Keratoconus Philippines

Is dry eye a reason that launches the boat of keratoconus ?   In  recent  years  when the pandemic ended, many new keratoconus patients sent to us by corneal specialists just had their diagnosis after the pandemic .    In  the Philippines,  community   locked   down was   more than  a year, and kids had more than a year  long  of online classes .   And  this meant prolonged hours of non-stop classes, surfing the net, gaming  and  watching Netflix.  Some facts: Patients with keratoconus  have   have   lower tear volumes and more severe dry eye symptoms   compared to  age-matched healthy controls. The prevalence of DED after the COVID-19 pandemic outbreak was 44.1%  which  was significantly  higher than the 18.7% before the COVID-19 outbreak .   Eye itchiness is one of the most common symptoms of dry eyes . 3  This would then cause eye...

KERATOCONUS, EYE RUBBING AND SLEEP POSITION EYE RUBBING Your position of sleep can cause keratoconus! Keratoconus is most often than not associated with eye rubbing. Do you know that keratoconus patients rub their eyes longer (10 to 180 seconds) than other patients without keratoconus (<5 seconds)?    Eye rubbing temporarily reduces the epithelial thickness by about 18% , and it will take about 15 to 45 minutes for the corneal thickness to get back to the baseline.    However, there are patients who deny that they rub their eyes, it has been said that there is a genetic factor that makes a patient more susceptible to keratoconus. The condition is also associated with some connective tissue disorders, allergies, and other environmental factors. Today, we talk about sleeping positions.    SLEEP POSITION AND KERATOCONUS Some studies say that incorrect sleeping positions may also contribute to the risk of developing keratoconus. A study found some associatio...

Keratoconus typically starts at puberty and progresses until the third or fourth decade of life. At initial diagnosis, younger patients with the steepest corneal curvature (Kmax) of over 55 D have a significantly greater risk of progression. Keratoconus seen at this age is more aggressive, leading to more severe cases. Without any management, the corneal curvature becomes more conical in shape, which can cause worsening of vision, thinning and scarring of the cornea, and possible development of hydrops. However, it tends to stabilize after 20 years from the first diagnosis.  To detect keratoconus progression, some corneal parameters need to be evaluated.  WHAT THE EYE DOCTOR IS LOOKING FOR? -Increase maximum corneal refractive power (Kmax) by more than 1 Diopter within one year.  -An increase in (corneal) myopia by more than 3 Diopter or astigmatism by more than 1.5 Diopter within one year. -An average corneal refractive power increase by more than 1.5 Diopter within one ...

Scleral lenses are fitted to patients with complicated prescriptions and irregular corneas. A common question I encountered is "Doc, is it safe to drink alcoholic beverages while I am wearing my scleral lenses?" . Looking into the different papers on the effects of alcoholic beverages on the eye, alcohol, similar to coffee and smoking, can induce some ocular dryness.  Studies noted the presence of ethanol in tears of patients within 6 to 12 hours after drinking alcoholic beverages. The presence of ethanol in tears may cause increased evaporation rate, increased corneal staining, and decreased tear volume, leading to dry eyes.  Unlike in soft contact lenses, the material of scleral lenses does not undergo dehydration. However, scleral lens wearers may still feel some symptoms of dryness.    It is essential, though, to be sure to be still able to remove your lenses when you get home, clean and store them properly. We have one patient who was ...

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 con...

Scarring on the cornea  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 a...

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 ...

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 condit...

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 ...

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, t he V alsalva  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 i...