Vital Facts about Keratoconus that One Should Know

Keratoconus is a disease of the front surface of the eye that often is visually debilitating. It affects about 1/2000 of the population, so in India it is estimated that at least 50,000 people suffer with this condition. Many struggle to function in everyday life due to inappropriate treatment options or advice.

An important point is that most eye-care practitioners see about 2,000 eye patients per year, so on average an eye care expert will only see one to five patients with keratoconus per year. It does not matter how smart you are; if you do not involve yourself frequently with an activity

you will never develop the skill to deal with it effectively and efficiently. Because there is a lack of experience in the keratoconus area often a person that has keratoconus will accidentally be

steered in a totally incorrect direction.

Keratoconus does not lead to blindness

It is amazing that most patients with keratoconus by us believe that they will go blind sometime in their life. This occurs simply because they have seen their vision get worse and worse so they believe that the eye condition will continue to degrade to the point that nothing can be done to recover the vision.

Some people have seen a number of eye care practitioners over time and no one has been able to fit them with contact lenses or glasses and they are too scared to pursue corneal transplant surgery.

They then try to function with poor vision and believe it is only a matter of time before they will see nothing at all.

The reality is that no one goes blind from keratoconus. There are currently multiple options before corneal transplantation might be required.

If corneal transplantation is finally required its success rate is greater than 95%, when done by an expert corneal surgeon. Please note that glasses or contact lenses are normally required after surgery, but visual quality is normally very good. It is important to understand vision correction is still required in most cases.

Somewhere along the line we always get reasonable vision

How do you know that you have keratoconus?

Getting the diagnosis correct is the first step.

Many patients are not diagnosed till quite late in the course of the disease.

Pointers to a possibility of keratoconus are:

Fluctuating vision (or your child says this all the time).

Rapid and repeated changes of spectacles.

“Unclear Vision” despite “new” spectacle numbers.

Inability of the optician to give you a “correct number”

for spectacles.

Family history of keratoconus

The correct diagnosis depends on a number of skilled clinical evaluations. None can replace your skilled eye surgeon and his examination skills.

What are the current management options for keratoconus?

Being at the forefront of keratoconus management Clear Vision Eye Center offers a variety of cutting edge options for its patients.

  • The typical management pathway we offer consists of checking refraction and working out suitability of spectacles.
  • Alternatively contact lenses are fitted for visual restoration.
  • If progression is demonstrated then we offer Corneal Collagen Cross Linking with Riboflavin (C3R) to stabilize the cornea.
  • This can be followed by addition of Intra Corneal ring segments (ICRS) to further stabilize the vision.
  • Most patients can return to contact lenses after these two treatments.
  • In the rare event that an eye with keratoconus needs surgery Clear Vision offers all surgical options ranging from Deep Anterior Lamellar Keratoplasty (DALK) to Penetrating keratoplasty (PK).

Keratoconus specialists are far and few between

At the beginning of this report I mentioned the prevalence of keratoconus in the general Indian population is guessed to be about 1/2000 to 1/3000. There are approximately 13,000 eye surgeons in India so if patients with keratoconus were evenly distributed to every eye surgeon, each would have only 30 keratoconus patients to look after. No eye surgeon in the country could possibly develop any expertise in this area.

The good news is that there are approximately twelve to fifteen centers around the country that look after many keratoconus patients. Clear Vision is proud to mention that it is probably the only centre in private practice where a single trained surgeon offers all the care in keratoconus.

This includes

  • All the different contact lenses (RoseK, modified keratoconus CL, Soft perm [soft edge], Scleral lenses),
  • Para surgical therapies like Corneal Collagen Cross Linking with Riboflavin (C3R),
  • Intracorneal Ring Segments (ICRS), and
  • corneal transplantation (both lamellar and penetrating keratoplasty).
  • This makes us one of the few national centers with end-to-end expertise in keratoconus management.

If you read this report and have or know someone with keratoconus that is having a difficult time, I invite you to contact me via email at: drvinay.agrawal@gmail.com or contact through our websites www.corneatransplant.net or www.clearvision.org.in

(this material is compiled from various sources and is correct to the best of our knowledge. Please consult your eye care expert prior to any action)

Corneal Cross Linking Treatment for Keratoconus now in India

The method works by increasing collagen cross linking, which are the natural anchors within the cornea

Corneal Collagen Cross linking with Riboflavin (C3-R), a treatment for keratoconus, a disease of the cornea, recently was pioneered in India by Mumbai’s Dr Vinay Agarwal of Clear Vision Eye centre, a corneal surgeon specialising in keratoconus management.

