Medical Management of Keratoconus
The initial management of keratoconus is providing the best possible vision.
In the beginning, glasses may provide excellent vision. As the keratoconus progresses, the vision will not be corrected with glasses as irregular astigmatism cannot be corrected with eye glasses.
Early in the disease soft contact lenses can correct the vision. Then, as the keratoconus progresses toric soft contact lenses can be used. Eventually, rigid or gas perm contact lenses will be needed to correct the vision. There are also a variety of specially designed keratoconus contact lenses.
Medical Treatment of Corneal Hydrops
Corneal hydrops occurs when one of the corneal layers splits and fluid infiltrates into the cornea. The cornea becomes swollen and turns white. Part of the cornea may be involved or most of the cornea may turn white. It is associated with pain, redness, blurred vision, and tearing. This is not a common complication of keratoconus and is usually occurs in the severe stage. It is treated with Muro 128 5% solution or ointment. Many times an eye patch is placed over the eye.
There is a high correlation between keratoconus and sleep apnea. Patients with keratoconus should be evaluated for sleep apnea.
Surgical Treatment of Keratoconus
The vast majority of patients do well with contact lenses. In some cases the patient is unable to wear contact lenses and may need to have a surgical procedure to correct their vision.
Intacs is a corneal plastic ring that is inserted into the peripheral cornea in the stromal layer. It provides support for the cornea.
Anterior Lamellar Keratoplasty
The anterior cornea layers are removed and replaced with donor tissue.
The central cornea is removed and replaced with a donor cornea. This treatment is the standard surgical treatment for keratoconus. It has a very high success rate and patients are able to see well enough to live and work normal lives. It may take several months for the vision to stabilize after the transplant. Rejection can occur in approximately five to ten percent of patients. If caught early, it can be treated and the rejection stopped.
New Research and Treatment for Keratoconus
Collagen cross-linking (CXL) with riboflavin and UVA light is under investigation and has been used in Europe. This treatment involves using the riboflavin vitamin that is soaked into the cornea after the epithelium is removed. An UV light is shown onto the eye for 30 minutes and a bandage contact lens is placed on the cornea. The collagen cross-linking stiffens the cornea. This has been shown to stop the progression of the keratoconus.
Patients with keratoconus do very well with all the treatment options available to them. It varies from glasses, contact lenses, and surgery. The new treatment shows great promise and will be available in the United States in the future.