The term keratoconus originates from the Greek ‘keras’ meaning cornea, and ‘conus’
meaning cone. Keratoconus causes progressive thinning of the cornea. It usually
affects both eyes, although one eye is usually affected more than the other. If there is
delay in detection or treatment of keratoconus, it can result in significant deterioration
Key facts about keratoconus:
Causes progressive thinning of the cornea, resulting in astigmatism.
Symptoms include blurred vision, double vision and imbalance between the eyes.
Affects both eyes, although one eye is usually more significantly affected than the other
More common in certain ethnicities, e.g. Asians and Middle Eastern populations
Cause is unknown, although likely to be multifactorial
Occurs in in late childhood to early adulthood, and often (but not always) stops progressing by
the age of 35 years.
Progression of keratoconus can be halted by cornea collagen cross-linking.
Treatment of keratoconus is stepwise:
Spectacles or soft contact lens
Hard contact lens
Laser refractive surgery combined with cornea collaged cross-linking
What are the causes?
Keratoconus is a corneal disorder of the eye leading to its thinning and subsequent bulging. While a
normal cornea appears round, Keratoconus leads in a cone-shaped cornea, thus is called so. It usually
onsets in early adulthood and, depending on its type, progresses for another ten years or more. Genetic
and Hereditary factors contribute to a great extent to Keratoconus. But frequent rubbing of eyes and
prolonged use of contact lenses has also been proved to be the reasons for cornea thinning and,
subsequently, Keratoconus. Once you start to notice the symptoms, it is better to plan Keratoconus
treatment as soon as possible.
You will start to notice its early symptoms in terms of blurred vision with light sensitivity and frequent
changes in power. The steep cornea-induced irregular astigmatism can result in problematic night
vision along with sudden blurring of vision on the rupture of the steep cone. It is bilateral and is more
common in women than men. Thus, one must start Keratoconus treatment as soon as possible because
it takes a lot of effort for Keratoconus cure if not started early.
The initial step in Keratoconus treatment includes vision evaluation with an auto-refractometer. A
visual acuity test to assess the amount of astigmatism is crucial before planning for Keratoconus
A thorough slit lamp examination to identify the thinning and irregular surface of the cornea with a
retina evaluation to assess for secondary retinal disorders would be the second step. But the most
important of them all is the Corneal Topographic Machine that will give you a clear idea about the
level, area and thinning present.
Keratoconus treatment modalities
There are a number of Keratoconus cure modalities available, but doctors will decide the best one for
you after evaluating your condition.
1. Glasses and soft contact lenses
Spectacle correction and contact lenses are the initial measures of Keratoconus treatment. Though
effective initially, refractive error more than -3D when presented in the form of irregular astigmatism
does not make glasses a very reliable option. Though marginally more effective, soft toric contact
lenses do not work in steep corneas because of the steepness-induced irregular fitting. Additionally,
regular changes in prescriptions initiate the search for more effective Keratoconus treatment modalities.
2. Hard contact lenses (RGP / Rose-K / Mini-Scleral)
Though initially uncomfortable, hard contact lenses can cause immense improvement in vision due to
their improved fitting. Piggyback lenses and hybrid lense- a combination of hard and soft contact
lenses- may be considered effective Keratoconus treatment modalities are providing equal measures of
vision and comfort. For advanced cases of Keratoconus treatment, scleral lenses are advised. But these
lenses need careful handling with frequent visits to the clinic for follow-ups. The need for a permanent
Keratoconus cure comes with surgical treatment modalities.
3. Laser refractive surgery
Lasik is often contradicted in Keratoconus owing to the risk of further thinning of the already thin
cornea. Procedures like LASIK and PRK operate by removing tissues from the eye to regulate the
refractive error. Taking out tissue in an already thin eye in the case of Keratoconus will worsen the
symptoms and threaten the cornea’s integrity. That’s why it is rarely considered as an ideal Keratoconus
treatment modality. But, in this regard, Keratoconus cross-linking comes as an ideal bet under any
Keratoconus cross-linking involves an application of riboflavin solution and corneal radiation
combined with UV radiation. The purpose of Keratoconus treatment is to improve the bonds between
the collagen fibrils of the cornea. This, in turn, results in an increased corneal strength with reduced
cone progression, thus drastically improving the vision. Keratoconus cross-linking can be done on its
own or in combination with other refractive procedures like laser ablation or lens-based surgeries.
