As an ophthalmologist, one of the most frequently encountered corneal diseases in my clinical practice is keratoconus. Often mistaken for simple nearsightedness or astigmatism, this condition can progress over time and, if left untreated, may result in permanent vision loss. In this article, I aim to share the most up-to-date and detailed information about keratoconus—what it is, how it progresses, how it is diagnosed, and what treatment options are available.
What Is Keratoconus?
Keratoconus is a progressive and degenerative eye disease characterized by thinning and forward bulging of the cornea, the clear front surface of the eye. Normally dome-shaped, the cornea begins to protrude into a cone-like shape, disrupting its structural integrity.
This distortion prevents light from focusing properly on the retina, leading to irregular astigmatism and nearsightedness. These refractive errors are often difficult to correct with regular eyeglasses because the cornea no longer maintains a smooth surface.
Who Is at Risk for Keratoconus?
Keratoconus typically begins during adolescence and may continue to progress into the late 20s. It can affect both eyes, although one eye is often more severely affected than the other. It affects all genders equally.
Common risk factors include:
- Genetic predisposition: Having a family history of keratoconus increases the risk.
- Chronic eye rubbing, especially in people with allergic eye conditions.
- Connective tissue disorders: Conditions like Down syndrome or Marfan syndrome are associated with a higher risk.
What Are the Symptoms of Keratoconus?
Keratoconus tends to progress slowly and silently. Early signs are often subtle, making diagnosis difficult without detailed testing. Patients commonly report:
- Frequent changes in eyeglass prescriptions
- Blurry or distorted vision
- Halos or glare around lights
- Difficulty seeing at night
- Inability to achieve clear vision even with glasses
- Eye fatigue and headaches
If you experience these symptoms, a comprehensive eye examination is highly recommended.
How Is Keratoconus Diagnosed?
A standard eye exam may not be sufficient to diagnose keratoconus. That’s why I use advanced corneal imaging technologies like corneal topography and corneal tomography. These diagnostic tools create a detailed map of the cornea, highlighting any thinning, steepening, or irregularities.
In some cases, keratoconus may exist without noticeable symptoms in the early stages. For this reason, individuals with a family history of keratoconus should undergo regular eye checkups.
Keratoconus Treatment: What Are Your Options?
The goals of keratoconus treatment are twofold:
- To halt disease progression
- To optimize visual clarity
The treatment plan is tailored based on the severity of the condition:
1. Eyeglasses and Soft Contact Lenses
In the early stages, vision correction may be possible with prescription glasses or soft contact lenses. However, as the disease progresses, these methods become less effective.
2. Rigid Gas Permeable (RGP) Lenses
These custom-made hard lenses help to smooth the irregular corneal surface and provide sharper vision. Although the adaptation period can be challenging, they significantly improve visual quality.
3. Hybrid and Scleral Lenses
For patients who cannot tolerate RGP lenses, hybrid lenses (rigid center, soft edges) or large-diameter scleral lenses offer better comfort and improved vision by covering more of the eye’s surface.
4. Corneal Cross-Linking (CXL)
One of the most effective methods for slowing or halting keratoconus progression. The procedure strengthens the collagen fibers in the cornea using riboflavin drops (vitamin B2) and UV-A light. It is especially effective when the condition is diagnosed early.
5. Intrastromal Corneal Ring Segments (ICR)
These half-moon-shaped rings are implanted into the cornea to help reshape it and improve vision. ICR is often combined with cross-linking for enhanced results.
6. Corneal Transplant (Keratoplasty)
In advanced keratoconus cases where other treatments fail, corneal transplant surgery may be necessary. Options include penetrating keratoplasty (full-thickness transplant) or deep anterior lamellar keratoplasty (DALK), which preserves the inner corneal layers.
Living with Keratoconus: Early Diagnosis Is Key
Keratoconus is a manageable condition when diagnosed and treated early. Although it can significantly affect visual quality and daily life, advances in diagnostic technology and treatment options allow patients to maintain stable vision for many years.
If you’re experiencing frequent prescription changes, blurry vision, or discomfort with contact lenses, I strongly recommend a detailed eye examination by a specialist.
Remember!
Your eye health directly influences your quality of life.
Regular eye exams play a critical role in early detection—not just of keratoconus, but of many eye diseases.
A healthy life begins with a clear vision.
Dr. Konuralp YAKAR
Ophthalmologist
