What is Keratoconus?
Keratoconus is a progressive eye disease where the typically round cornea (the front clear window of the eye) becomes thin, beginning to bulge and steepen, creating more of an irregular cone shape. It simply means the cornea assumes a conic shape. The change in shape disables light from entering the eye properly. The cone shape deflects light as it enters the eye, causing distorted vision. As the shape of the cornea becomes more irregular due to the keratoconus, your vision will continue to worsen, resulting in frequent changes in your prescription. Typically, keratoconus begins during teenage years and early 20s and these patients often require a new prescription for their contacts and glasses at each yearly eye exam. Keratoconus can occur in one or both eyes but typically appears in both. It often makes daily activities such as driving, watching television or reading extremely difficult.
Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. Until recently, eyeglasses or contact lenses corrected vision until the point of a patient possibly requiring surgery. If a patient’s mild to moderate keratoconus progressively worsened, a corneal transplant would possibly be the only treatment option. Luckily, the FDA recently approved corneal collagen cross-linking, a much less invasive procedure that corrects keratoconus and can even eliminate the need for a corneal transplant later in life.
Characteristics of Keratoconus
- It’s a bilateral condition(always concerns both eyes)
- It’s an asymmetric condition (one eye may be worse than the other)
- It’s a non-inflammatory condition (keratoconus is not related to infection or inflammation)
- It’s a progressive condition (progression is more common and aggressive in young patients and naturally progression stops after the age of 45)
- Keratoconus is related with allergies, with eyerubbing, its gene related and with down syndrome
Keratoconus symptoms typically include
Keratoconus typically first appears in individuals who are in their late teens or early twenties, and may progress for 10-20 years, and then slow or stabilize. Each eye may be affected differently. In the early stages of keratoconus, people might experience:
- Distorted vision
- Blurring of vision
- Light sensitivity
- Mild to moderate irritation
How is vision influenced by keratoconus?
The cornea is one of the two lenses of the human eye that focus light on the retina in order to create clear images. The cornea is responsible for 70% of the total refractive (focusing) power of the eye. This important lens normally is shaped like a dome, has a smooth surface and its clear. Keratoconus, results in change of the corneal shape (the cornea assumes a conic shape), which does not allow for proper focusing of light onto the retina, resulting in decreased vision.
Why is the cornea becoming conic or shaped like a football?
The exact pathophysiological mechanism of keratoconus is unclear. We now understand that corneal collagen in patients with keratoconus is more elastic (softer, more expandable) allowing for ballooning of the cornea, resulting in deformation of the cornea.
Why is keratoconus more aggressive in younger ages?
In simplistic terms, as the skin (skin is mainly made from collagen) of babies is soft and elastic the same way the corneal collagen in younger patients is more elastic allowing for aggressive progression of keratoconus. With age collagen shrinks and becomes stiffer (that is why as we age, we acquire wrinkles) and thereby the cornea in older patients is stiffer and retains its shape not allowing ballooning and deformation.
Is there a way to stop keratoconus progression?
The only available treatment that halts the progression of keratoconus with a success rate of 90% is corneal cross linking. After the introduction of corneal cross linking the need for corneal transplants in Europe for patients with keratoconus has decreased by more than 50%.
Meet Your Cornea Care Specialists
Neel R. Desai, M.D. is a fellowship-trained, board-certified, ophthalmologist strictly specializing in LASIK, cataract, and corneal diseases of the eye. Dr. Desai is a top graduate of the Pennsylvania State University College of Medicine and completed his fellowship in cornea, cataract, and refractive surgery at the Wilmer Eye Institute at Johns Hopkins University. He is recognized throughout the country and internationally as one of only 100 surgeons able to perform advanced corneal transplants and another complex cataract, corneal and refractive procedures. He holds pending patents to new surgical products and advanced cornea surgical procedures of his own design. Additionally, Dr. Desai has authored many book chapters in his field of study and continues to write articles in peer review journals.
Vasilios F. Diakonis, M.D. has completed training in Ophthalmology both in Europe and in the United States. He holds a Ph.D. in Refractive Surgery that was acquired under the supervision of Professor Loannis G. Pallikaris, a worldwide opinion leader in the field of Ophthalmology that developed LASIK surgery. Dr. Diakonis completed his residency at the University hospital where Professor Pallikaris was the chairman. After residency, he joined the Bascom Palmer Eye Institute for a 6-month research fellowship and then continued with a Corneal Fellowship for another 18 months. Dr. Diakonis has a strong academic record with more than 70 publications in scientific journals and serves as an Editorial Board Member in 2 peer review journals. His main research interests include Corneal Refractive Surgery, Corneal Cross-Linking for Keratoconus, and modern Femtosecond Laser-Assisted Cataract Surgery. He is a member of the Young’s Ophthalmologist Committee and the education committee of the European Society of Cataract and Refractive Surgeons.