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Keratoconus is a progressive degenerative disease in which the cornea becomes thinner and loses its natural symmetry. The cornea is on the front of the eye and is the window into the eye. The cornea slowly becomes cone-shaped, thus the name: KERATO (cornea) and CONUS (cone shaped).
Keratoconus is a disease that it’s normally diagnosed as a teenager or young adult with symptoms of visual distortion, multiple images and sensitivity to light that may not be fully corrected by spectacles or contact lenses.
Keratoconus is diagnosed in about 1 out of every 2000 people in the United States. Chronic eye-rubbing is strongly associated with keratoconus and progression of the disease. Conditions associated with eye rubbing such as allergic conjunctivitis, eczema, and floppy eyelid syndrome (which is often associated with obstructive sleep apnea) should be treated to reduce eye rubbing. Keratoconus may continue to progress at any age if eye rubbing continues. Refractive surgery, such as LASIK, can further destabilize the cornea and should be avoided in keratoconus patients.
The goal in the treatment of Keratoconus is divided into preventing progression of the condition and improving the vision.
Spectacles and soft contact lenses are often used early in the course of the disease, but as the corneal shape becomes more atypical, specialty rigid lenses (such as RGP, hybrid, or scleral lenses) may be needed. With advances is specialty lens design and fitting, many patients achieve good vision with these lenses. If there is scarring of the cornea or if the keratoconus is very advanced, a corneal transplant of the entire corneal thickness (penetrating keratoplasty) or of the front 95% of the cornea (deep anterior lamellar keratoplasty – DALK) is performed for visual rehabilitation. This surgery is generally only performed if a patient is unable to achieve good vision with contact lenses because of the long recovery time and risk of surgical complications.
The only FDA-approved treatment shown to reduce the risk of progression of keratoconus is corneal collagen cross-linking. This procedure is performed in the office for one eye at a time. The recovery time is up to 3-6 months and it has been shown to reduce the risk of progression in numerous clinical trials. By avoiding progression, the patient is able to maintain their current level of vision and avoid a riskier, and more costly, corneal transplant.