Keratoconus Treatment

Keratoconus is a disease that manifests as the progressive bulging and steepening of the transparent layer in front of our eye, known as the cornea. Initially, it starts in one eye, and then may appear in the other eye.

Thanks to today's technological possibilities, patients can investigate their complaints and identify their conditions earlier, making keratoconus a more frequently discussed issue in recent years. The visual disturbances caused by this condition can range from visual impairment, reduction of visual quality, to loss of depth perception.

These symptoms can vary from person to person; however, it is not a congenital condition. In very early stages, there can be types of keratoconus that do not show intense symptoms, do not cause any visual impairment, and do not bring the individual to see a doctor. However, during routine eye examinations, children or young individuals who continuously have changing glasses prescriptions and despite this, still do not see well, can be observed.

In this age group, changes in eye prescription are already expected, but in keratoconus, myopic and astigmatic prescriptions progress more rapidly, and with this progression, these children find that they are not receiving the expected benefit from their glasses. Special attention should be given to these patients. Additionally, early-stage complaints mentioned include glare, distorted vision (seeing an object as bent), increased ghosting (seeing multiple images of one object at once), and deterioration of night vision. It is particularly observed earlier among patients with allergies who constantly rub and scratch their eyes, causing trauma due to these actions.

There is a close connection between them. The coexistence of allergy and its development is very significant. Our country is a region where this condition is commonly seen in this regard. With allergies, tearing, itching, and crustiness of the eyes lead to vigorous rubbing, which over time can pave the way for keratoconus.

 

Keratoconus is especially observed more frequently in our country in regions where heat and allergies are prevalent (Southeastern Anatolia Region). It can emerge particularly around the ages of 15-16, that is, during adolescence, but it can also be seen at earlier ages. Having an annual eye check-up and paying attention to symptoms is essential. This eye condition can progress until the ages of 35-40. After the forties, it has not been observed to progress extensively. However, the frequency of occurrence and advancement in younger ages is definitely higher. Also, since it is a genetically inherited disease, individuals with a family history of this condition must have annual eye examinations.

 

The diagnosis of the disease is identified through routine eye examinations in patients with progressively increasing prescriptions, in suspected individuals, or in those with a family history of this condition through certain tests we perform. Particularly, we can reach results within minutes through a detailed scanning method known as corneal topography. We frequently use corneal topography both in the early stages of the disease and during follow-ups.

In patients with keratoconus who are no longer progressing (ages 35-40), we can recommend glasses and contact lenses to enhance the quality of vision. These lenses, specifically designed for keratoconus, were previously only available as hard lenses, but now include semi-hard lenses, soft-center hard lenses, and hard lenses. Patients needing contact lenses must be somewhat patient since finding the right lenses can take time and experimentation. This fitting and adjustment process can take sometimes 2 hours or even 6-7 hours. If the patient still struggles with wearing contact lenses and glasses, the Circular Treatment Method is recommended for those who meet the conditions.

Treatments for this condition are personalized, meaning different procedures can be applied to each patient. Currently, the most common surgical application in keratoconus treatments is known as Cross-linking, or in common terms as riboflavin treatment. This is a procedure that halts the progression of the disease.

In the Cross-linking procedure, topical anesthesia is used. First, a very thin layer of epithelial tissue is removed from the cornea. Subsequently, riboflavin vitamin is instilled for 3 minutes at intervals over the course of one hour, and in the final stage, 30 minutes of ultraviolet (UVA) light exposure is applied. After the procedure, it is not necessary for the patient to keep the eye covered. After a check-up on the first and third days, the contact lens placed for protection is removed. Patients may experience blurred vision for some time after the operation, but this period is temporary. It is also very important for the patient to use their eye drops regularly after the procedure. The primary aim of this procedure is to stop the disease. After this procedure, glasses or keratoconus-specific contact lenses are recommended. If the patient is still not satisfied with the quality of vision, other treatment methods are suggested.

The second treatment method is the circular treatment method, also known as corneal ring treatment. The goal of this method is to improve the quality of the patient's vision. It is preferred among patients unsuitable for contact lenses. Previously, this method utilized a knife, but now a femtosecond laser creates the channel in approximately 10 seconds, and placing the ring takes 1-2 seconds. This surgery uses topical anesthesia and takes a total of 3-4 minutes. The patient can continue with social life that same day, and there is no need to cover the eye. Because the intra-laser creates nearly perfect incisions, there are no stitches, resulting in minimal discomfort or pain.

In selected patients with limitations, different surgical interventions can be performed, including intraocular lens applications.

 

As a surgical intervention has been performed, patients are primarily expected to use their medications regularly. The patient must avoid rubbing their eyes. Since sensitivity to sunlight will occur due to the procedure done on the eyes, sunglasses should be worn during daylight. It is also necessary to avoid microbial environments.

As with every disease, early diagnosis and identification are very important in this condition as well. Sometimes, the disease may progress to a point where the cornea is excessively steepened, bulged, and opaque, which unfortunately may make corneal transplantation the only option for the patient. However, with the ease of access to information in today’s world, early diagnosis and treatment can stop the progression of the disease with Cross-linking, thus allowing patients to be treated before the need for corneal transplantation arises.