Keratoconus: symptoms, causes and treatment

Definition of keratoconus

Keratoconus (or keratoconus) occurs when the cornea becomes thinner and gradually protrudes outward, like a cone. The cornea is the clear, convex surface of the eye. The narrowing of the cornea causes blurred vision and makes you more sensitive to light.

Keratoconus usually occurs in both eyes. This condition generally occurs in people aged 10-25 years. This disease develops slowly, can be 10 years or more.

In the early stages, vision can be improved with glasses or contact lenses. Gradually you need contact lenses with a stiff material, known as contact lenses rigid gas permeable (RGP) or other type of lens.

If the condition continues to get worse, you may need a corneal transplant.

Signs and symptoms

What are the signs and symptoms of keratoconus (keratoconus)?

Keratoconus signs and symptoms may change as the disease progresses. Keratoconus symptoms that may arise are:

• Blurred or blurry vision
• It is very sensitive to glare, so driving at night can be difficult
• Change prescription eyeglass lenses often
• The view looks like it's foggy and keeps getting worse

There may be other symptoms not listed above. If you have any questions about this sign, consult your doctor.

When should I see a doctor?

Check with an eye doctor if your vision continues to deteriorate, which may be due to astigmatism. The doctor also may check for keratoconus symptoms at your routine eye exam.

If you are considering LASIK (laser-assisted in-situ keratomileusis) surgery your doctor will also check for signs of keratoconus before starting surgery.

Cause

What causes keratoconus (keratoconus)?

Keratoconus occurs because the protein fibers responsible for holding the cornea in place and shape become weakened. This condition can occur due to reduced antioxidants that protect the cornea.

The very fine protein fibers in the eye are made of collagen. As these fibers weaken, the shape and position of the cornea changes, whipping outward.

Corneal cells produce harmful waste products, much like vehicle exhaust. Usually, antioxidants will fight and try to protect collagen fibers. However, when the antioxidants are lacking or depleted, the collagen weakens so that the cornea protrudes outward.

This condition may run in families. If you have keratoconus, get your son and daughter's eyes checked regularly from age 10.

This condition develops more quickly in people with certain medical conditions, such as allergies. This could be because people who are allergic to rub their eyes more often.

Keratoconus usually begins to appear in adolescence. However, it can also occur in childhood or at the age of 30. This condition may be experienced by people aged 40 years and over, but it is very rare.

These corneal changes can occur quickly or slowly. Your vision may become blurry or see patches or tinge of white light, especially at night.

These changes can stop suddenly, or they can continue to develop over the decades. There is no way of predicting its development yet.

In most cases, both eyes will eventually be affected, although the severity is not necessarily the same. However, usually it appears the first time only on one side of the eye.

In serious cases of keratoconus, these damaged collagen fibers can cause serious injury. If the back of the cornea is torn, it can swell for months and leave a large scar.

Risk factors

What increases the risk of keratoconus?

There are several risk factors for keratoconus, including:

• Heredity in the family
• Vigorously rubbing or rubbing your eyes
• Health conditions, such as retinitis pigmentosa, Down syndrome, Ehlers-Danlos syndrome, and asthma

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is this condition diagnosed?

To diagnose this condition, your eye doctor will check your health and family history, as well as perform an eye exam. Depending on the shape of your cornea, your doctor may also order the following tests.

1. Eye refraction

In this test, your doctor may ask you to look through a special instrument with a variety of lenses to determine which combination will best help sharpen your vision. Some doctors may use a retinoscope to evaluate your eye.

2. Examination slit-lamp

In this test the doctor will direct the light in a vertical direction at the surface of the eye. After that, the doctor will use a microscope to examine your eye. You may also be given eye drops to dilate the pupil and make it easier to examine.

3. Keratometry

In this test, the eye doctor will direct a circular light at your cornea and measure its image to determine the shape of the cornea.

4. Computerized corneal mapping

There are several computer tests, such as optical coherence tomography and corneal topography to record your cornea. From here, the doctor will map the shape and thickness of the cornea.

What are my treatment options for keratoconus?

The treatment given will depend on the severity of the condition and how fast it progresses.

Moderate to severe keratoconus can be treated with glasses or contact lenses. For some people, the cornea will stabilize again in a few years. Usually after that you don't need any further treatment.

Meanwhile, for some other people, the cornea can become injured or it becomes difficult to wear contact lenses. In this case, you may need surgery.

Quoted from the Mayo Clinic, the following treatment options for treating keratocunus:

1. Glasses or contact lenses

Glasses or contact lenses can correct vision problems at an early stage. However, you may have to change prescriptions for the lenses frequently due to corneal changes.

In addition, lenses your doctor may recommend are:

• Rigid contact lenses will usually be prescribed as a follow-up treatment.
• A double lens can be recommended if you feel uncomfortable wearing a rigid lens. You can use soft contact lenses first, then stiff.
• Hybrid contact lenses have a stiff center while the edges are softer for added comfort.
• Sclera contact lenses are used in people whose condition is quite severe. These contact lenses are quite comfortable because they are placed on the sclera (white part of the eye), not on the cornea like contact lenses in general.

Stiff contact lenses or sclera contact lenses should be adjusted to your eye by an ophthalmologist.

You also have to regularly check whether the size is still suitable or needs to be changed again. Contact lenses that are not the right size can damage the cornea.

2. Operation

You may need to have surgery if you have a corneal wound, your cornea is too thin, you can't use any contact lenses, or your vision is too bad. The operation also varies, depending on your condition.

Surgery can be performed by inserting a small, clear, crescent-shaped plastic filling into the cornea to flatten the cone and improve the shape of the cornea. After that the filling can be removed again from the cornea. However, this procedure leaves your eye vulnerable to injury or infection.

Another way, namely with a corneal transplant (graft) which is also called keratoplasty. Especially for people whose corneas are very damaged or thin. Your original cornea may be removed and replaced with the cornea of ​​the donor eye.

Usually this procedure has a high success rate. However, possible complications include visual disturbances, astigmatism, infection, and your eye rejecting the new cornea from a donor.

3. Treatment that is still being developed

New keratoconus treatment, ie collagen cross-linking shows promising evidence for people with this condition. This procedure is performed with special eye drops and illumination with ultraviolet A (UVA) light on the corneal tissue.

Unfortunately, further research is still needed to test the safety and efficacy of this treatment technique.

If you have any questions, consult your doctor for the best solution to your problem.