About Keratoconus
Keratoconus is a progressive corneal disorder in which the cornea — the transparent front layer of the eye — gradually thins and bulges forward into a cone shape. It usually begins in adolescence or young adulthood and, if untreated, can seriously degrade visual quality.
Its course varies from person to person; in some it progresses slowly, in others it worsens rapidly. Early diagnosis and regular follow-up are therefore crucial to halt progression in time and protect vision.
What Is Keratoconus?
A healthy cornea has a balanced, dome-shaped structure that refracts light evenly to form a sharp image on the retina. In keratoconus the corneal tissue weakens and, under the eye’s internal pressure, bulges forward into a cone. This irregularity causes light to refract unevenly and produces an astigmatism that is difficult to correct.
The disease usually affects both eyes but is generally more pronounced in one. As it progresses, glasses and standard lenses may no longer give adequate vision. For treatments that preserve the structural strength of the cornea, an assessment for corneal cross-linking and other corneal conditions is also made.
Symptoms
Keratoconus can be silent early on; as it progresses the following become apparent:
- Frequently changing prescription: Prescriptions that increase at short intervals and never quite settle.
- Progressive astigmatism: Blur that becomes increasingly hard to correct with standard lenses.
- Glare and halos at night: Halos, streaking and flare around headlights and lamps.
- Blurred and ghosted vision: Double vision in one eye or shadowing of letters.
- Contact lens intolerance: Lenses that no longer sit properly and become uncomfortable.
Causes & Risk Factors
The exact cause of keratoconus is not fully known, but several factors play a role:
- Genetic predisposition: Risk is higher in people with a family history of keratoconus.
- Persistent eye rubbing: Vigorous rubbing, especially due to allergy, mechanically weakens the cornea.
- Allergic eye disease: Chronic allergy and eye itching can trigger the disease.
- Young age: It usually begins in adolescence and tends to progress.
- Certain systemic conditions: It may be associated with some connective-tissue and genetic syndromes.
Avoiding eye rubbing and keeping allergy under control are simple but effective measures to slow progression.
Diagnosis
Early diagnosis is critical so progression-halting treatments can be applied in time. Assessment uses:
- Corneal topography: Maps the corneal surface to reveal the earliest changes.
- Corneal tomography (e.g. Pentacam): Measures the front and back surfaces and thickness of the cornea in detail.
- Pachymetry: Measures corneal thickness to grade the degree of thinning.
- Slit-lamp examination: Thinning, striae and other signs are examined under magnification.
- Refraction follow-up: The speed of prescription change is an important indicator of progression.
Treatment
Cross-Linking
The key treatment in progressive keratoconus, strengthening the cornea to halt the disease.
Riboflavin
Vitamin B2 (riboflavin) is applied to prepare the corneal tissue.
UV Light
Controlled ultraviolet light creates new bonds between the corneal fibres.
Healing
A bandage lens protects the surface afterwards and supports healing.
Progression Halted
Lenses & Rings
Lens and intracorneal-ring options that compensate for the shape distortion to deliver clear vision.
Rigid / Scleral Lens
Rigid gas-permeable or scleral lenses compensate for the irregular surface.
Corneal Ring
Ring segments placed within the cornea flatten the cone.
Corneal Transplant
In very advanced cases a corneal transplant restores vision.
Clear, Comfortable Vision
Is your keratoconus progressing?
Based on topography and tomography findings, the most suitable treatment plan is decided together.