27 SEPTEMBER 2022
When patients ask us about our vision correction options, quite a few of them mention keratoconus and the effects it’s had on their vision. We’re going to answer some of the most common questions about keratoconus, its causes and symptoms, and how it can be treated to prevent further deterioration to your vision over years to come.
Keratoconus is a progressive disorder which affects the shape of your cornea. The cornea is the transparent layer covering the front of your eye, accounting for two thirds of the focusing power of the eye. You can read a bit more about the structure of the human eye here to discover how the cornea works with the other parts of your eye. With keratoconus, your cornea thins and loses its round shape, bulging outwards into a cone shape. This can result in a number of changes to your vision, and it gets progressively worse over a number of years. Keratoconus typically begins during puberty and stabilizes in your thirties.
The main statistic which was circulated about keratoconus is that it typically affects 1 in 2,000 people. However, due to advancements in detection, diagnosis and general awareness, it’s now thought that up to 1 in 400 people are living with keratoconus. This isn’t because the condition is becoming more common – it’s simply because we’re better at recognizing what it is, ensuring that more people get the right treatment.
There are a number of symptoms of keratoconus which can get worse as the condition progresses. If you suspect that you have keratoconus, you might be experiencing symptoms like:
While some of these symptoms may present mildly at first, they will worsen over the years. Often, keratoconus is first diagnosed when children entering puberty find that they regularly need new glasses. If your prescription changes often and your vision seems to get worse over a short period of time, it could be a sign of keratoconus developing. Make sure you mention this to your optician so that they can look out for it at your next eye test.
Your optician will use a number of tests in order to assess whether or not you have keratoconus.
A test with a slit-lamp involves a lamp with a vertical beam of light directed onto the surface of your eye. This, combined with the use of a microscope, helps the optician to evaluate the shape of your cornea to see whether or not you’re experiencing keratoconus.
This is what a basic eye test usually consists of and it’s an examination you’ll have experienced each time you visit your optician. You will look through a number of different lenses to see which strength of lenses give you your sharpest vision. This is what is used to help determine which glasses or contact lenses you need in order to improve your vision.
Corneal mapping is an advanced test to map out the shape of your cornea, with all its curvatures and imperfections. This can be repeated at regular intervals in order to assess the progress of your keratoconus and discover the severity of it. Corneal mapping can also measure the thickness of your cornea and helps to detect keratoconus in its early stages.
This test relies on shining a bright circle of light onto your cornea, measuring the reflection to see the basic shape of your cornea.
A pachymetry test measures the thickness of your cornea. As keratoconus causes thinning of your cornea – often unevenly – this test is a very good indicator for diagnosing the condition.
There is no definitive answer when it comes to understanding what causes keratoconus. Technically, it occurs when the collagen protein fibres in the eye become weak, leading to the cornea losing its shape. Your corneas produce free radicals every day which need to be cleared from your eyes by antioxidants, but one theory is that people with keratoconus don’t produce enough antioxidants to clear the free radicals. This in turn causes collagen levels to decrease, leading to your corneas losing strength and then bulging.
It’s also thought that rubbing your eyes too vigorously too often might lead to keratoconus. This is because the physical action disrupts your cornea and can lead to its breakdown. Not only can this be a potential cause of the condition, but it can also cause keratoconus to progress more quickly once you already have it.
A final cause of keratoconus is thought to be your genes. Around 10% of people with keratoconus actually have a parent with the condition, suggesting that it could be hereditary to some degree. If you have a parent with keratoconus, you should have your eyes checked every year to monitor your cornea for any changes that could suggest the onset of keratoconus.
Keratoconus itself is not painful. You won’t experience pain as a result of your cornea changing shape, but you may experience some discomfort as a side effect of the symptoms that come with the condition. This can include eye pain due to light sensitivity or headaches, or eye strain that comes from struggling to focus when dealing with double vision. If you do experience sharp, sudden eye pain, you should seek medical advice as soon as possible.
As keratoconus progresses, it goes through different stages. At first, it is mild and its effects on your vision are minimal however, over time, it becomes more damaging and destroys more of your cornea. As it progresses, your vision becomes more and more short-sighted and you may struggle to see objects clearly in the distance. As each of these stages passes, your vision will worsen.
This is the first stage of keratoconus and it’s a mild form of the condition. It causes few visual issues and some people may not even notice they have the disease at this point.
At this point in your keratoconus journey, your cornea forms a cone shape, leading to blurry vision as light is distorted when it hits your eye.
After your cornea has formed a conical shape, it bulges into an oval shape which usually happens at the lower outer section of the cornea.
Following this, your cornea will begin to thin from the outside in, destroying your remaining vision even further.
This is the final and most severe stage of keratoconus, during which your cornea thins further and bulges into a round shape. At this point, a corneal transplant would be needed to restore good vision.
There are different forms of treatment available for keratoconus and you may be recommended different types based on how much your keratoconus has progressed. In the early stages, you may be prescribed corrective contact lenses which can treat mild to moderate keratoconus. These types of contact lenses include:
The type of lens you are recommended will depend on how advanced your keratoconus is and which lenses you respond best to. You may also be given glasses to help correct your progressive short-sightedness, but you will likely require new glasses with an updated prescription regularly as your keratoconus worsens.
Corneal cross linking is a very effective treatment for keratoconus. This is a procedure during which your cornea is strengthened using a combination of Riboflavin (Vitamin B) drops and ultraviolet light which reacts with the collagen fibres in your cornea. This mimics the corneal stiffening which naturally happens with age, thereby halting the progression of keratoconus. Although this procedure cannot reverse the effects keratoconus has already had, it can prevent it from causing any further damage to your cornea.
This treatment is available at Optimax and you can discover more about it on our dedicated information page. Corneal cross linking is typically a very successful treatment for keratoconus, with trials showing that over 90% of patients show no further change to their corneal shape, and 45% of patients gain an improvement in their corneal shape.
In the most severe cases of keratoconus, you may be recommended a corneal transplant to restore any lost vision. Corneal transplants are successful in treating keratoconus in over 90% of cases. During a corneal transplant, your surgeon will remove a part of your central cornea and replace it with donor tissue. This procedure is generally very successful among keratoconus patients and keratoconus is in fact the leading cause of corneal transplants in the US. Your vision is likely to remain blurry for up to 6 months after a corneal transplant as your eye heals. You must also take medication for the rest of your life to prevent your body from rejecting the transplant.
Although keratoconus can cause severely distorted and blurred vision, not to mention the other symptoms from the list above, it does not lead to blindness. Even the worst, most severe cases of keratoconus can be treated with a corneal transplant which restores vision.
No, keratoconus can never be completely cured. Although it is possible to stabilise vision with the treatment options we discussed above, there is no cure for keratoconus yet. Ensuring that you monitor your symptoms consistently and have regular check-ups will help you to seek stabilisation treatments as soon as possible.
If you have keratoconus and would like to discuss corneal cross-linking treatment options, please request your free info pack, send us an email to firstname.lastname@example.org or give us a call on 0800 093 1110. Our customer advisors can provide you with further information about the treatment process at Optimax and get you booked in for a consultation with one of our specialists.