Understanding Keratoconus and Laser Surgery: Options and Innovations

Refractive errors most commonly cause blurred vision. The cornea is misshapen, so the light entering your eye does not bend correctly. Nearsightedness is a result of the cornea being too oval-shaped, whereas farsightedness occurs because the cornea isn’t curved enough. Keratoconus is when the cornea bulges outward, like a cone.

Like nearsightedness and farsightedness, keratoconus also causes blurred vision. However, without proper management and treatment, it can lead to permanent vision loss. Although it can be treated with regular prescription glasses and contact lenses in its early stages, moderate to advanced keratoconus requires more intensive and sometimes more invasive treatment.

There are several treatment options available, ranging from re-strengthening the cornea with corneal cross-linking to replacing the cornea with a transplant. At Clearview Vision Institute, we specialize in conventional cross-linking and LASIK cross-linking to halt the progression of the disease and preserve your vision.

What is keratoconus?

Keratoconus is a progressive eye disease affecting the cornea. The cornea is the clear, curved outer surface of your eye. It’s what allows your eye to focus. The dome shape of the eye bends light as it enters, allowing it to focus correctly on the retina. When the cornea is diseased or damaged, your vision can become blurry.

If you have keratoconus, it means your cornea is thinning and bulging into a cone-like shape. The fibres normally responsible for maintaining the cornea’s basketball shape have loosened and, as a result, the normal eye pressure pushes outward on the cornea. This causes the cornea to transition from a sphere into a cone shape.

As the cornea protrudes outward, it becomes increasingly harder for you to see. In addition to blurry vision, you might also experience double vision, dizziness, headaches, and sensitivity to light.

Keratoconus is a degenerative disease, meaning it will continue worsening without treatment. If left untreated, it can lead to permanent vision loss requiring corneal transplantation. Symptoms typically appear in your late teens or early twenties. It occurs in approximately 1 in 1000 individuals.

Symptoms

• Blurred vision
• Double vision
• Eye strain
• Trouble seeing despite wearing glasses or contact lenses
• Dizziness
• Headaches
• Sensitivity to light
• Halos and ghost images
• Difficulty driving at night or in low light
• Eye irritation
• Excessive eye rubbing

Diagnosis

Early diagnosis is very important. The sooner that keratoconus is detected, the sooner treatment can be administered. We can slow the progression of the disease before significant damage and corneal distension occur.

It was once challenging to diagnose keratoconus in its early stages. Fortunately, modern advances have improved matters. Using advanced diagnostic tools, we can accurately diagnose keratoconus earlier than ever before. We can also monitor its progress more effectively and tailor treatment plans to slow the disease and preserve your vision.

There are several options for accurate diagnosis and monitoring of keratoconus:

• Optical Path Difference (OPD) scan
• Scheimpflug imaging
• 3D mapping of the anterior eye
• Optical Coherence Tomography (OCT)
• Slit-lamp eye exams

How does keratoconus affect your vision?

Keratoconus causes your vision to deteriorate. Blurred vision, sensitivity to light, and reduced low-light vision are common. Although it can lead to blindness without treatment, this is easily avoidable.

Proper monitoring and the wide variety of treatment options mean that keratoconus is now very manageable. There is no cure, but there are now permanent interventions that can stabilize the cornea and prevent further deterioration, such as Laser Light Transepithelial Cross-Linking (CXL), offered by Clearview Vision Institute.

How is keratoconus treated?

Contact Lenses

In some cases, contact lenses can help manage the blurry vision associated with keratoconus. Soft contact lenses (or prescription glasses) can be used in the very early stages of the disease; however, they do not stop its progression.

Rigid gas permeable lenses (or RGP lenses) can help your cornea maintain its shape. Because of their rigidity, these contact lenses do not mould to the cornea and, instead, can slightly mask its irregular shape. This also means that they can be uncomfortable to wear.

Lastly, scleral lenses rest on the white of the eye, vaulting over the cornea. Since they don’t come into contact with the cornea, they’re more comfortable than RGP lenses. Your eyes are able to breathe better, so you shouldn’t experience any eye dryness.

Intacs

Intacs (intrastromal corneal ring segments) are small prescription inserts placed into the mid-layer of the cornea to flatten it. They’re made from a thin, removable, and interchangeable plastic. Since the cornea becomes less pronounced, Intacs can improve your distorted vision, particularly once contact lenses or eyeglasses are no longer effective.

The disadvantage of Intacs is that they do not stop the progression of keratoconus. They can also be dislodged if there is trauma to your eye.

Corneal Cross-Linking (CXL)

Corneal cross-linking, also known as CXL, is an innovative treatment for keratoconus. It involves stiffening and bonding the fibres in the cornea to stop the cornea’s bulging and stabilize its shape. By creating new links between the fibres and the cornea, it strengthens the cornea, thereby stopping the progression of the disease.

Conventional cross-linking uses riboflavin (vitamin B2) drops and ultraviolet light to strengthen collagen fibres within the cornea. The riboflavin eye drops were applied directly to the cornea and then activated by ultraviolet A (UVA) light.

At Clearview Vision Institute, we offer both traditional CXL and a revolutionary, significantly improved version. Laser Light Transepithelial Cross-Linking uses a specialized laser delivery system to strengthen the cornea and improve its shape.

Corneal Transplant

Advanced keratoconus often needs to be treated with surgery, specifically a corneal transplant or keratoplasty. During this procedure, most of the cornea is removed and replaced with corneal tissue from a donor. It has a success rate of over 97%.

In 15% to 20% of cases, keratoplasty is the only therapy that can restore clear vision and reduce your discomfort.

LASIK for Keratoconus 

LASIK for keratoconus is a non-invasive procedure that stops the progression of the disease and delivers permanent improvements to your vision. It does not involve any incisions or stitches. Furthermore, the LASIK cross-linking time is only three minutes, compared to the one hour required for traditional cross-linking.

Traditional cross-linking removes the outer surface layer of the cornea, which can prolong the healing process and increase the risk of complications. LASIK preserves the surface layer, significantly accelerating the recovery process. You are less likely to have complications and less likely to need a corneal transplant in the future.

Laser Light Transepithelial Cross-Linking, offered by Clearview Vision Institute, provides improved outcomes for patients with keratoconus.

Keratoconus Laser Surgery at Clearview Vision Institute

Clearview Vision Institute is a leader in innovative vision procedures using advanced, state-of-the-art technology. We are proud to be at the forefront of vision care, introducing revolutionary procedures that are safer and more effective than their predecessors.

Our personalized approach ensures that you receive the best possible treatment. We take the time to evaluate your eye health and history, and clearly explain the details and potential complications of every treatment. At every step, we help you make an informed decision that you’ll feel good about.

To learn more about keratoconus and laser eye surgery, please contact our office in Toronto. We are happy to offer a complimentary consultation, allowing you to learn more about our treatment options and determine which one is best suited for you.

To request more information on keratoconus laser surgery, call Clearview Vision Institute today at 647-493-6371 or contact us here.