Keratoconus literally means ‘conical or cone-shaped cornea’. The cornea is the clear tissue that covers the front of the eye, and is its major focussing surface. It is normally round but with keratoconus, it becomes stretched and thin near its centre, and slowly transforms to a cone shape. The distorted cornea affects the focusing ability of the eye impairing the vision, due to associated irregular astigmatism and myopia.
Keratoconus patients develop progressive corneal bulging/protrusion due to an weakness of the corneal collagen. Keratoconus usually begins in the late teens to early 30s and affects men and women. It produces significant symptoms in 1:2000 of people, but mild cases occur up to ten times more often. One or both eyes may be affected. Keratoconus may begin in one eye and later involve the other
The main symptom of keratoconus is blurred vision even with glasses. Patients usually seek corrective lenses at first for driving or reading. Keratoconus at this stage is difficult to differentiate from other more common vision defects. The glasses prescription increases with time and usually shows high levels of myopia (short sightedness) and astigmatism. (distortion of vision) Some patients have glare driving at night or from sunshine. That is why
That is why rigid gas permeable (RGP) hard lenses and to a lesser extent, intracorneal rings can give the best visual outcome in keratoconus cases, as they both can correct the highly irregular surface of the cornea.
If the distortion of the cornea worsens, so will vision. This happens in some patients but in many the condition stabilises. It is not possible to predict whether keratoconus will be progressive or at what rate it will worsen but in general the younger the age and the more severe the disorder when it begins, the more rapidly it is likely to deteriorate. Keratoconus symptoms
One way Dr Ahmad Khalil make early diagnosis of keratoconus, is when he finds rapid progression in the glasses measurement he makes for his patients espicially at the late teens stage, which is the commonest time in life that keratoconus usually occurs in.
Actually no, many cases with mild keratoconus exist with no sypmtoms at all. Many of these cases stavilise spontaneously with no need to any treatment for keratoconus.
When the curvature and distortion of the cornea increases, keratoconus patients begin to feel its symptoms. It is important to remember that not all cases of keratoconus progress to a degree that affect eyesight.
Dr Khalil mentions that it is not easy to know which cases will stabilise, and which cases will progress, and consequently need collagen crosslinking to stabilise the keratoconus. Generally speaking, progression most commonly occurs in late teens.
Gross cases of keratoconus can be seen even by the naked eye. Moderate cases can usually detected by a specially designed microscope at Dr Khalil office, called the slit lamp. Retinoscopes and keratometers are used to measure eyes for glasses and contact lenses: in keratoconus they show abnormal readings. The cornea topographer is the most important diagnostic device: it makes a map of the cornea surface and accurately measures the keratoconic protrusion. Dr Khalil uses the Pentacam system, which is one of the most advanced systems in this regard today. Diagnosis of keratoconus
One of the commonest ways nowadays Dr Khalil can diagnose early keratoconus is people coming to seek laser vision correction. An important test to be done before making final decision is this corneal topography using the modern Pentacam System..
NO
In the rare occasions early keratoconus is detected, laser vision correction is aborted, and necessary management for keratoconus is carried out.
Many keratoconus cases have their early diagnosis for the first time when visiting Dr Khalil eye clinic for other purposes. This early diagnosis of keratoconus helps largely in the early treatment of keratoconus cases, preventing their further deterioration
Contrary to many common eye conditions, keratoconus and ectasia do not have a single preferable solution. There are many new modalities for treatment, and for each case there is one or more specific treatment which is most useful for this particular case. Sometimes, it is collagen cross linking, other times it is ring implantaion and other times lens implantation or contact lens, and frequently a combination of one or more of these done one after another. In advanced cases, which does not respond well to these lines of treatment, corneal transplantation or keratoplasty can be the best treatment for keratoconus
No, in many instances, keratoconus can only be a mild disease which does not affect the eyesight much, and if these cases are stable, then no special treatment is required
Timely treatment of keratoconus is of utomost importance. Not only it can stop the disease, but also has the best possible results in eliminating symptoms of keratoconus. Some modalities of treatment are only possible in the beginning of the disease, like collagen crosslinking and RGP lenses. In advanced cases ‘hydrops’ can occur: this is the sudden onset of discomfort, redness and reduced vision caused by a split in the inside of the cornea. It usually clears after a few weeks but may leave permanent scarring. A ‘proud nebula’ is a small white scar at the tip of the keratoconic protrusion: it may worsen vision and glare and decrease contact lens comfort. Keratoconus symptoms
