Keratoconus

What is Keratoconus?

Keratoconus is a disease in which the cornea (outermost clear part of the eye) becomes thin and irregular over a period of time.

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How do I know I have keratoconus?

If you have a high cylindrical spectacles number, frequent change in spectacles power, you should get investigated for Keratoconus. Investigation involves scanning the cornea (Corneal topography) and measuring its thickness.

I have keratoconus. What next?

The ophthalmologist after comprehensive examination will formulate a plan based on number of factors.

Decision to treat is also based on progression of keratoconus which can be judged by looking at serial corneal topography performed over a period of time. If you have a family history of keratoconus or have history of eye allergy, you may require early intervention. If you have stable disease you can continue following up with your doctor regularly.

What are the treatment options for keratoconus ?

For stable keratoconus spectacles or contact lenses may suffice.
For progressive disease and/or high risk patients the treatment is based on disease grading.

Corneal collagen cross linking also called C3R, CXL etc.. is usually the first line treatment to halt the progression of the disease. It involves removal of corneal epithelium followed by application of riboflavin drops and ultimately cross linking using UV-A radiation. Its efficacy is already proven and is the method of choice to halt progression of the disease.

For early grades of keratoconus with good corneal thickness, a procedure called Topography guided Photorefractive Keratectomycan be done along with corneal collagen cross linking to regularize the cornea, leading to better contact lenses fitting/ spectacle number.

For advanced disease INTACS or corneal transplantation can be done.

I have keratoconus but my doctor says my cornea is too thin for  corneal collagen cross linking. What should I do now?

In patients with inadequate corneal thickness ,corneal collagen cross linking ( C3R or CXL or KXL) cannot be safely done. For this group, Corneal collagen cross linking using specialized riboflavin drops, that increase the thickness during the procedure can be done, followed by regular cross linking. Alternatively corneal collagen cross linking can be done without removing the epithelium (outermost layer of the cornea) using specialized riboflavin drops in a process called trans epithelial corneal collagen cross linking.

How Should i follow up with you ?

Management of keratoconus requires compliance from the patients. Cross linking can slow down the progression of the disease but cannot eliminate the same. It requires long follow up, serial corneal topography and much more. Similarly corneal transplantation warrants regular follow up with the operating surgeon.

Dr Vishal Arora’s special area of interest is keratoconus, with a number of international peer reviewed papers to his name. Patients/readers are advised to go through them for further insights into the disease.