Treatment of Keratoconus

Keratoconus is a disease affecting people from preteens to the elderly. At New Jersey Contact Lenses we spend much of our time and energy working with people who have this disease.

Our goal is to be able to get you to see all the things you need to, and to do so comfortably. We do not want you spending your time thinking about your eyes. We want you to get on with the things you want to do! None the less getting to that point requires patience, but the end result is well worth the effort- to have the best possible vision you can achieve with contact lenses.

Usually by the time we see you in our office, you are at the point where glasses are not giving you adequate vision. There are many options of contact lenses to provide you with much better clarity of vision.

Soft toric (corrects astigmatism) lenses may work for mild cases of keratoconus.

Gas permeable lenses are also available. These lenses tend to be your best option for keratoconus because they give you the best clarity of vision.

Hybrid contact lenses These lenses provide the crisp vision of a rigid contact lens, but also have a soft “skirt” which can sometimes offer better comfort if a patient in rigid contact lens intolerant.

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Piggyback lenses (a soft lens fit under a rigid contact lens) can also be used to offer better comfort. If a patient is having a difficult time being fit with a rigid lens, or unable to tolerate the comfort of the rigid lens, this is also a great option to consider.

Intacts are also a surgical option for mild cases of keratoconus. This is when a crescent shaped implant is inserted into the cornea to help reshape the cornea for better vision. These implants can also be used as a device to help to better fit a contact lens.

When a patient has advanced keratoconus and adequate vision cannot be achieved with a contact lens (due to scarring for example), a Penetrating keratoplasty is considered. This is a corneal transplant where the keratoconic cornea is removed and replaced with a donor cornea. This surgical procedure may allow you to no longer need contact lenses, or in most cases- provide a clear cornea to work with so that a rigid contact lens could be fit more successfully.

The Eye:
At the very front of the eye is a clear tissue called the cornea. This tissue is clear so that light can pass directly through it to reach the retina. Contact lenses are placed on the cornea to provide adequate vision. Behind the cornea is a fluid called the aqueous. Behind the aqueous is the colored part of the eye called the iris. The iris has a black circle in the center, the pupil, which also allows light to reach the retina. Posterior to the iris is the lens – the part of the eye that focuses to let us see things that are close and relaxes to let us see things that are distant. The eye is actually a hollow ball filled with a gel-like substance called vitreous. The vitreous pushes from the inside and holds the retina against the rest of the eye. The retina is the sensory part of the eye that allows us to see images.

What is Keratoconus? Using simple language
Keratoconus is a disease where the front part of the eye becomes thin and less smooth; the cornea becomes distorted making it hard to see clearly. Some people with Keratoconus can use glasses to improve their vision; more frequently however, contact lenses are required for visual correction.

People usually discover they have Keratoconus in 2 ways: either they find that the new glasses or contact lenses they bought recently are no longer working, or they have always had trouble seeing clearly and they attempted to get refractive surgery. In the screening for refractive surgery, Keratoconus is an absolute contra-indication.

People with Keratoconus CAN NOT get LASIK

What to Expect
The progression of the disease varies and for every patient it is different. For the most part, Keratoconus develops gradually in one eye and faster in the other. In most cases, the progression slows as you get older and can completely stop; the progression can also start again or remain stable forever. The CLEK (Collaborative Longitudinal Evaluation of Keratoconus) study found some diseases are associated with it more than the normal population, but we still do not know its causes.

Typically, vision loss can be corrected early by spectacles; later, irregular astigmatism makes functional vision without rigid contact lenses impossible. Although most patients can continue to read and drive, others feel their quality of life is adversely affected. It is important to know at the time of the initial diagnosis that it is very likely contact lenses will be required later on. The new smooth front surface of the contact lens will give the patient a much better chance to see by compensating for the irregularly shaped cornea.

Some professionals feel that corneal scarring is secondary to contact lenses. I have seen many patients without contacts, who have never worn them, to have scarring. With a proper fit I feel that scarring secondary to contact lenses is less common than often thought. Eye examinations will be required at least annually to monitor the progress of the disease. At New Jersey Contact Lenses we request our gas permeable lens wearers return every six months to monitor the health of the cornea.

Intacs for treating Keratoconus. Intacs® is a pair of plastic arcs inserted into the cornea to flatten the center. Intacs®, while not always successful, are thought a good alternative to transplant. It is our feelings that they can forestall the transplant. While some people are able to return to contact lens it is not that simple. For a complete explanation of Intacs® please visit their website

According to the National Keratoconus Foundation, only 20-25% of those with keratoconus ultimately require penetrating keratoplasty (PKP)…the technical term for corneal transplant. For those individuals who do, it is a crucial and sometimes frightening decision. However, those who know what to expect before, during and after surgery are better prepared and feel more in control of their health care. During the transplant, the keratoconic cornea is replaced with a donor cornea and held in place by sutures. Suture removal occurs at different times for different patients and depends on the rate of healing, which is faster in younger people. The majority of keratoconus patients have their sutures removed 6-12 months after surgery.

Dr. McGlone defines three different levels of success for a transplant: the first being the surgeon’s satisfaction, the second the patient’s satisfaction and the third is comparing the outcome to the standard result that is expected. The surgeon has performed a successful procedure if there is no rejection and the cornea remains clear with no central scarring. The patient generally considers it successful if they never need glasses or contacts again. A small percentage of transplant patients do obtain uncorrected vision good enough that neither glasses nor contacts are required. However, one thing to keep in mind is that many individuals will need some form of correction even after the transplant. The difference is that the overall vision is usually much improved from before the transplant. Most surgeons only allow their patients to use gas permeable lenses after transplants.

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