Keratoconus – What You Need To Know
Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. Symptoms and Signs of keratoconus can occur in one or both eyes and often begin during a person’s teens or early 20s. A comprehensive eye examination combined with specialized instrumentation can diagnose keratoconus even in the earliest stages.
What Causes Keratoconus
New studies are showing that the corneal tissue weakens due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from free radicals causing it to weaken and bulge forward. There might be a genetic predisposition to keratoconus as it often affects more than one family member.
Keratoconus has also been associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses.
In the early stages of keratoconus, glasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes more irregular, glasses and regular soft contact lenses no longer provide good quality vision.
Treatment options typically fall into two broad categories, specialty contact lenses and surgery. At Abbey Eye Care we specialize in fitting all different types of specialty contact lenses to optimize your vision and improve your quality of life. We also partner with several surgical centres in the GTA to co-manage and direct patients towards the most appropriate surgical option when appropriate.
Gas permeable or RGP contact lenses. These lenses are made of a rigid plastic material that enables the lens to ‘vault’ over the cornea, replacing it’s irregular shape with a smooth, uniform refracting surface to enhance vision. RGP lenses typically are less comfortable than soft contacts. In addition, fitting RPG lenses over a keratoconic cornea can be difficult and require frequent visits to your Optometrist to fine tune the fit.
Hybrid contact lenses. The Ultrahealth contact lens manufactured by SynerEyes combines the optics or vision of a hard RGP contact lens with the comfort of a soft contact lens. The centre of the lens is comprised of a hard RGP lens, surrounded by a soft ‘skirt’. Comfort and vision with this lens tends to be very good.
Scleral Lenses. These are large diameter hard RGP lenses, typically 40% larger than a standard hard RGP lens. They are large enough so that they land or sit on the white part of the eye and do not touch the cornea whatsoever. Despite the large size of these lenses they tend to be very comfortable to wear as they do not rub the sensitive cornea. Insertion and removal can be a challenge with this lens but with proper instruction and technique that can easily be overcome.
Custom Soft Lenses. The Kerasoft IC contact lens from Ultravision is a revolutionary soft lens design for irregular corneas. Complex geometrics and mathematics create a lens that offers good comfort and vision for patients with keratoconus.
Corneal Collagen Crosslinking (CXL): This procedure strengthens the corneal tissue to halt the bulging of the cornea. The cornea is bathed in riboflavin, a type of B vitamin, and then activated with UV light. The goal of CXL is to slow down or stop the progression of keratoconus and in some cases actually improves overall vision as well. The Ontario government (OHIP) is reviewing whether or not to make this procedure a covered service.
Intacs. These are surgically implanted plastic inserts placed just under the surface of the eye to help reshape the cornea and provide clearer vision. The implants also have the advantage of being removable and exchangeable. The procedure takes only about 10 minutes. OHIP at present does not cover this service.
At Abbey Eye Care we have the expertise, specialized equipment, and experience to manage your keratoconus. Our goal is to provide you with the best possible comfort and vision if you choose to be fitted with contacts or to work with you and your surgeon if you desire a surgical treatment option.
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