What to do when you have keratoconus?


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.  

Corneal Map w/ cone located inferiorly
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.  

Slit Lamp Photo 
showing corneal scars

If your case is just starting, using glasses or regular soft contact lenses for astigmatism (toric lenses) can still help improve your vision, but when the nearsightedness and astigmatism gets higher, glasses may not be sufficient in providing you with good vision.  As keratoconus progresses, the cornea adapts an irregular shape, similar to a bumpy road.  Light when casts onto the this irregular cornea will be scattered, thus keratoconus patients may complain of blurriness, glare, shadowing of vision and even seeing double or quadruple of lights at the same time. This is where special customized contact lenses come in.  The specialized contact lenses have smooth surfaces that mimic what a normal cornea needs to be. And because of this smooth surface, light reaching the cornea can be more focused thus allowing keratoconus patients to achieve good vision.  The type of specialty lenses to be used depends on the severity of your condition.  

Now let us not forget about collagen cross-linking.  The thing that you want is to halt the progression of the cones.  The only proven to be effective in stabilizing the thinning of the cornea is called collagen cross-linking.  This can be done with the corneal epithelium on or off. The cornea under ultraviolet exposure will be given drops of Vitamin B.  In doing this, the corneal fibers will be linked better and stronger to resist progression.   It depends on your corneal specialist as what he deems to be more appropriate for your case.  After collagen cross-linking, contact lenses is still needed to improve your vision.  We do not recommend to wait for the condition to be too severe as some corneal specialists do not want to do the procedure anymore when the cornea is too thin.  By the way, if you are almost 40 years old and you are reading this, you are in luck. At the fourth decade of life, keratoconus are said to be more stable due to the natural cross-linking effect of your corneas.  Humans are made that way. 

Intracorneal Ring

Intracorneal rings may also be planted on the cornea (to be discussed more thoroughly in a future blog), because this procedure flattens the cornea, it can aid to improve the vision when no eyeglass correction or contact lenses are worn.  However, if you want to have better vision still, customized contact lenses is still needed.   

Some parents would ask me if their child can live a normal life.  Well, their eyes will not be normal, but with the proper management, patient can still see beyond what they need.   They will be able to drive, they will be able to use their computers, enjoy going out with friends, get employed.  Keratoconus should not define them, limitation is created only by individuals.  Knowing that they have this condition, they can better plan their future careers.  We have already heard of pianists who are deaf, artists who are either blind or have no arms, pilots without arms and other amazing people.  Our body knows how to compensate for what is lacking, with proper guidance, keratoconus patients have endless possibilities.  

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