What Are My Keratoconus Treatment Options?

Do you have keratoconus? It may seem like there’s nothing you can do, but that’s not true!

Keratoconus is a progressive eye condition where the cornea pushes outward into a cone shape. If you have keratoconus, you may be sensitive to glare and light.

Having a misshapen cornea can cause blurry vision and is most common among people aged 10 to 25. Keep reading for some treatment options to consider if you have keratoconus!

Glasses or Soft Contacts

Woman comparing eyeglasses to contact lenses

Keratoconus develops slowly. You may not notice symptoms at first if you have this condition. Eventually, your vision will blur, making it harder to see things around you.

Keratoconus can be diagnosed by your eye doctor during a comprehensive eye exam.  Often a special test called topography is done to map the steep part of the cornea.

For people in the early stages of keratoconus glasses and soft contact lenses may be a great option. They will temporarily correct vision impairments.

You may have keratoconus in one or both eyes. Your eye doctor can prescribe glasses or contact lenses with different powers in each eye if needed.

Contacts that have a wider diameter provide stability. You may feel more comfortable with this option because they don’t move around as much when you wear them.

Scleral or Rigid Gas Permeable Contacts

Scleral Contact Lenses

People who have advanced keratoconus may need to wear scleral or rigid gas permeable (RGP) contact lenses. These lenses are customized to fit over the cornea and provide a more spherical shape.  This allows light to be refracted into the eye more precisely, providing better vision.

RGP lenses are typically smaller than soft contact lenses and rest on the cornea.  Scleral lenses are larger than the cornea and rest on the sclera or white part of the eye to reduce distortions.  Scleral lenses are often more comfortable than RGP lenses and have become the most popular treatment option for patients with keratoconus.

If you wear scleral or RGP contacts, you will need more frequent visits with your eye doctor to ensure a proper fit.  As keratoconus worsens, you may need updated contact lenses.  Getting a proper fit is critical in making the contacts comfortable.

Scleral and RGP lenses last longer than soft contacts because they won’t rip or tear. One pair may last for a year. However, you might have prescription changes, meaning you’ll need new contacts before then.

Scleral or RGP contacts can provide better vision than soft contact lenses. They won’t change shape or lose clarity like soft lenses. People with astigmatism also prefer the improved fit of these lenses.

Corneal Cross-Linking

Less Cross-linking (weaker) vs More Cross-linking (stronger)

Another treatment option that’s available for keratoconus is corneal cross-linking. Also known as corneal collagen cross-linking or CXL, cross-linking is a minimally invasive procedure that can slow down keratoconus progression.

This procedure increases the strength of the corneal tissue to prevent bulging. CXL is best for people with mild keratoconus that is showing signs of progression.  It is often done at a younger age, as keratoconus often stabilizes by the time a patient has reached their 30’s.

CXL is an outpatient procedure that takes less than an hour.  Most patients can return to their daily activities within 24 hours of having the procedure. During epithelium-off CXL, your surgeon will remove the outermost layer of tissue on the cornea, which is the epithelium.

After removing the epithelium, they will apply eye drops made with vitamin B called riboflavin to the cornea.  After applying the riboflavin drops, your surgeon will use ultraviolet light to activate the drops’ vitamin B. With this combination, the bonds between collagen molecules in the cornea become stronger or “cross-linked.”

Some people get epithelium-on CXL or transepithelial cross-linking. With this version of corneal cross-linking, the epithelium stays intact and isn’t removed. This option has a lower risk of infection and a faster recovery time.

For patients with keratoconus in the early phase, corneal cross-linking is now the preferred treatment for stopping its progression.

Intacs®

Intacs

If you have moderate-to-severe keratoconus, you may be a suitable candidate for Intacs. Intacs are clear, thin inserts called intrastromal corneal ring segments (ICRS).   They are crescent-shaped pieces of a plastic polymer and are placed in the cornea’s outer edge and help to erase or reduce astigmatism and nearsightedness. They can also help to flatten the cone for patients with keratoconus.

The Intacs procedure is best for people who are no longer finding relief when they wear glasses or contact lenses, or if it has become difficult to fit contact lenses due to the advanced steepening of the cornea.

During the Intacs procedure, your surgeon will use a femtosecond laser to create a small channel. Then your surgeon will insert the Intacs segments into the channel.  The procedure takes about 15 minutes.

After having Intacs surgery, many patients find that it becomes more comfortable to wear contact lenses. You may also notice that your vision is better when you wear glasses or contact lenses only a few days after having Intacs implanted.

Corneal Transplant Surgery

Corneal Transplant

If you have severe keratoconus, you may need a corneal transplant. This procedure is also known as keratoplasty. Often, your eye doctor will try some of the previously mentioned treatment options to avoid a corneal transplant.

A corneal transplant may become necessary if you have severe corneal thinning or if you’ve attempted using specialty contact lenses and you still cannot see well.

During a corneal transplant, your eye surgeon will use lasers to remove all or half of your misshapen cornea. After removing the appropriate amount of your misshapen cornea, they’ll replace the tissue with donor corneas.

There is a chance that after having a keratoplasty, your body may reject the tissue or develop glaucoma after the procedure. Patients who have keratoplasty often take medications for years to ensure their transplants remain successful.

Diagnostic Eye Center is a full-service eye health practice. Our experienced team provides eye exams and prescription glasses and contacts. We also treat common conditions like dry eye, glaucoma, and keratoconus.

Are you wondering if you may have keratoconus? Schedule an appointment at Diagnostic Eye Center in Houston, TX, today!