Keratoconus
Keratoconus is a progressive eye disorder that affects the cornea, which is the clear, dome-shaped tissue at the front of the eye.
In this article you will find information about the following:
What is Keratoconus?
Keratoconus is a progressive eye disorder that affects the cornea, which is the clear, dome-shaped tissue at the front of the eye. In individuals with keratoconus, the cornea gradually thins and bulges into a cone-like shape instead of maintaining its normal rounded curvature. This irregular shape causes visual distortions, blurred vision, near-sightedness (myopia), astigmatism, and increased sensitivity to light.
What causes Keratoconus?
The exact cause of keratoconus is not fully understood, but both genetic and environmental factors are believed to play a role. The genetic component of keratoconus has been a subject of research, and several genes have been implicated in its development. Here are some key points about the genetics of keratoconus:
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Genetic predisposition: Keratoconus tends to run in families, suggesting a genetic predisposition. It has been observed that individuals with a family history of keratoconus have an increased risk of developing the condition themselves.
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Complex inheritance: Keratoconus is considered a complex genetic disorder, meaning it is influenced by multiple genes as well as environmental factors. The exact genetic mechanisms and interactions involved are still being investigated.
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Candidate genes: Several candidate genes have been identified that may contribute to the development of keratoconus. These genes are involved in various processes, including collagen synthesis and cross-linking, oxidative stress response, and corneal cell adhesion.
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Genetic variations: Certain variations (mutations or polymorphisms) in these candidate genes have been associated with an increased susceptibility to keratoconus. These variations can affect the structure, function, or regulation of proteins involved in corneal integrity.
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Gene-environment interactions: While genetic factors are important, the development and progression of keratoconus also appear to be influenced by environmental factors, such as chronic eye rubbing, contact lens wear, and ultraviolet (UV) light exposure. These environmental factors can interact with genetic predispositions, potentially accelerating the progression of the disease.
It's important to note that not everyone with genetic risk factors for keratoconus will develop the condition, and individuals without any family history can still be affected. Regular eye examinations and early detection are crucial for timely diagnosis and management of keratoconus. If you suspect you may have keratoconus or have a family history of the condition, it is recommended to consult with an ophthalmologist or an eye care professional for a comprehensive evaluation.
What are the symptoms of keratoconus?
Keratoconus can cause various visual problems due to the irregular shape of the cornea. These visual problems may include:
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Blurred vision: The irregular curvature of the cornea in keratoconus can cause blurred or distorted vision. This can make it difficult to see fine details and can affect both near and distance vision.
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Astigmatism: Keratoconus often leads to high degrees of astigmatism, which occurs when the cornea has uneven curvature. Astigmatism can cause blurred or distorted vision and may require special corrective lenses to improve vision.
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Near-sightedness (myopia): As keratoconus progresses, near-sightedness can develop or worsen. This means that distant objects appear blurry while close objects may still be relatively clear.
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Glare and light sensitivity: Many individuals with keratoconus experience increased sensitivity to bright lights and glare. This can make it uncomfortable to be in brightly lit environments or to drive at night.
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Multiple images (ghosting): The irregular shape of the cornea can result in multiple images or ghosting of objects, especially in low-light conditions or with high-contrast objects. This can further impact visual clarity.
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Decreased visual acuity: In advanced stages of keratoconus, visual acuity can significantly decline, even with corrective lenses. This may require specialized contact lenses or, in severe cases, surgical intervention.
It's important to note that the severity of visual problems can vary from person to person and can progress differently over time. Regular eye examinations and consultations with an eye care professional or a specialist in corneal disorders are crucial for monitoring the condition, assessing visual changes, and determining appropriate treatment options to optimize visual function.
What are the treatment options for Keratoconus?
While there is no known cure for keratoconus, there are several treatment options available to help slow down or halt the progression of the condition. The choice of treatment depends on the severity of keratoconus and the individual's specific needs. Here are some common treatment options:
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Corneal cross-linking (CXL): This is a procedure aimed at strengthening the cornea and preventing further bulging. It involves applying riboflavin (vitamin B2) eye drops to the cornea and then exposing it to ultraviolet light. This process helps to create new cross-links within the corneal collagen fibers, making the cornea more rigid and stable. Corneal cross-linking is considered the standard treatment to halt the progression of keratoconus.
