I have keratoconus, will I lose my sight?

Any condition that threatens eye health can create anxiety. The question “will I lose my sight?” is very often a question asked by patients suffering from keratoconus. Mr Arun Brahma is an expert consultant ophthalmologist and here he explains all you need to know about the condition and preserving your sight.

“Will I lose my sight?”

In short, the answer is no. With modern approaches, you should not lose your sight. This does, however, depend on the condition being diagnosed early, with adequate monitoring and treatment being initiated as soon as possible.

What is keratoconus?

It is a condition that primarily affects the cornea (the clear window of the eye) and can run in families. It can occur in conjunction with other medical conditions, such as allergic eye disease or it may occur on its own. It tends to start during the teenage years and is often picked up and diagnosed when glasses do not improve a patient’s vision. Fortunately, most cases of keratoconus stop progressing naturally after forty.

The main job of the cornea is to remain clear in order to allow light to pass from the front to the back of the eye so that it can focus on the retina. Secondly, it needs to remain spherical so that the light rays land on the same part of the retina, meaning a focused, sharp image is formed.

The term keratoconus literally means that the clear window has become cone-shaped. This occurs due to progressive thinning of the central part of the cornea, the stroma, which forms the main bulk of the tissue. As the cornea thins, the shape becomes more irregular, meaning the light is focused poorly onto the retina, and the quality of vision becomes progressively less sharp.

If the cornea thins too much, it begins to lose clarity and can become waterlogged as a result of the fluid within the eye. Although this only usually happens in advanced cases, it can lead to scarring, reduced corneal clarity and sudden loss of vision.

How the condition is managed

Modern keratoconus management depends on the stage and severity of the condition when diagnosed. Most surgeons want to catch the disease early, with the main aim being slowing or halting the progression of the disease. Most patients will not require surgical treatment, and patients usually only come to see a doctor if their eyesight is badly affected. If the progression of the disease can be delayed, and the cornea remains clear and thick enough, it may be possible to avoid more invasive operations such as corneal transplantation.

Contact lenses

If visual improvement is not possible with glasses, then specialist hard contact lenses are an excellent option. Hybrid and mini-scleral lenses may also be good options, with some patients finding them more comfortable to wear.

Corneal implants

If contact lenses are unbearable to wear then surgical techniques may be needed. Corneal segments are rigid implants that can be placed in the stroma (the thickest layer of the cornea) in order to strengthen a certain area. These techniques are only possible if the cornea is thick enough. Most of the time, contact lenses or glasses are needed in addition to implants to enable good vision but not as strong as prior to having the segments.

It is important to remember, however, that none of the treatments mentioned so far affect the long-term progression of the disease.

Corneal cross-linking: a new treatment to halt the progression

A new form of treatment, called corneal cross-linking, is able to slow and sometimes halt the progression of keratoconus. Using light rays and specific vitamins called Riboflavin, the stroma can be strengthened by more than 300%. This procedure can only be performed if the cornea is thick enough and although long-term data does not currently exist for this procedure (as it is relatively new), it appears to be safe with good success rates.

Corneal transplant

If the condition has advanced to the point where none of the above options are likely to be successful, it may be necessary to perform a corneal transplant. This may be needed if the cornea becomes scarred, swollen with fluid, or too thin and irregular. The aim of corneal transplantation is to replace a patient’s natural cornea with that of a donor. This should make the cornea clearer and less irregular than previously.

Different forms of surgical procedures are available, including full thickness and partial thickness transplants. It is important to discuss these options with your surgeon, as not all patients will be suited to these procedures. These procedures require fairly lengthy rehabilitation following surgery and may require further procedures in order to optimise vision in the longer term. At the very least, the sutures holding the transplant in position will need to be removed many months after surgery. Once the patient has healed, contact lenses can be used to improve vision.

In short…

As you can see, management of keratoconus is not straightforward and often a tailored approach to each individual patient is required. It will depend on the age of the patient and the severity of the condition. However, the good news is that with the help of these techniques, it is rare for patients to lose their vision as a result of keratoconus.

Mr Arun Brahma provides expert care for many aspects of eye health including keratoconus, cataracts, lenses and surgery. Get in touch with Mr Brahma via his profile.