5. Keratoconus Corneal Transplantation
Keratoconus corneal transplantation is advised when the cornea becomes dangerously thin or the
scarring too prominent for enabling any vision. It involves replacing the thin conical cornea surgically
with a normal donor cornea for improving the previously impaired vision.
People with advanced Keratoconus damage or with severely impaired vision following complications
after a Keratoconus treatment are ideal candidates for Keratoconus corneal transplantation.
Additionally, people ineligible to wear any contact lens due to an extremely steep cornea or people with
ulcerative keratitis due to infection with contact lenses are also eligible for Keratoconus corneal
transplantation. You can be more sure about your eligibility for the procedure by talking to best eye
doctor in Ahmedabad at Cornea Centre.
Two types of Keratoconus corneal transplantation, namely Penetrating Keratoplasty (PK) and Deep
Anterior Lamellar Keratoplasty (DALK) are indicated depending on the severity of the condition. It is a
fairly successful procedure involving 1 out of every four transplants. It is performed under general
anesthesia. The cornea is sutured after the surgery and monitored closely for two weeks, followed by
weekly follow-ups. Such Keratoconus corneal transplantation provides a lasting benefit for
Keratoconus patients and is amongst the most popular Keratoconus treatment modalities to date.
INTACS or IntraCorneal Rings Segment consists of 2 rings implanted over the stroma. Made of
polymethyl methacrylate, these rings help improve vision, thereby acting as an ideal Keratoconus cure
model in the long term. Additionally, they provide a comfortable position for the contact lenses to rest
on, thereby improving their tolerance. Apart from making the cornea more durable, they open the scope
of laser application on the cornea, which was not possible before their insertion. In short, they convert
the cornea into a vision-rehabilitation platform that can be used for enhancing the BCVA (Best
Corrected Visual Acuity). If you are confused about these terms or Keratoconus treatment modalities,
feel free to contact Dr Mehul R Patel.
Factors leading to Keratoconus treatment
Various risk factors like rubbing your eyes frequently due to allergic conditions and improper contact
lens fitting may lead to corneal thinning and subsequently result in Keratoconus. That’s why avoiding
rubbing eyes by managing the allergic conditions and doing a regular contact lens evaluation will
ensure you don’t require any Keratoconus treatment in the long term.
Sometimes genetic conditions like a family history of Keratoconus with conditions like Retinitis
Pigmentosa and Ehlers-Danlos Syndrome may lead to Keratoconus treatment. Early evaluation and
diagnosis and timely management is the best solution compared to any other Keratoconus treatment
Risk factors for keratoconus include modifiable and non-modifiable risk factors. Modifiable risk factors are eye rubbing and eye allergy. Treating eye allergies helps minimise eye rubbing, although the latter can also be a habit not related to eye rubbing.
The gold-standard treatment to stop keratoconus getting worse is cornea collagen cross-linking. If there is evidence of progressing keratoconus, this treatment should not be delayed.
Cornea collagen cross-linking is performed using the latest technology at Cornea Centre, reducing the treatment time from 45 minutes to 15-20 minutes
There are numerous research studies showing an association between eye rubbing and keratoconus. It is advisable that eye rubbing is avoided or at least minimised by the patient. Treating eye allergies is an important aspect of keratoconus treatment, and will help you avoid rubbing of the eyes.
At Cornea Centre, we use Pentacam. This is the latest and most robust technology enabling extremely high definition actual measurements of each corneal layer. This technology is available in few clinics around the world. Furthermore, AI is utilised to aid in clinician diagnoses.
Keratoconus cross-linking and INTACS are emerging as the best keratoconus treatment modalities because of their high success rate and subsequent improvement in vision. Keratoconus corneal transplant is also a popular treatment option enabling the patient to have improved vision along with giving a new life to his eye via transplantation.
As Keratoconus cross-linking treatment is a medical emergency, most insurance companies in India cover the cost for collagen cross linking along with the diagnostic procedures required for the surgery.