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Customized contact lenses: Specially designed contact lenses, such as rigid gas permeable (RGP) lenses or scleral lenses, can help to improve vision and provide a more regular corneal surface for individuals with keratoconus. These lenses vault over the cornea, creating a smooth optical surface and compensating for the irregular shape. These lenses can provide better visual acuity and reduce distortions caused by keratoconus.
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Intracorneal ring segments (ICRS): In some cases, small plastic or metal ring segments may be surgically implanted within the cornea to reshape it and improve visual acuity. These segments help to flatten the cornea and reduce irregularities, thereby improving the quality of vision. ICRS can be considered for individuals who are unable to achieve satisfactory vision with contact lenses alone.
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Topography-guided or wavefront-guided laser surgery: In certain cases, advanced laser techniques such as topography-guided or wavefront-guided ablation may be used to reshape the cornea and improve visual acuity. These procedures aim to reduce irregularities and improve the optical quality of the cornea. However, laser surgery is typically considered when keratoconus has stabilized, and contact lenses are no longer providing adequate vision correction.
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Combination treatments: Depending on the individual's condition and specific needs, a combination of treatments may be recommended. For example, corneal cross-linking may be performed along with the use of specialized contact lenses or other surgical interventions to optimize visual outcomes.
It's important to note that the appropriateness of each treatment option can vary depending on the individual's unique circumstances. Consulting with an eye care professional or a specialist in corneal disorders is crucial for a comprehensive evaluation and personalized treatment plan. Regular follow-up visits are essential to monitor the condition and make any necessary adjustments to the treatment approach.
What is Collagen Cross Linking and how is it done?
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Collagen cross-linking (CXL) is a procedure performed to strengthen the cornea, specifically in the treatment of progressive keratoconus, a condition characterized by thinning and bulging of the cornea. CXL aims to halt or slow down the progression of keratoconus by increasing the cross-linking or bonding between collagen fibres in the cornea, making it more rigid and stable.
The standard method of collagen cross-linking involves the following steps:
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Anaesthetic eye drops: Before the procedure, numbing eye drops are applied to the surface of the eye to ensure comfort during the treatment.
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Removal of the epithelium (optional): Depending on the specific protocol used by the surgeon, the thin outer layer of the cornea called the epithelium may be partially or completely removed to allow better penetration of the cross-linking agent. This step is not always necessary, and some procedures may be performed with the epithelium intact.
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Riboflavin (vitamin B2) application: Riboflavin eye drops are applied to the cornea, usually at regular intervals over a period of time (e.g., every few minutes for about 30 minutes). The riboflavin serves as a photosensitizer that enhances the effectiveness of the subsequent ultraviolet (UV) light exposure.
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UV light exposure: Following the application of riboflavin, the cornea is exposed to a controlled amount of UV-A light for a specific duration. The UV light activates the riboflavin, causing it to release free radicals that create new bonds (cross-links) between collagen fibres in the cornea. This strengthens the cornea and improves its stability.
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Bandage contact lens: After the UV light exposure, a bandage contact lens may be placed on the eye to protect the cornea and facilitate healing. This contact lens is usually left in place for a few days to a week and is then removed by the surgeon.
The entire collagen cross-linking procedure typically takes about one to two hours, including preparation and recovery time. After the procedure, patients may experience temporary discomfort, light sensitivity, tearing, and blurred vision. It is essential to follow the post-operative instructions provided by the surgeon, including the use of prescribed medications and protective measures.
Collagen cross-linking has been shown to be effective in stabilizing or slowing the progression of keratoconus in many cases. It is generally considered a safe and well-established treatment option, but like any medical procedure, it carries potential risks and complications. It is important to consult with an eye care professional or a corneal specialist to determine if collagen cross-linking is suitable for your specific condition and to discuss the potential benefits and risks associated with the procedure.
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