Keratoconus makes the cornea become weak and it may gradually bulge outward. Most often, this bulging is in the lower half of the cornea and first presents as astigmatism. “However, not all astigmatism is due to keratoconus. In mild or early stages of Keratoconus (forme fruste keratoconus), eyeglasses may correct the astigmatic vision,” informs Dr Agarwal. Continue reading

Treatment Options for Keratoconus

There are currently multiple options before corneal transplantation might be required. They range from:

  1. Glasses
  2. Soft contact lenses
  3. Rigid gas permeable contact lenses (when fitted properly this is the most successful option).
  4. Rigid gas permeable lenses piggybacked on soft disposable contact lenses
  5. Mini-scleral contact lenses
  6. Corneal Cross Linking with Riboflavin (C3R)
  7. Intracorneal Ring implantation (Corneal Ring)
  8. Re-prescribing glasses, soft contact lenses or rigid gas permeable contact lenses after Corneal ring implantation /corneal cross linking with riboflavin. Continue reading

Coping With Keratoconus

What is the future of patients with this problem?

Keratoconus does not lead to blindness.

It is amazing that most patients with keratoconus managed by us believe that they will go blind sometime in their life. This occurs simply because they have seen their vision get worse and worse so they believe that the eye condition will continue to degrade to the point that nothing can be done to recover the vision. Some people have seen a number of eye care practitioners over time and no one has been able to fit them with contact lenses or glasses and they are too scared to pursue corneal transplant surgery. They then try to function with poor vision and believe it is only a matter of time before they will see nothing at all. Continue reading

FAQs for Keratoconus

What part of the eye is affected in keratoconus?

The cornea is the clear, transparent front covering which admits light and begins the refractive process. It is this clear convex cornea which bends (refracts) a ray of light and slows it down. It also shrinks the light to a manageable size (a little smaller than a one rupee coin). It is this front covering of the eye that is affected in keratoconus. Continue reading

Clinical Management of Keratoconus

Corneal Collagen Cross-linking Treatment

Corneal collagen cross-linking induced by treatment of impregnating Riboflavin (B2) in to the cornea and exposure to ultraviolet-A light is a safe and effective, minimally invasive procedure both to reduce disease progression, increase the strength of the cornea and to improve upon the cornea’s optical properties in eyes with early keratoconus.

As long as keratoconus is diagnosed early enough – a stabilization of clinical findings and visual acuity can be achieved without a need for a corneal transplant or further progression. Continue reading

Types of Keratoconus

In clinical practice, three distinct forms of keratoconus have been identified, each with a unique clinical presentation. Differentiating between the three forms can be helpful in counseling patients about what to expect regarding eventual progression of the disease. However, the clinical classification of keratoconus should be viewed as only a general guide. It is important to communicate to the patient that the condition can be extremely unpredictable and that its ultimate course can only be determined with time. Continue reading

Understanding Keratoconus

Introduction

Keratoconus, also called conical cornea, results in the cornea changing from domeshaped to cone-shaped through the progressive thinning of the cornea. Because the cornea is the part of the eye that refracts most of the light entering, the change of its shape prevents incoming light from being focused properly, ultimately distorting vision. In addition, vision may be impaired as a result of swelling and scarring of tissue. Keratoconus is a slow-developing disorder that almost always affects both eyes, though each eye may be affected differently. It is also almost fortuitous that usually one eye is much more affected than the other. This allows many patients to carry on with their normal activities. However, it is also responsible for delayed diagnosis in many cases. Continue reading

Characteristics of Keratoconus Patients at a Tertiary Eye Center in India

Vinay B Agrawal, MS, DNB

Clear Vision Eye Center, Mumbai, India

Purpose: To evaluate the presentation and characteristics of patients with keratoconus at a tertiary eye care center in Mumbai, India.

Methods: This single center, non-comparative, retrospective cohort analysis was performed on patients with keratoconus who presented to the Clear Vision Eye Center clinic from April 2007 to March 2009. Data was collected to characterize correlations among visual acuity, corneal biomicroscopic findings, and refractive and topographic findings in keratoconus. Continue reading