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Can I Still Have 20/20 Vision Even with Keratoconus?

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It is often disheartening to learn that one has keratoconus.  But somehow, it gives a sort of relief as the vision issues being experienced before while growing up has a name and can now be managed appropriately. According to the American Optometric Association, keratoconus is a condition that occurs when the normally round cornea (outer, transparent part of the eye) becomes thin and cone-shaped.  This irregularity prevents the light entering the eye from being focused correctly on the retina which then causes distortion and blurring of vision.  
Growing up, parents would notice that there was a need to change the prescription of their child more frequently.  It seemed that the prescription was always taken incorrectly, and your child’s astigmatism and nearsightedness got higher with each vision examination. Then eventually, the prescription was not enough to provide the patient with the usual coveted 20/20 perfect vision with their glasses or conventional contact lenses.  And it is be…

Is Corneal Transplant Needed in Keratoconus Patients?

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Does a scar on the cornea in a keratoconus patient mean it is time for corneal transplant?   

Keratoconus we know can cause deterioration of vision due to the high nearsightedness and astigmatism brought about by the irregular corneal surface.  You can imagine a road with a hilly peak. When keratoconus progresses, that peak can have scarring which makes the vision turn worse. Oftentimes patients would just see shapes and shadows and have difficulty recognizing images. At this time, it seems discouraging, but before jumping into the decision of a definite corneal transplant, why not try to have contact lenses fitted?  In a more advanced condition, the contact lens of choice will be scleral lenses.  Unlike small gas permeable lens which can pop out and be unstable in advanced cases, scleral lens vaults the entire cornea and so is stable and comfortable on eye.  Scleral lenses make the cornea artificially smooth, allowing better quality of light rays to enter the eye.   With corneal scar…

What to do when you have keratoconus?

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Many people freeze when they get their eye doctors's diagnosis that they have KERATOCONUS.   A lot would go into the denial stage, but the weak-hearted ones go into depression. 

Keratoconus is a progressive condition that makes the front transparent surface (cornea) of the eye thinner.  It is a disease correct, but it can be managed; and it is better to act early and not bury yourself under your sheets for a very long time.  
Chances are if you are already diagnosed to have keratoconus, you may already have a corneal map.  This map will show where the cone of your eye is and help corneal specialists and optometrists know what is the best possible management that they can recommend to you.  A detailed slitlamp examination will also reveal if you have scarring on the eye.  The size of the scar, depth and position of the scar will also help determine if you will be able to still achieve good vision with contact lenses or not.  
If your case is just starting, using glasses or regular…

Hydrops in Keratoconus

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Heard about corneal hydrops?  This is a not so common complication found in patients with advanced keratoconus.   What exactly happens when you develop corneal hydrops?  The normal average thickness of a cornea is about 550 microns.  When we were studying, our professor often says that it is thinner than a credit card.  So, a patient with keratoconus may have corneas thinner than 500 microns, the thinnest so far I have seen is about 200 some microns.  Now, when the cornea continues to thin down, some layers may break, which can cause fluid from the internal environment to leak out.  In hydrops, the Descemet's membrane, which is the 4th layer of the cornea, ruptures, when this happens, the aqueous fluid inside the eye may leak towards the stroma-- the 3rd corneal layer--- causing corneal swelling. You may develop blurring of vision, glare and pain.  When this happens, you have to quickly go to your corneal specialist who will be managing the condition.  Conservatively, acute hydrop…

Can Wearing Contact Lenses Stabilize My Keratoconus?

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When patients come to the clinic for contact lenses, many would think that contact lenses can help stabilise their keratoconus.  As much as we would like to say yes, the answer is no.  Contact lenses can only improve your vision and they do not prevent the progression of your keratoconus. It is therefore important that you consider collagen cross linking early on as this procedure makes the corneal collagen fibrils stronger and more resistant to coning, thus stabilising your condition. 

Good news though for those who have reached 30's because by the 4th decade of life, there is a natural cross-linking effect, which basically stabilises your condition.  This is the time that you can say, it is good to be 40...😀


Another common question is that if contact lenses can provide 20/20 vision.  It really depends on the severity and the condition of the cornea.  No doctor can promise you a 20/20 vision.  We can just promise that we can maximise your vision so you can be functional and get ba…

Can You Do Weight Lifting If You Have Keratoconus?

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Many patients are asking if they can still do weight lifting since they have keratoconus.  During weight lifting, in order to carry tons of weight, a powerlifter may utilise a breathing pattern which involves  Valsalva manoeuvre.  According to wikipedia, the Valsalva manoeuvre is performed by moderately forceful attempted exhalation against closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon. Other situations where Valsava manoeuvre is done are during diving, hyperbaric oxygen therapy, air travel and sometimes even going to the restroom doing your number 1.  
According to Findley, Keating and Toscano (2003), the Valsalva manoeuvre is commonly used in powerlifting to stabilise the trunk during activities such as squat, deadlift, and bench press.   So what happens to the cornea when Valsalva manoeuvre is done?  A study by Drun et al (2017) recorded the measurements of the corneal curvature, central corneal thi…

Eye Rubbing Due to Eye Lashes Poking The Eye

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When you asked keratoconus patients, almost all would say that they indeed had a history of eye rubbing.  I always tell patients that the eyeball is similar to a bread, when you try to use your hand to squeeze the bread, some portion will be dented.  Similar to it, the cornea, when rubbed may be dented in one area.  The difference in the curvature produced by eye rubbing can lead to astigmatism.  Eye rubbing can produce surface irregularity on the cornea and triggers keratoconus in some susceptible patients.  
Why do patients rub their eyes?  Eyes can be itchy due to allergies.  When allergies are found, it is important to rule out the cause and manage it well. Anti-histamine medicines can be taken, but if the allergy is only found on the eye,  then anti-histamine drops can be used to control the itchiness.   Sometimes, mechanical issues such as eyelashes growing inwards (photo above), which poke the cornea can cause the eye to be irritated.  Irritation of course will lead to patients …