Keratoconus Surgery: Symptoms, Causes & Treatment

Keratoconus is a condition of the eye in which the front clear, dome-shaped surface of the eye called the cornea thins and begins to bulge outwards in a cone shape. This abnormal curvature causes keratoconus vision to be distorted and blurry. The exact cause of keratoconus remains unknown, but it may be caused by genetic and environmental factors. Some symptoms of keratoconus are sensitivity to light, blurred vision, and prescription changes. There are several treatment methods for keratoconus, including glasses, contact lenses and keratoconus surgery. The time required to recover from the surgery varies from one keratoconus surgery to another. Treatments for keratoconus, including corrective eye surgery for keratoconus, can help improve vision.

The cause of keratoconus is not known, but there are several factors thought to play a role in the development of keratoconus

• Genetics: If someone in the family has keratoconus, there is a higher risk.
• Environmental Factors: Eye rubbing, allergies, and contact lenses can play a part.
• Underlying Medical Conditions: Certain systemic diseases, such as Down syndrome and connective tissue disorders, are associated with keratoconus.
• Oxidative Stress: An imbalance in the cornea's ability to cope with oxidative stress can compromise the structure of the cornea and cause keratoconus eye disease.
• Hormonal Changes: There is some evidence that hormonal changes, especially in puberty, can contribute to the onset of this eye condition.

It is important to identify the signs and symptoms of keratoconus to receive early diagnosis and treatment. Common symptoms include:

• Blurry Vision: Distorted and blurred vision, that may get worse over time.
• Rapid Prescription Change: Prescription changes in eyeglasses or contacts that happen often.
• Multiple images: Seeing multiple images or ghosting.
• Eye Strain: Fatigue and discomfort of the eyes, especially when performing visual tasks for a long time.

The diagnosis of keratoconus usually requires a comprehensive eye exam, which may involve the following tests:

• Corneal Topography: This is a test that maps the curvature of the cornea to identify any abnormalities.
• Pachymetry: Measurement of the thickness of the cornea to detect thinning spots.
• Slit-Lamp Examination: Using a special microscope to examine the cornea’s shape and other eye structures.
• Keratometry: Measuring the curvature of the cornea.

Treatment for keratoconus will depend on the severity of the condition and the impact it has on vision. These are the main treatment options:

• Eyeglasses or Soft Contact Lenses: These work well in the early stages of mild keratoconus.

• Rigid Gas Permeable (RGP) Contact Lenses: Offer better vision by creating a smooth refracting surface.

• Hybrid Contact Lenses: Soft and rigid contact lenses in one.

• Scleral Lenses: These are larger lenses that sit on top of the sclera (the outer layer of the cornea) and avoid the irregular cornea.

• Corneal Cross-Linking (CXL): A relatively simple process that hardens the cornea to stop the cornea from bulging further.

• Intacs (Intracorneal Ring Segments): Tiny, curved implants placed in the cornea to reshape it.

• Corneal Transplant (Keratoplasty): A replacement of the damaged cornea with a donor cornea, which is reserved for severe cases.

If surgical intervention is deemed necessary, understanding the process can help alleviate concerns and ensure a smoother experience.

Your ophthalmologist will perform a thorough examination before surgery to decide on the best procedure for you. This includes:

• Detailed Eye Examination: Evaluating the severity and progression of keratoconus.
• Medical History Review: Discussing any underlying health conditions or medications.
• Lifestyle and Visual Needs Assessment: Taking into account the impact of the condition on your lifestyle and vision needs.

The surgery will differ depending on the surgery that is performed:

• Duration: Approximately one hour.

• Process: The procedure involves the removal of the corneal epithelium (outer layer) and the application of riboflavin (vitamin B2) and controlled exposure to UV light.

• Duration: Around 15-30 minutes.

• Process: Local anaesthetic is used and the ring segments are inserted into the cornea via a small cut.

• Duration: Several hours, depending on the transplant type.

• Process: Full or partial thickness of the cornea is replaced with donor tissue.

Post-operative care is crucial for successful recovery. Here are general guidelines:

• Follow-Up Visits: Regular visits to check healing and resolve problems

• Medication: Apply eye drops as prescribed to prevent infection and inflammation.

• Protective Eyewear: Use of sunglasses or protective eyewear to prevent eye irritation and UV exposure.

• Activity Restrictions: Do not do heavy work, swim or rub your eyes until your doctor says it is OK.

Ans: The success rate of most keratoconus surgeries like CXL and Intacs, is high for stopping the keratoconus from worsening and for better vision. Corneal transplants also have a high success rate, but may take longer to recover.

Ans: Local anaesthetic is used during the procedures so that the patients experience minimal discomfort. Prescribed medicines can help control post-operative discomfort.

Ans: This depends on the procedure. CXL and Intacs typically heal within days to weeks, while corneal transplants may take months to heal.

Ans: Cross-linking is aimed to stop keratoconus from worsening and to prevent it from recurring. But regular monitoring is critical, though.

Ans: Like all surgery, there are risks involved, such as infection, scarring and vision changes. Generally, these risks are low, and your ophthalmologist will discuss them with you prior to surgery.

Keratoconus is a very tricky condition and at times it feels impossible to get a good grip on its effect. But with appropriate care and treatment, patients can really make it work for them and continue having normal functioning and good vision. Being aware of what causes keratoconus signs, symptoms, and possible treatment ways in particular involving surgery, is essential for making choices that best fit your situation. Should there be a chance that you yourself or someone close gets keratoconus symptoms, the best decision is to seek an ophthalmologist's help to find the right treatment plan for the person in question and the beginning of better eyesight in general.