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Keratoconus (corneal collagen crosslinking)

Keratoconus (corneal collagen crosslinking)

What is it?

Keratoconus is a disorder occurring in the eye where the cornea, which is normally dome-like in shape gets worn down over time causing it to thin gradually, resulting in a more cone-shaped bulge to emerge. Normally, when light enters through the cornea, it goes past the lens and then the retina and finally to the brain which presents a visual representation of it. Due to the dysmorphia of the cornea, the light entering it gets distorted and therefore, the brain is unable to form an accurate depiction of it, or in layman’s terms it causes visual imparities.

What Causes Keratoconus?

The exact cause is still unknown. However recent studies show It is caused by a reduction in preventive anti-oxidants in the cornea, which in turn cause sub clinical inflammationin corneal substance and cause it to weaken and therefore is unable to retain that the ideal dome-like shapeand become more conical.

Cornea can also get weakened by some other factors

  • Genetic factors,
  • Excessive rubbing of the eye,
  • People with allergy-related diseases, down syndrome and some diseases relating to the connective tissue, such as the likes of Marfan’s Disease.
  • Usingcontact lenses that poorly fit your eyes continuously for a long period of time.

Risk Factors to Look out for

Genetics is one of the major players of keratoconus occurring in someone. It usually presents itself after a person passes puberty, generally in their late teens and early twenties. Although in some cases, it can also begin way earlier in childhood or later as the person ages, in their 30s and 40s.

Although keratoconus starts out pretty mildly, causing more and more damage over 10-20 years, people who have certain other medical conditions, especially related to allergic reactions can cause the effects of their disease to accelerate faster than others. Therefore, the fluctuations in the figure of cornea can take place over a long period of time or it can be rather swift.

If you have keratoconus, usually both your eyes are affected. It, but both to different degrees and the rate of progression in each eye may be dissimilar. It occurs in both males and females equally, and no ethnicity or specific part of the world is discovered to have caused more cases to emerge.

On the other hand, the effects of keratoconus can halt at any given time, or they can persist for years and years – no one can tell, and there is no way to make predictions. But they can be detected early and that could help in early treatment which will help keep the damages contained. So, if a close relative in your family has keratoconus, it is a good idea to get yourself checked as early as possible.

Signs and symptoms of Keratoconus

The earliest form of symptom that is experienced by people with Keratoconus is near-sightedness. As mentioned earlier, it causes the thinning of the cornea, and therefore objects begin becoming blurrier the farther they are, and it gets worse over time.

Some patients also experience ghost vision or halo like vision. Ghost vision is when a single object is seen as being multiple and halo vision occurs when bright lights appear with a halo-like appearance around them.

Other symptoms might include ones caused by irregular as tigmatism which can cause the vision to be either blurred or distorted. It can also cause headaches and eye strain, especially after an extended period of visual tasks such as reading.

Patients may also experience a sensitivity to light. Some people are only affected by bright lights such as sunlight and fluorescent lightings, but in some extreme cases, patients have been recorded to have felt irritation in the eyes even in mild or low levels of light.

How would your doctor diagnose you with Keratoconus?

An ophthalmologist (for your information an optometrist is not an eye doctor) will conduct an eye examination and will generally determine whether the patients displays any of the symptoms that were discussed previously. He may use a standard chart used generally in most eye tests called the Snellen Chart which has letters going from large to very small.

Further the eye doctor will go through the patient’s medical history, looking for any diseases that the patient may have that could cause Keratoconus. He will also check the medical history of the patient’s family members, namely if any of them have had the disease in the past.

In some extreme cases, aretinoscopy is performed, in which a beam of light is focused on the retina of the patient’s eye and tilted back and forth so observations can be made by the physician.

A Keratoscope, often known as “Placido’s Disk”, is a handheld device that may give patients a much more non-invasive option. While an advanced case of Keratoconus could be easily identified with this method of testing, more specialized testing may be required in the early stages of it.

A corneal to pographer may be utilized to identify the arc the cornea to determine whether it has bent out of shape. It is an automated machine which projects animated patterns onto the patient’s cornea and from their observations are made digitally.

What are the treatments available?

The most common treatment method used for Keratoconus in mild cases of it is the prescription of eye glasses or soft contact lenses to give the patients more comfort and better vision correction. Some patients may also need special contact lenses designed specifically for their eyes.

Surgery is the other treatment option available for patients with keratoconus

  • Phototherapeutic Keratectomy (PTK): This type of procedure is suggested for patients who have mild scarring on their cornea, which makes it uncomfortable for them to wear contact lenses.
  • Corneal Transplant: A doctor might suggest a corneal transplant surgery to patients where the damage to their cornea due to scarring is irreparable. The patient is put under either local or general anesthesia and the scarred cornea is removed, replaced by a clear cornea and stitched in place.
  • Intacs surgery: The surgery involves the removal of the cornea to place implants called intacs underneath, after which the cornea is then re-attached. This helps in changing the shape of the cornea to back to a normal one.
  • Cornea Collagen Crosslinking: Another ongoing development in the treatments of Keratoconus has given patients the option of cornea collagen crosslinking. This is mainly used to assist in stopping the progress of Keratoconus in patients.

Positive effects from the treatment for Keratoconus can be observed starting from the third month and may even take up to a year.

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