HEALTH CORNER NEWSLETTER
Article Title: Keratoconus
Author Name: Prophetess O.A. Duroshola, R.N. PhD
Published: April 2021 (Quarter 2)
Keratoconus is a condition where the cornea becomes thin and stretched near its center, causing it to bulge forward into a conical shape. As a result vision becomes distorted. Keratoconus does not cause total blindness, however, without treatment it can lead to significant vision impairment. With current treatments now available most patients with keratoconus are able to lead normal lifestyles.
Keratoconus is a progressive eye disease, usually affecting both eyes. The degree of progression in each eye is often unequal, and it isn’t unusual for the condition to be significantly more advanced in one eye. The cornea is the clear surface at the front of the eyeball. It refracts the light entering the eye onto the lens, which then focuses it onto the retina.
Causes: The cause of keratoconus is unknown. However, it is believed to be an inherited condition. Some studies have connected keratoconus with allergies such as asthma and eczema. It has also been found that poorly fitted contact lenses and excessive rubbing of the eye may contribute to the cause.
Symptoms: The initial symptom of keratoconus is an irregular shaped cornea, where it appears to ‘bulge’ forward from the eye socket. This may not be that obvious at first, though will develop over time. Vision is usually affected once the cornea starts to change shape. Blurring, light sensitivity and seeing ghost-like images can occur.
Diagnosis: Most people with keratoconus begin to develop the condition in their late teens or early 20’s, with the majority of transplants being performed on patients between 20 – 45 years of age.
Treatment: There are various options for the treatment of keratoconus, including; spectacles/glasses, contact lenses, corneal implants and corneal transplants.
- Glasses – In the early stages of keratoconus, glasses are usually successful in correcting the myopia and astigmatism, however as the condition advances the cornea becomes highly irregular and vision is no longer adequately corrected with glasses.
- Contact lenses – Contact lenses are used to maintain the regular shape of the cornea, however in 5 – 10% of patients there comes a stage when contact lenses are no longer effective and a corneal transplant is considered. Contact lenses do not slow down the rate of progression of the conical cornea, however they do give good vision during that period which could not of otherwise be achieved.
- Surgery – Corneal transplants have a very high success rate following transplantation, with 98.1% of transplanted corneas surviving the first year, and 97.5% surviving beyond four years. To find out more on corneal transplant procedures.
A thorough examination with your ophthalmologist will help establish which treatment is best for your individual case. There are Eye Institutions that conduct an array of Clinical Trials e.g. Lions Eye Institute also conducts an array of Clinical Trials.
The Procedure: Corneal transplant surgery usually takes about an hour and is performed under a general or local anaesthetic. Fine instruments are used to remove the affected cornea and it is replaced with a clear donor cornea. Fine nylon stitches are used to suture the graft into place. In the case of endothelial keratoplasty, an air bubble is used to attach the graft into place. Most patients go home on the day of the surgery, though some may require an overnight stay.
Recovery: A pad or plastic shield will be placed over the eye after the operation and is left in place until the eye is examined the following day. Eye drops will be prescribed for several months to years in order to reduce the chance of infection and rejection. Some sutures will be removed as early as four weeks, but suture removal can take up to one year for most people. There is usually mild to moderate discomfort after the surgery, it is very unusual for there to be severe pain. Your ophthalmologist will explain your expected recovery time and vision quality in detail.
Risk & Complications: When using modern surgical techniques, the risks are small, however, as with any operative procedure, occasional complications can occur. For more information on the possible risks and complications make an appointment with one of our ophthalmologists.
Visit your Ophtamologist (eye doctor) before carrying out any of the above treatments. They will be able to best advice you on options that can improve your concerns.