot provide comfortable vision, specialised types of keratoconic lenses (rigid lenses with a soft skirt or Rose K lenses) are useful in moderate disease without scarring to provide better quality vision With progressive thinning cross-linking therapy is done to strengthen the bonds between the collagen layers. This improves the quality of vision and stabilizes the disease. It also improves contact lens fitting Corneal segments or topography-guided laser are other options in select cases, In advanced cases with scarring transplant may become necessary and usually has a good outcome All persons with high astigmatism or frequently increasing astigmatism should get themselves screened for keratoconus

3689 people found this helpful

I have keratoconus. Not done yet c3r. I'm using spectacles I'm fine with them as of now. Tell me how to overcome keratoconus motivate me. Tell me a few key points to handle.

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
I have keratoconus. Not done yet c3r.
I'm using spectacles I'm fine with them as of now. Tell me how to overcome kera...
Currently there is no cure for keratoconus. It is a lifelong eye disease. Thankfully, however, most cases of keratoconus can be successfully managed. For mild to moderate keratoconus, scleral contact lenses made of advanced rigid gas permeable lens materials typically are the treatment of choice.
1 person found this helpful
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I am suffering from keratoconus (both eyes). I successfully takes a treatment and operated with c3r. Doctor advised me to take contact lenses for eyes. Price of contact lenses is 25000rs but as I know and see that contact lenses are easily available in optical shop in a range of 2000 to 5000. Can you please tell me what type of lenses did doctor advised me.

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
I am suffering from keratoconus (both eyes).
I successfully takes a treatment and operated with c3r. Doctor advised m...
Contact lenses come in many qualities and even foreign lenses are also used. You can enquire the merits and demerits of both types ad decide on your purchasing power.in any material or things cheap things always can have troubles. If you can have an interaction with the doctor it will be very useful.
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