Does keratoconus need urgent treatment?
The treatment of keratoconus is twofold. One is to prevent progression of the disease, because it’s a progressive disease, and the other is to provide vision correction.
Until recently there was no way that we could prevent progression of the disease, but now we can with a treatment called corneal cross-linking. And what this does, it strengthens the cornea. We know that a baby’s corneas are very elastic and very mobile and that an elderly person’s cornea is quite stiff. The reason for this is that ultraviolet light affects the collagen in the cornea and essentially causes the collagen to bind and harden the cornea.
Understanding this, a very bright Ophthalmologist in Switzerland Theo Seiler, came up with the idea that if in some way we could apply ultraviolet light to the cornea quickly, we could strengthen the cornea. So the technique involves using a substance called riboflavin that’s placed on the cornea and ultraviolet light is applied to the cornea.
This procedure used to take about 40 minutes, but now with accelerated cross-linking, this takes only five to ten minutes to carry out the procedure. Not only does it strengthen the cornea but in cases where there’s been significant warpage, sometimes corneal cross-linking can lead to improvement in the bulging (or corneal ectasia).
Not everybody needs treatment with corneal cross-linking, it depends on the rate of progression of your disease and typically it’s the younger population in whom this progresses most rapidly and the older we get the stiffer our cornea gets, so the less likely we are to have progressive keratoconus.
The other aspect of treatment is vision correction, often the cornea is to walk for spectacles to be effective. So contact lenses need to be worn. Contact lenses usually the harder gasping type of contact lenses, because the soft contact lenses will conform to the shape of the cornea and conform to the bulge, so they are ineffective.
Now at The Grange Eye Consultants and other specialist centres, one can laser the cornea using special so-called topography-guided treatments to smooth out the cornea. The way this is done, is that detailed maps of the cornea are taken and the data from that map, that electronic data, is transferred to the laser, and the laser program to smooth out the cornea. So over the last five to 10 years the management of keratoconus has been revolutionised.
More about Robert Morris
Rob Morris is a Consultant Ophthalmic Surgeon at The Grange Eye Consultants. His special expertise is in cataract and refractive surgery, including Refractive Lens Exchange, and adult squint. He has over 30 years experience in treating people with eye problems. Rob Morris founded Grange Eye Consultants to manage the increasing demand for more complex refractive surgery. He leads clinical trials investigating novel eye treatments. He is currently Medical Director at Optegra Eye Hospitals.