Condition

What Is Keratoconus?

Keratoconus is a progressive eye disorder that affects the cornea, the clear, dome-shaped front surface of the eye. In this condition, the cornea gradually thins and bulges into a cone-like shape, leading to visual distortions and potential vision impairment.

Origins

Causes of Keratoconus

The exact cause of keratoconus is not entirely understood, but several factors may contribute, including:

Genetics

As it often occurs in multiple members of the same family, evidence suggests a genetic predisposition to keratoconus.

Corneal Tissue Changes

Abnormalities in the corneal structure and biochemical changes can weaken the cornea over time.

Environmental Factors

Frequent eye rubbing and excessive exposure to ultraviolet rays might play a role in the development of keratoconus.

Diagnosis

Symptoms of Keratoconus

Blurred Vision

Vision becomes progressively distorted and blurry, making it difficult to focus.

Light Sensitivity

Eyes become increasingly more sensitive to glare and bright lights.

Prescription Changes

Individuals might notice frequent changes in their prescription for glasses or contact lenses.

Astigmatism

Irregular corneal shape causes astigmatism, leading to distorted vision at all distances.

Keratoconus Treatment

An eye care professional can diagnose keratoconus through a comprehensive eye exam, which may include corneal mapping (topography) and measurements of corneal thickness.

Glasses or Contact Lenses

Initially, mild to moderate cases might be managed with glasses or specialized contact lenses to correct vision.

Corneal Cross-Linking

A procedure that involves applying riboflavin (vitamin B2) eye drops and exposing the cornea to ultraviolet light to strengthen and stabilize the corneal tissue.

Intacs

Surgical implants inserted into the cornea to flatten and restructure the cone-like shape, improving vision.

Corneal Transplant

In severe cases where other treatments are ineffective, a corneal transplant might be necessary to replace the damaged cornea with a healthy donor cornea.

Condition

What Is Corneal Cross Linking?

Corneal cross-linking (CXL) is a treatment designed to prevent progression of corneal weakness. This treatment is recommended for patients whose corneal scans show evidence of worsening keratoconus, or those judged to be at especially high risk of the conditioning worsening. As cross-linking of the collagen within the cornea naturally increases with age, the progression of keratoconus usually stops when patients enter their mid-30s, so it is not usually required for older patients.

Corneal Cross-Linking will not reverse keratoconus but in the majority of cases prevents the condition from worsening, and in some cases, will achieve significant improvement in vision.

Corneal Cross Linking Treatment Process

Corneal Cross-Linking is a minimally invasive procedure. It slows or halts the progression of keratoconus by increasing the strength of the natural fibres within the cornea. It does not cure the condition.

The cornea consists of a number of layers of which the stroma is responsible for strength. The stroma consists of millions of collagen fibres in close contact with each other which gives shape and structure to that area. These fibres are responsible for preventing the cornea from bulging out and becoming steep and irregular, which is what happens when a patient develops keratoconus.

The Cross-Linking treatment used at Optimax employs a combination of Riboflavin (Vitamin B) drops and ultra violet light that reacts with the collagen fibres in the cornea, strengthening them by creating more 'cross-linking' among them, and mimicking the natural corneal stiffening which occurs with age. The resulting increased strength of the cornea inhibits the progression of keratoconus. The procedure is usually pain-free.

The cost for this treatment is £2,495 per eye. Different treatment payment methods and easy payment plans are available at Optimax. Consultations with us cost £50.

Success Rate

Treatment Outcomes & Risks

Treatment Success Rate

Cross-linking is currently one of the only available treatments which appear to stop the worsening of keratoconus. Clinical trials (based on outcomes 1 year after cross-linking) show success in the halting of the condition in more than 90% of treated eyes, with more than 45% of eyes also gaining an improvement in corneal shape. A separate study over a 5 year period showed a similar success rate.

Treatment Recovery

The treated eye is usually painful for 3 to 5 days. However, levels of discomfort vary from patient to patient. Recovery time is about one week although most patients may find that it may be slightly longer. Patients may experience increased light sensitivity after treatment. It is important to rest as much as possible during this period to let the eye heal. If you partake in activities or sport, please ask your doctor to advise you on when you can resume.

Wearing Glasses

Visual improvement after treatment occurs in approximately 50% of cases. However, patients will still need to wear glasses or contact lenses after treatment.

Corneal Transplant

In general, cross-linking is very safe, but time should be allowed for the eye to heal and problems do occasionally occur. About 3% of patients will experience some loss of vision in the treated eye as a result of haze, infection or other complications. In most cases, any visual loss can be reversed with a corneal transplant. Without cross-linking treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant.

References

Imperial College Healthcare NHS Trust (2023), Corneal Cross-Linking: Information for Patients, Relatives and Carers (online), available from https://www.imperial.nhs.uk/~/media/website/patient-information-leaflets/ophthalmology/corneal-cross-linking.pdf [Accessed 22 July 2024.]
National Keratoconus Foundation, Cornea Transplants (online), available from https://nkcf.org/corneal-transplants/ [Accessed 22 July 2024.]
SightMD (unknown date), What Is Corneal Cross-Linking (CXL)? (online), available from https://www.sightmd.com/services/corneal-diseases/cxl/ [Accessed 22 July 2024.]
University Hospitals Coventry and Warwickshire NHS Trust (unknown date), Corneal Cross-Linking (online), available from https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Surgical%20Services/Ophthalmology/Corneal%20cross-linking.pdf [Accessed 22 July 2024.]

Treatment Suitability

Can you have surgery with keratoconus?

Laser Eye Surgery

Laser eye surgery, such as LASIK or PRK, is generally not recommended for individuals with keratoconus. The reason being that these procedures reshape the cornea, and in the case of keratoconus, where the cornea is already irregularly shaped and thin, such surgeries can further weaken the cornea and worsen the condition.

ICL or RLE Surgery

ICL (Implantable Collamer Lens) and RLE (Refractive Lens Exchange) surgeries might not be suitable for individuals with advanced or severe keratoconus due to the irregular shape and thinning of the cornea. These procedures typically involve placing a lens either in front of the natural lens (ICL) or replacing the natural lens with an artificial intraocular lens (RLE).

For individuals with mild or stable keratoconus, ICL or RLE might be considered as potential options for vision correction. However, it's crucial to undergo a thorough evaluation by an experienced eye care professional specializing in treating keratoconus. They will assess the condition of your cornea and overall eye health to determine if these procedures are appropriate for your specific situation.

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