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Posts Tagged ‘treatment’

I’ve Just Been Diagnosed With Keratoconus

Sunday, August 1st, 2010

By: David Kading, OD, FCLSA, FAAO

If you have just been diagnosed with keratoconus, let me first of all reassure you that there have been many recent advancements in the realm of keratoconus to equip eye care professionals with the proper tools to help you.

Keratoconus is a vision disorder that affects the front surface (cornea) of the eye.  The changes that take place occur because the cornea becomes thinner in certain areas.  The condition causes the normal regularly shaped cornea to become microscopically irregular in shape.  This causes light to scatter in irregular ways causing vision to be blurry, distorted, warped, and haloed as opposed to crisp and clear.  Because glasses and normal off-the-rack contact lenses cannot help to make the surface of the eye even and regular, for most keratoconus patients, they are not able to provide ideal vision.  Additionally, lasik surgery is not an option for patients with this thinning disorder because lasik surgery thins the cornea in an effort to correct vision.  Therefore it would only make the condition worse.

Keratoconus affects thousands of Americans and people all across the world.  It is believed that there may be a genetic component to the disease as it has been seen in identical twins.  However many keratoconus patients develop the condition after a mild accident, trauma to their eye or after years of eye rubbing.  Many other patients are not able to trace the condition to a family member or any type of eye trauma.

The first thing that you should do when you are diagnosed with the condition is ensure that you are under the care of an eye care practitioner who is knowledgeable about the condition.  A knowledgeable practitioner will know, understand, and be able to decide on the best course of treatment for you.  Although many keratoconus patients appear similar when they present to an eye care office, no two patients are alike.  Each has specific needs related to the shape of their eyes and how they use their vision on a daily basis both for work and recreation.  It is critical that your practitioner knows both you and your eyes.

In order to get the best idea of what the shape of your eye is, your practitioner may consider using an instrument called a corneal topographer.  This allows them to measure the specific areas of the eye in order to get the best assessment of the shape and contours of the eye.  This is extremely helpful in order to properly diagnose, and decide on the proper treatment options.

In mild cases of keratoconus, eyeglasses can still be used to help correct vision.  However, in most all cases of the condition, proper vision correction is best achieved with the use of specially designed contact lenses.  Depending on the shape of the eye, type of prescription, and discussion with you, your eye care practitioner will decide on an initial contact lens type.  In order to get the proper contact lens for you, a contact lens fitting must be performed.  This is often times performed as a separate visit to the office.  Following this visit, the lenses will be ordered from a contact lens laboratory or manufacturing plant.  Typically contact lenses can be made in several days, but it can take up to 2 weeks in some cases for the lenses to arrive back in the office.

Once the lenses arrive in the office, an additional visit is usually scheduled to ensure that the lenses are fitting on the eyes correctly and giving the optimal vision.  At this visit you are typically instructed on how to insert and remove the contact lenses.  Many times a wearing schedule will be described to you so that you can begin to adjust to the lenses.  As with most medical devices and things that are new to our bodies, it may take several days to weeks to adjust to the comfort, vision, and feeling of the new lenses.  This is very typical in most cases.  Most offices will request a follow up visit within one to three weeks to ensure that the lenses are fitting correctly.  Make sure to wear the lenses for several hours prior to this visit as an assessment of the lenses is best done after the lenses have been worn for at least three hours.  It is critical to ensure that the fit of the lenses is correct as they can cause damage to the eye if they are incorrect.  On occasion the initial type of lens that is tried does not work.  This is not uncommon and should not cause alarm.  Fortunately as stated earlier, there are many options.  The practitioner may switch you from one type of contact lens type to another if your eyes were not able to adapt to the initial lens type.

In very severe cases when contact lenses cannot provide ideal vision, there are also surgical options available.  These surgical options are progressing and are showing improving results.  However they are not a perfect solution, they require a significant healing time and most patients still must wear specialty designed contact lenses following the procedure.

Keratoconus is a condition that will last a lifetime.  Within the past 10 years dramatic insight, knowledge, and research has come out regarding the condition, its diagnosis, and treatment options.  Find a practitioner that you can trust and is up to date with the most recent advancements.  Make sure that they know everything there is to know about your eyes and vision, but most importantly, they should know you.  This is the type of relationship that will last a lifetime.

Surgical Treatment Options for Keratoconus

Tuesday, July 27th, 2010

Medical and surgical options for the treatment of keratoconus are also expanding and improving. Corneal transplantation (penetrating keratoplasty or “PK”) has been utilized for the surgical management of keratoconus for many decades. The criteria for PK surgery typically is either the development of corneal scaring that reduces best corrected vision (even with contact lenses) or intolerance to contact lens wear (due to poor comfort or the inability to achieve a stable fit). Modification and improvement in surgical techniques has made PK much more successful. It should be noted however that keratoconus patients undergoing PK most often still require contact lenses to provide optimal vision. It is the exception to the rule to find patients who do not need some form of contact lens correction following PK, and even rarer to find a patient who does not need any type of vision correction after this surgery.



Intacs Corneal Segments

Click to enlarge



Intacs (by Addition Technology) is a relatively newer surgical method to address the corneal irregularity found in keratoconus. It involves the implantation of tiny plastic segments within the cornea. The result is to make the optical surface of the cornea relatively more regular, thus reducing the degree of vision distortion. This technology is only indicated for keratoconic corneas without scaring, yet have become contact lens intolerant. Results with Intacs have been encouraging, but once again are not a total solution for this disease. As with PK, patients who have had Intacs implanted most often still require contact lens correction for maximum vision. By making the corneal surface more regular contact lens fitting may be more successful following Intacs.

The newest development in the medical treatment for keratoconus is termed “Collagen Crosslinking with Riboflavin”. It involved the exposure of the cornea to riboflavin (vitamin B2) and ultraviolet light for a period of time. The result is a change in the crosslinking of collagen fibrils within the substance of the cornea. For some patients this treatment strengthens the cornea and therefore slows down or halts the progression of keratoconus. For some more fortunate patients this treatment may also improve corneal surface regularity. Numerous studies evaluating this so far non-FDA approved procedure are going on throughout the United States.

Keratoconus is a corneal disease that results in progressive visual distortion. Technologies in contact lens correction, medical treatment, and surgical options for keratoconus continue to improve. The primary treatment for the disease is with specialized contact lenses. Seeing an eye care professional who is skilled and experienced in the diagnosis and management of keratoconus provides the best opportunity to experience the best vision possible.

Article Written by: S. Barry Eiden, OD, FAAO

President and Medical Director of North Suburban Vision Consultants, Ltd.

Website: http://www.nsvc.com

EyeVis Eye and Vision Research Institute

Immediate Past Chair of the Contact Lens and Cornea Section of the American Optometric Association


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