Current Treatments of Keratoconus

Christopher J. Rapuano, MD – Chief of the Cornea Service

Discusses the latest treatments for the Treatment of Keratoconus. To view the full transcript. Click Here

Definition

Progressive central/inferocentral corneal thinning and irregularity. It usually develops during teenage or young adulthood years, but can occur later. Almost always bilateral but typically asymmetric.

Symptoms

Decreased vision, frequent change in glasses.

Causes

The cause is unknown, but eye rubbing is thought to be a factor in some patients.

Risk Factors

Eye rubbing, ocular allergies, occasionally runs in families.

Complications

Corneal scarring, acute hydrops (break in Descemet’s membrane resulting in the sudden development of mild or severe corneal edema causing pain, redness and poor vision).

Tests and Diagnosis

Slit lamp examination is essential. Corneal topography and tomography are extremely helpful in identifying mild cases. They are quite useful in monitoring for progression of the condition.

Treatment

Stepwise approach depends on severity, beginning with glasses, soft contact lenses, toric soft contact lenses, rigid gas permeable contact lenses, hybrid lenses, scleral lenses (including the PROSE lens). Patients who are contact lens intolerant can be treated with INTACS or corneal transplantation such as a deep anterior lamellar keratoplasty or a full thickness corneal transplant. Corneal crosslinking should be considered in eyes with progressive corneal steepening/thinning. All patients should be counseled not to rub their eyes. Ocular allergies should also be treated to reduce the impetus for eye rubbing.

Support: KCN support websites.

Prevention

NO eye rubbing! Corneal crosslinking can prevent progression.