Keratoconus: causes, symptoms and treatments

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Last updated 1/8/2024

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What is keratoconus?

Keratoconus is an eye condition in which the cornea (the clear outer layer of the eye) progressively thins and becomes irregularly (coned) shaped.

The abnormal curvature of the cornea causes the cornea to bulge and prevents the light entering the eye from focusing correctly on the retina, and causes vision to become increasingly distorted. As the condition worsens and the front of the cornea expands, you begin to experience myopia(nearsightedness) and develop irregular astigmatism.

What are the symptoms of keratoconus?

Signs and symptoms of keratoconus can include:

Blurred vision or distorted vision with difficulty seeing near and far
Increasing light sensitivity and glare, and halos, which can compromise night driving
Unstable vision leading to frequently changing eye prescriptions
Increased dry eye symptoms while wearing conventional contact lenses.

What causes keratoconus?

Keratoconus is more prevalent in teenagers and adults in their 30s. It can progress gradually or quickly and usually affects both eyes. Unfortunately, the cause of keratoconus is not fully understood. There is a known genetic connection since ten percent of keratoconus sufferers have a parent with the condition. It’s also often seen in patients who suffer from retinitis pigmentosa, Down syndrome, Ehlers-Danlos syndrome, hay fever, and asthma.

Some medical researchers theorize that an enzyme imbalance within the cornea makes it vulnerable to damage from free radicals, which causes the cornea tissue to weaken and bulge.

Keratoconus risk factors

Frequent vigorous eye rubbing is thought to increase your risk of developing keratoconus. Additionally, overexposure to ultraviolet rays, improper contact lens wear, and chronic eye irritations may increase your odds of developing keratoconus.

How is keratoconus diagnosed?

Typically, keratoconus is diagnosed during an eye exam when our doctors observe the irregularly shaped cornea.

As part of a comprehensive eye exam, our eye doctor measures the shape of your cornea to screen for keratoconus. By performing annual eye exams, we can detect and track subtle changes in the early keratoconus stages.

At AGEI, we use state-of-the-art corneal topography, which involves imagining the cornea to analyze its surface shape and characteristics in just a few seconds.

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What are treatments for early keratoconus?

There are several stages of keratoconus, starting with early diagnosis. The earlier you are diagnosed, the greater the chance we can often easily correct visual issues with glasses or special contact lenses.

Early treatment options, which can often provide excellent quality vision and avoid vision loss for many years, include:

Rigid gas-permeable keratoconus lenses

Rigid gas-permeable lenses are made of specialized plastic that transmits oxygen. These lenses reshape your cornea’s curvature to correct your vision while wearing them.

Custom Toric soft contact lenses

While these are usually more comfortable than rigid gas-permeable contact lenses, they are best for individuals with more astigmatism.

Scleral contact lenses

These are oversized contact lenses whose outer rim extends to the white of your eye, known as the sclera. These lenses vault over the cone-shaped part of your cornea without touching its surface due to a special fluid-filled reservoir that lies over the cone-shaped cornea, restoring clear vision comfortably.

Finding properly fitting corrective lenses is crucial. Poorly fit lenses can result in corneal scarring and intolerance of any lens.

At AGEI, we have experts who can help identify the lens option that fits your needs and provide you with the best vision and comfort.

Corneal Collagen Crosslinking for keratoconus

The progression of keratoconus can be treated with early detection and a treatment called Collagen Crosslinking (CXL). This FDA-approved technology is the only kind designed to reduce the progression of keratoconus.

Cross-linking collagen involves activating riboflavin (vitamin B) using ultraviolet light to generate collagen bonds between corneal fibers. This treatment can strengthen your cornea by up to 300%. By strengthening the cornea, the bulging process is slowed down.

Studies have found that combining keratoconus contact lens wear with corneal cross-linking appears to be even more effective in avoiding transplantation surgery than either treatment alone.

Intacs

Intacs is a keratoconus treatment introduced over 20 years ago that involves placing concentric plastic rings under the corneal surface to flatten it and improve vision.

While AGEI was one of the principal investigators during the initial FDA trials for Intacs, we’ve since stopped offering this procedure to our patients.

What are the treatments for late-stage keratoconus?

In up to twenty percent of keratoconus patients, the cornea eventually becomes so scarred that they can no longer tolerate wearing contact lenses. At this point, a corneal transplant may be the only way to preserve vision.

Corneal Transplantation

Corneal transplantation (or Penetrating Keratoplasty) is an outpatient eye surgery that offers Keratoconus patients excellent results.

The procedure involves removing the abnormal corneal tissue from the eye and replacing it with a graft of healthy corneal tissue from a cadaver donor. The donor cornea graft is held in place with stitches one-third the width of a human hair.

