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Keratoconus and FAQ

What is Keratoconus?

Keratoconus, often abbreviated to “KCN”, is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment.

Symptoms and Diagnosis

The earliest signs of keratoconus are usually blurring of vision and the need for frequent changes in eye glass prescription, or blurred vision that cannot be corrected with glasses. Symptoms of keratoconus generally begin in late teenage years or early twenties, but can start at any time. Other symptoms include:

  • Increased light sensitivity
  • Difficultly driving at night
  • Halos and ghosting especially at night
  • Eye strain
  • Headaches and general eye pain
  • Eye irritation, excessive eye rubbing

Keratoconus, especially in the early stages can be difficult to diagnose and all of the above symptoms could be associated with other eye problems. Simply recognizing symptoms does not by itself diagnose keratoconus. Keratoconus requires a diagnosis from a competent eye doctor who is trained in not only recognizing the symptoms but also observing signs of keratoconus through direct measurement as well as inspection of the cornea at a microscopic level using a slit lamp.

Who gets Keratoconus?

The actual incidence of KCN is not known. It is not a common eye disease, but it is by no means rare. It has been estimated to occur in 1 out of every 2,000 persons in the general population. Keratoconus is generally first diagnosed in young people at puberty or in their late teens. It is found in all parts of the United States and the rest of the world. It has no known significant geographic, cultural or social pattern. Whereas KCN has not been linked to genetic markers, it has been known to run in families. One widely accepted theory is that KCN has been linked to aggressive eye rubbing. Much like that of habitual fingernail biting, eye rubbing is a learned behavior and thus can run in families as well.

What happens?

The cornea is the clear window of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea severely affect the way we see the world making simple tasks, like driving, watching TV or reading a book difficult.

In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to light. These symptoms usually first appear in the late teens and early twenties. Keratoconus may progress for 10-20 years and then slow or stabilize. Each eye may be affected differently.

Living with KCN

People react differently to the news that they have keratoconus. Lack of knowledge often creates fear, so learn all that you can about this condition. Ask questions and discuss your concerns with your doctor and others who have keratoconus. This will be both enlightening and reassuring. While it is important that you accept keratoconus as a fact in your life and realize that you have to adapt to it, it is essential for you to understand that adapting is not surrendering. From a medical standpoint, the most important thing you can do is to keep in touch with your eye care practitioner and follow his/her instructions.

FAQs

No, historically very few, if any, persons suffer from total blindness from keratoconus alone. Legal blindness and partial-sightedness/low vision can occur and one’s vision can be significantly impaired to the point that normal everyday activities may be difficult. This said, true blindness has to do when the retina or optic nerve have been damaged. Therefore, Keratoconus cannot directly cause blindness. Finally, if keratoconus has significantly affected your vision, there are treatment options available to help rehabilitate your eye.

Keratoconus invariably does get worse in the majority of cases, however progression is difficult to predict. In some cases it changes very little from the time it is first diagnosed. In other cases, progression occurs rapidly over a relatively short period of time. The younger the patient is when keratoconus first appears, however, the more chance there is that it will progress significantly, particularly during the teenage years. It is very important to control any allergies which affect the eye during this time, so that any eye rubbing can be avoided.

Most experts believe that keratoconus is always bilateral – that is, that it always affects both eyes. However, because of variability, the condition may be so mild in one eye that it is virtually undetectable. It may stay that way or the better eye may progress over time. Unfortunately, there is no way to know which will occur.

No, keratoconus is a corneal thinning condition and LASIK is a corneal thinning procedure. Surgically making a thin cornea thinner will weaken an already weak cornea and speed the progression of keratoconus thereby exacerbating the condition.

A corneal transplant is an invasive surgical procedure, requiring the removal of a section of your cornea and having it replaced with donor tissue. The transplant carries risks such as infection, rejection, cataracts, glaucoma, astigmatism, failure as well as intra-operative dangers. Young keratoconus patients are likely to need one or more repeated grafts during their lifetime. Although an extremely successful outpatient surgery, it does take one year to recover vision from a cornea transplant.

The Cross-linking procedure is an outpatient surgery that works by increasing collagen cross links which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular. Cross linking involves creating a superficial scratch on the cornea which is much less invasive than a cornea transplant. It is much safer than a corneal graft and takes about one week to heal significantly from this procedure. Having cross linking does not eliminate the possibilities of having a cornea transplant in the future. This said, patients with cornea transplants cannot have cross linking at this time.

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