WHAT IS KERATOCONUS TREATMENT?
Keratoconus treatment corrects an eye condition which mainly affects people in their teens through to their early thirties. It affects up to 1 in 2000 people, but is most common in people with Down’s Syndrome, and in Asians, and can also affect people with asthma or eczema. It affects males and females equally, and it can affect only one eye, or both.
Keratoconus thins the cornea, causing cone-shaped bulges to appear. It is a condition which gets progressively worse, and may eventually result in the splitting of the back surface of the cornea. This is known as acute corneal hydrops.
The bulging, cone-shaped cornea distorts the light that travels to the retina, resulting in distorted images being passed to the brain.
The symptoms are blurring and reduced quality of vision, and can make tasks such as driving and reading difficult. You may also experience sensitivity to bright light, and ‘ghosting’ of images, particularly of a bright light on a dark background. The symptoms may develop and change over time.
Keratoconus causes vision to change frequently and if you find your lens prescription changes often, this could be a sign of Keratoconus.
Keratoconus is a bilateral condition, although there can be a marked difference in the severity of each eye affected. Main keratoconus symptoms are blurring of vision and reduced quality of vision, which can give problems such as ghosting of images. Opticians and Optometrists sometimes pick up keratoconus due to an increase in the astigmatism of their patients, together with a ‘scissoring’ reflex on retinoscopy. The astigmatism associated with keratoconus is not regular, which means that it cannot be fully corrected with glasses. In very mild/early cases people may see relatively well with glasses alone although most people undergoing keratoconus treatment a special keratoconus contact lens. Mr Barsam works with several world class keratoconus contact lens treatment specialists in Hertfordshire, Bedfordshire, Buckinghamshire and London to which he will refer you after evaluation.
How do you know if you have Keratoconus?
If you are experiencing poor quality of vision, speak to your optician or contact us for an appointment. Keratoconus can be similar to astigmatism and is often picked-up during astigmatism consultations.
Keratoconus can be diagnosed using state of the art elevation-based scheimpflug corneal topography. This technology also allows detection of subclinical forms of keratotoconus, such as forme fruste keratotoconus, which is very important as part of a safe laser eye surgery evaluation. It also allows the condition of the eye to be quantified, so that your surgeon can let you know if and at what rate your condition is progressing. This is very helpful in deciding keratoconus treatment options. Below is an interesting expert article on this that Mr Barsam was invited to write.
Keratoconus can take many years to develop and regular check-ups are recommended for anyone diagnosed with this condition.
There are a range of causes of Keratoconus, including hereditary factors, eye rubbing and allergies.
How can Keratoconus be treated?
Mild cases of Keratoconus can be treated through the use of glasses and specialist contact lenses. In more serious cases, a corneal implant or transplant may be needed. Up to 1 in 4 people with Keratoconus will need surgery.
Most cases of Keratoconus can be corrected with a range of specialist contact lenses, or a combination of corneal surgery and soft contact lenses. The disease generally stops getting worse in your 30s.
Mr Allon Barsam has carried out the largest prospective study of this eye condition that has ever been done in conjunction with the British Ophthalmic Surveillance Unit and its results will allow other keratoconus specialists to detect which keratoconus sufferers are at greatest risk for developing severe disease. Mr Barsam has vast experience in diagnosing Keratoconus and works with world class specialist contact lens suppliers to which he can refer you depending on your needs.
Keratoconus is a more serious eye condition but advances in technology mean that it can be treated and activities such as driving and reading are now possible for Keratoconus sufferers. Keratoconus treatments have a high success rate and further research will increase this success even further still.
SURGICAL TREATMENT OPTIONS
Accelerated Corneal Collagen Crosslinking
Corneal collagen crosslinking has revolutionised the management of keratoconus. Now, for the first time, there is a keratoconus treatment available that can stop the disease from progressing.
The procedure is painless and is done as a day case under topical anaesthetic drops. The cornea is soaked in Riboflavin (vitamin B2) drops and then an ultraviolet light (UVA) is shone onto the cornea. With traditional crosslinking, this keratoconus treatment takes an hour, but now with accelerated crosslinking, the procedure can be done safely in a matter of minutes. A bandage contact lens is places on the cornea at the end of the procedure and this is removed once healing is complete between 3-5 days after the treatment.
Intrastromal corneal rings – Kerarings
The main two ring options are intacs and kerarings. Allon Barsam prefers kerarings, as these rings are custom-made for each individual corneal shape and thickness.
The plastic ring segments are inserted into a specially made channel in the cornea and they act to flatten the cornea into a more normal shape. This normally results in less need for contact lenses. They can be inserted prior to accelerated crosslinking or at the same visit. They can also be used in some situations where crosslinking is not indicated or not needed. The periphery of the cornea has to be more than 450 microns (0.45 mm) in thickness to allow for safe ring insertion. The keratoconus treatment procedure is painless and is done with anaesthetic drops.
Implantable Collamer Lens (Phakic IOL)
A Phakic IOL, an implantable collamer lens, is a good option for those with keratoconus who would like freedom from contact lenses or glasses. The small operation is performed under a local anaesthetic and takes around 10-15 minutes from start to finish. It is not painful and recovery times are surprisingly short.
For those who find that vision with glasses is satisfactory but limited, Phakic IOLs are most useful.
Topography guided Excimer Laser Advanced Surface Ablation
This can be a useful adjuvant to corneal collagen crosslinking in carefully selected patients requiring keratoconus treatment.
First, the laser is used to carry out a transepithelial ablation. A maximum of 60 microns of corneal tissue is then reshaped to help improve the vision as well as to diffuse the stress strain of the cone on the cornea.
Big-bubble Selective Deep Anterior Keratoplasty
Allon Barsam is a specialist in carrying out this innovative eye procedure which leaves the endothelial cell layer undisturbed by only transplanting the diseased portion. This removes the risk of endothelial rejection, but is more technically demanding. 4 in 5 cases are able to be treated using this technique, with the other case in 5 receiving the traditional penetrating corneal transplant.
This eye treatment requires a general anaesthetic, and eyes will be mildly uncomfortable for around a week after the operation. Eye drops are administered over the course of several months. The inserted sutures are removed after a year, and success rates are high, with all patients being able to see clearly unassisted, or with a regular contact lens or glasses prescription.
Allon Barsam is a specialist in the diagnosis and treatment of diseases of the cornea, the clear natural lens which covers the front of the eye, and the conjunctiva which covers the surface of the eye and the inside of the eyelids.
These diseases and ailments include corneal scarring, Fuchs endothelial dystrophy, blepharitis, keratoconus, microbial keratitis (contact lens-induced corneal infection), complications of contact lens wear, dry eyes and pterygium.