In its earliest stages, keratoconus may be treated effectively with eyeglasses or soft contact lenses. But as the disease progresses, your cornea will continue to thin and become even more irregular, bulging into a steeper cone shape that increasingly distorts vision. At that point, glasses and standard contacts can no longer correct vision adequately.
At Turner Eye Institute, we offer a range of treatments for progressive keratoconus. Our eye doctor evaluate each case individually to recommend the most effective treatment option, such as:
Intacs for Keratoconus
Intacs are corneal inserts that must be surgically placed within the peripheral cornea, working to reshape and stabilize the eye surface to sharpen vision. These thin, transparent, arc-shaped inserts can be a highly effective treatment for keratoconus when patients can no longer achieve functional vision with glasses or conventional contacts. Approved by the FDA in 2004, we’ve already been treating keratoconus patients with Intacs for years.
Your eye surgeon will implant Intacs in a position that molds the corneal curvature, improving the natural shape of the eye. The procedure is done in-office and takes approximately 15-20 minutes. Recovery may involve a temporary sensitivity to light, the feeling of a foreign object in your eye, or excess tear production. These symptoms (related to how the incision heals) are usually mild and short-lived. Intacs are also removable and exchangeable, if necessary.
Typically, people with keratoconus experience better vision with Intacs, yet many people still need to wear prescription glasses or contacts to see clearly. Studies show that Intacs can improve visual acuity of an eye with keratoconus by two lines on a standard eye chart (on average). However, now that the cornea has been molded into a healthier dome shape, wearing contact lenses becomes possible and comfortable!
When keratoconus worsens to the degree that no other treatments provide adequate vision, it’s generally time to consider a surgical cornea transplant. There are a few types of corneal transplants, including full thickness, partial thickness, and endothelial keratoplasty. Your eye doctor will evaluate your condition thoroughly to determine which surgery is most suitable.
In all corneal transplants, a small incision is made in order to remove the unhealthy corneal cells. Then, new tissue is implanted and the incision is stitched shut. Even after a corneal transplant, you will probably need to wear glasses or contact lenses to see clearly.
Conductive Keratoplasty (CK)
Conductive keratoplasty is a refractive surgery approved by the FDA for treating farsightedness in patients over age 40. Using low-level radiofrequency energy (not a laser), this procedure reshapes the cornea. Although conductive keratoplasty is not FDA-approved specifically as a keratoconus treatment, it may be done by an eye surgeon, when appropriate. Studies are ongoing to investigate how conductive keratoplasty may help smooth corneal irregularities and improve contact lens fit over the keratoconic cone.
Corneal Collagen Cross Linking
Corneal cross-linking also referred to as CXL, strengthens corneal tissue to slow or stop the way the eye surface bulges if you have keratoconus. It does this by increasing the bonds that hold your eye’s collagen fibers together. CXL is a non-surgical, FDA-approved therapy that generally leads to visual improvement within one month.
To perform this innovative treatment, your eye doctor will apply a special riboflavin solution (B-vitamin) on your cornea for about a half-hour. Afterward, your eyes will be exposed to UV light for about 10-30 minutes. These lights are similar to the blue lights installed at many deli counters to sterilize the surface. Now, there’s nothing left to do but wait for the results.
Two types of corneal collagen crosslinking are available:
- Epithelium-off crosslinking – in this method, the outer layer of the cornea (the epithelium) is removed to enable the entry of riboflavin into the cornea.
- Epithelium-on crosslinking – also called transepithelial cross-linking, this method involves leaving the outer layer of the corneal totally intact during treatment. Some advantages of this approach include better patient comfort, reduced risk of infection, and a rapid visual recovery
Corneal crosslinking has shown promise as a way to significantly reduce the need for corneal transplants in people with keratoconus. Sometimes, this therapy is used in combination with Intacs implants.
Scleral contact lenses are a type of extra-wide specialty lens that vaults over the cornea, resting on the whites (sclera) of your eye. This fit creates a new domed optical surface that acts as a substitute for your bulging cornea. Also, the way the scleral lens sits on your eye doesn’t rub painfully against the keratoconic cornea. Scleral lenses can be an ideal solution for keratoconus, providing smooth comfort and crisp vision.
Rigid Gas Permeable (RGP) Contact Lenses
Gas permeable hard contact lenses bridge over the distorted cornea, creating a smooth surface for sharper vision with keratoconus. It can be tricky to fit GP lenses for people with keratoconus, and you may need a few visits to your eye doctor before an optimal fit is found.
Custom Soft Contact Lenses
In recent years, contact lens manufacturers have designed custom soft contacts to correct mild-to-moderate keratoconus. These made-to-order lenses are crafted based on precise measurements of the person’s cornea. Many people have found them to offer comfort superior to rigid gas permeable lenses.
Wearing a hard contact lens on top of a soft one may give higher comfort than rigid gas permeable lenses.
These specialty contact lenses have a hard center surrounded by a softer ring, which many people prefer over contacts that are entirely rigid.
To find out which keratoconus treatment is most appropriate for your condition, schedule an eye exam and consultation with our experienced eye doctors at Turner Eye Institute.