5 Keratoconus Treatments

Keratoconus is a degenerative corneal disease that results in blurred vision and often requires scleral contact lenses to correct vision or even a corneal transplant in advanced cases. In today’s video I’ll cover all the treatments for this disease.

Welcome back to the eye school blog, with me Dr. D, where I teach you about products and treatments related to dry eye syndrome and eye beauty so you can have healthy, beautiful, comfortable eyes. I am so excited to share with you what I believe are the most effective and eye safe treatments for Keratoconus.


All About the Standard Keratoconus Treatments


Traditional Glasses/Contact Lenses - traditional spectacle prescriptions and soft contact lenses will only work in the treatment of keratoconus typically very early in the disease process. Because Keratoconus causes irregular astigmatism and traditional glasses and soft contact lenses are meant to correct regular astigmatism, these are just not the best treatment options for keratoconus.


Many of my patients with keratoconus do have back up glasses that they can use in a pinch, but generally their best corrected visual acuity in these glasses is much less than it is in their hard contact lenses.


Hard/Scleral Contact Lenses - in keratoconus the irregular shape of the cornea degrades image quality so vision correction is needed in most keratoconus patients. This is particularly challenging in keratoconus patients and often requires a very tailored approach. In early keratoconus you might be able to wear glasses or soft contact lenses, however as a disease progresses in the corneal con protrudes more glasses or soft contact lenses no longer provide sufficient vision correction.


Hard lenses are much more effective because their rigid structure allows them to VAULT the irregular cornea, trapping tears beneath and creating a new, regular refracting surface.


Specialized Contact Lenses Available to Treat Keratoconus


Piggy-back Lenses - piggybacking lenses refers to the practice of using a soft bandage contact lens first with a hard lens over top. This is perfect for patients who cannot tolerate an RGP alone.


Hybrid Lenses - Hybrid lenses emerged as an option for patients who couldn’t tolerate the traditional small diameter RGPs. Hybrid lenses consist of an RGP in the middle with a soft lens skirt around the outside of the lens. The most popular type of hybrid lens is called synergeyes.


RGP lenses - Traditional RGP lenses are still a great treatment choice for keratoconus. Your doctor has the ability to customize to your eye, and may go with a wider diameter design or mini-scleral before moving you to scleral lenses.


Sclerals - In extremely protruding cones, fitting a hard contact lens may become difficult. Patients may benefit from larger diameter lenses that lie on the white part of the eye (the sclera) and vault over the cornea without touching its surface. Such hard contact lenses are referred to as scleral lenses. In general, these lenses are very comfortable to wear and provide excellent vision in select patients.

PROSE lenses - A special subtype of scleral lenses is called PROSE (prosthetic replacement of the ocular surface ecosystem). This prosthetic device may be especially useful in extreme cases of keratoconus, and is generally reserved as a last resort before a corneal transplant is considered.


All About the Most Cutting Edge Keratoconus Treatments


Corneal Cross Linking - corneal cross-linking as a little bit newer in the United States but it has been performed successfully around the world for at least the past decade. It’s a minimally invasive advanced therapy that slows down or stops the progression of the corneal deformation of care to conus by making your collagen bonds in the cornea stronger; this allows the cornea to be very stiff and stop bulging out.


Corneal cross-linking is an in office procedure that involves three steps it’s done by an ophthalmologist and first you’re going to have your cornea numbed with eye drops and then they’ll gently the bride or remove the outer layer of your cornea instep two they’ll put special vitamin drops which are riboflavin on your eye many times over 30 minutes or more and finally in the third stop those shine a special ultraviolet light on your eye for another 30 minutes and keep adding drops. The vitamin drops and ultraviolet light work together to make collagen bonds in the cornea stronger allowing it to get stiffer and stop bulging out.


Intacs Implants - Intacs is the brand name of intra corneal ring segments that I’ve seen in my patients. Intracorneal ring segments are plastic, shaped like a C, and inserted within the cornea in order to flatten the surface allowing it to refract light better. The procedure is done in the office and takes about 15 minutes.


During the procedure small tunnels are formed between layers in the stroma which is the middle of your cornea and the implants can be placed inside those tunnels. Intracorneal ring segments do not always correct vision fully. I have seen many cases in which contact lenses were still needed to correct vision. In addition implants do not hold the progression of the disease so while it is an effective treatment option it is not a cure.


Cornea Transplant - cornea transplant for care to conus are usually saved for the advanced stages of the disease. Once we’ve tried corneal cross-linking soft and hard lenses and we no longer can improve your visual acuity, it may be time for a corneal transplant. Corneal transplant happens on an outpatient basis. The surgery usually takes about an hour to complete.


In a corneal transplant the cornea of the patient is carefully removed and a donor cornea is sewn into place using stitches corneas I received from recently deceased persons with the permission of their next of kin. After a corneal transplant vision can be very blurry and you must take medication a Steroid Continuing to avoid rejection of the cornea as with any transplanted tissue within the body. After corneal transplant glasses or even hard contact lenses are necessary to provide your best clearest vision even after the surgery.


Feel free to comment if you have used any of these treatments successfully or unsuccessfully for your Keratoconus, we deeply appreciate feedback and are always looking to learn more!


Reference Links:

Updated Review https://www.sciencedirect.com/science/article/pii/S1367048421002058

https://www.hopkinsmedicine.org/wilmer/research/cornea/keratoconus/treatments.html

https://medcraveonline.com/AOVS/piggyback-lens-system-in-the-management-of-keratoconus.html

https://keratoconusdoctors.com/synergeyes-hybrid-contact-lenses/