Our patients usually get excellent results with a cornea transplant, although their vision may stay blurry for several months following surgery. To ensure the best possible outcome, you will be placed on medication, including eye drops, to prevent graft rejection following a transplant. In most cases, you will likely continue to need eyeglasses or contact lenses to achieve your best vision.

Learn more about cornea transplants.

Do all keratoconus patients eventually need a cornea transplant?

No! Early detection and treatments like corneal cross-linking and therapeutic contact lenses can often successfully treat keratoconus and restore visual acuity. These early treatments have proven to be very effective in slowing or stopping the progression of keratoconus.

Why is Assil Gaur Eye Institute the best keratoconus specialist near me?

The Assil Gaur Eye Institute team of keratoconus doctors is Southern California’s Leader in Keratoconus Treatment. They have extensive experience in keratoconus corneal eye disease and its management. Dr. Assil's leadership in corneal transplantation surgery began while serving on the university faculty in St. Louis decades ago in one of the largest corneal transplant practices in the USA.

Dr. Assil and his team have performed thousands of corneal transplants and are nationally recognized leaders in the field.

The doctors at AEGI ophthalmology group have a combined 100 years of healthcare experience and are nationally recognized specialists in treating glaucoma, macular degeneration, and diabetic retinopathy.

This is one of the reasons that Los Angeles Magazine named Assil Gaur Eye Institute as one of the Top ophthalmology eye centers in Los Angeles, year after year. Optometrists from all over Southern California refer their patients to us for care.

We are conveniently located for patients throughout Southern California and the Los Angeles area in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

Schedule a consultation to discuss your Keratoconus and learn what treatments are right for you.

Schedule Now

Or call

866-945-2745

Keratoconus FAQs

How common is keratoconus?

While keratoconus is the most common cornea ectatic disorder, it affects about 5% of the population worldwide.

Can LASIK help keratoconus?

No, LASIK is not recommended for keratoconus patients. The reasons include:

The cornea in keratoconus is already weak and unstable, and LASIK can further compromise its structural integrity.
The irregular shape of the cornea in keratoconus makes accurate measurement and correction challenging, leading to unpredictable and potentially unsatisfactory outcomes.
LASIK does not address the underlying progression of keratoconus, which may render the corrective procedure ineffective as the condition advances.

How do you find the best keratoconus specialist near me?

Seek Referrals: Start by asking for recommendations from your primary eye care provider or ophthalmologist. They can provide valuable insights and refer you to specialists experienced in managing keratoconus.
Research Credentials: Look for ophthalmologists or cornea specialists with specific expertise in diagnosing and treating keratoconus. Check their credentials, education, and certifications. Board certification in ophthalmology and memberships in professional organizations can be good indicators of their expertise.
Experience and Specialization: Consider doctors with significant experience in managing keratoconus and related corneal conditions. Look for specialists who focus on the cornea and external disease or refractive surgery.

Sources:

Chou, B., Onofrey B. "Keratoconus." In Ocular Therapeutics Handbook: A Clinical Manual (Fourth Edition), edited by Onofrey, B, Skorin L, Holdeman N, 700-704...

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Keratoconus articles from our blog

What's New in Keratoconus Treatment? A 2024 Update

Written by Dr. Kerry Assil

Kerry K. Assil, MD, is regarded as one of the world’s foremost experts in refractive surgery, having made significant advances in the field with his numerous inventions. Additionally he has the unique distinction of having trained thousands of eye surgeons in the latest refractive surgical techniques.

Dr. Assil has authored more than one hundred textbooks, textbook chapters and articles on refractive surgery and has appeared regularly on major television network news programs as a pioneer in refractive surgery. He also leads educational forums for other eye care professionals, which have included featured lectureships at Harvard University, Johns Hopkins University and Tokyo University.
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Keratoconus: causes, symptoms and treatments

What is keratoconus?

What are the symptoms of keratoconus?

Signs and symptoms of keratoconus can include:

What causes keratoconus?

Keratoconus risk factors

How is keratoconus diagnosed?

What are treatments for early keratoconus?

Rigid gas-permeable keratoconus lenses

Custom Toric soft contact lenses

Scleral contact lenses

Corneal Collagen Crosslinking for keratoconus

Intacs

What are the treatments for late-stage keratoconus?

Corneal Transplantation

Do all keratoconus patients eventually need a cornea transplant?

Why is Assil Gaur Eye Institute the best keratoconus specialist near me?

Keratoconus FAQs

How common is keratoconus?

Can LASIK help keratoconus?

How do you find the best keratoconus specialist near me?

Keratoconus articles from our blog

Patients talk about AGEI's quality of care

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LeBron James

Anthony Davis

Chris Paul

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