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Keratoconus Treatment
Keratoconus is a condition characterized by the progressive bulging and steepening of the cornea, which is the transparent layer at the front of the eye, over time. The disease may initially appear in one eye and can later be observed in the other eye as well.
Thanks to the advanced diagnostic methods available today, keratoconus can be detected at an earlier stage. This condition can lead to visual disturbances, a decrease in visual quality, and in advanced cases, vision loss.
What Are the Symptoms of Keratoconus?
Symptoms can vary from person to person, but it is not a congenital disorder. In very early stages, there can be forms of keratoconus that do not present significant symptoms and do not cause visual disturbances, which may not bring the individual to see a doctor. In routine eye examinations, children and adolescents whose glasses prescriptions are constantly changing but who still do not achieve adequate vision levels may raise suspicion for keratoconus.
Although changes in eyeglass prescriptions can be expected in this age group, myopia and astigmatism values in keratoconus can progress more rapidly, which may prevent achieving the expected level of vision with glasses. Additionally, early-stage complaints often include glare, distorted vision (seeing an object as bent), the proliferation of images (seeing several instances of an object side by side), and a deterioration in night vision. It is especially important to be cautious regarding keratoconus in individuals who frequently and vigorously rub their eyes due to allergies.
Relationship Between Keratoconus and Allergies
There is a relationship between keratoconus and allergic eye diseases. Itching and tearing caused by allergies can lead to frequent rubbing of the eyes. Rubbing the eyes frequently and vigorously is considered a risk factor for the development and progression of keratoconus.
Who is Affected by Keratoconus?
This condition is more frequently observed in regions of our country where heat and allergies are prevalent (Southeastern Anatolia Region). It can particularly manifest around the ages of 15 to 16, coinciding with adolescence, but can also be seen at even younger ages. Regular eye examinations and monitoring of symptoms are important. This eye condition can progress until the ages of 35 to 40, but significant progression has not been observed after the forties. However, its prevalence and progression in younger ages are definitely higher. In keratoconus, where genetic predisposition can also play a role, it is essential for individuals with a family history to continue with regular eye check-ups.
Diagnosis of Keratoconus
In the diagnosis of keratoconus, various tests are utilized in addition to routine eye examinations. Individuals with constantly changing eyeglass prescriptions, those with a suspicion of keratoconus, or those with a family history are evaluated in detail. Thanks to detailed imaging known as corneal topography, results can be obtained in a matter of minutes. Both the diagnosis and the follow-up process can benefit from corneal topography.
Keratoconus and Contact Lenses
In patients with non-progressive keratoconus (between ages 35 and 40), it is possible to enhance visual quality with glasses and contact lenses. These specially designed lenses for keratoconus were previously only hard lenses, but now include options such as semi-rigid lenses, soft-center rigid lenses, and hard lenses. Patients using contact lenses need to be somewhat patient as finding the right lenses may require some time due to the trials involved. This fitting process can sometimes take 2 hours and sometimes 6-7 hours. In selected and suitable patients who do not achieve sufficient vision with glasses or contact lenses, ring treatment may be considered.
Keratoconus Surgeries
Treatments for this condition are personalized; thus, different procedures may be applied to each patient. Among the most common surgical treatments today is the procedure known as Cross-linking, which is also referred to as ultraviolet light therapy in layman’s terms. This is a procedure that halts the progression of the disease.
In the Cross-linking procedure, drop anesthesia is used. First, a very thin layer of epithelial tissue at the front of the cornea is removed. Following this, Riboflavin vitamin is instilled in intervals of 3 minutes for half an hour, and the final step involves applying ultraviolet light (UVA) for 30 minutes. After the procedure, there is no need to cover the patient’s eye. After a check on the first and third days, the contact lens used for protection is removed. Patients may experience blurry vision for a while post-operation, but this is temporary. It is also crucial for the patient to use eye drops as prescribed after the procedure. The primary goal of this operation is to halt the disease. Following this procedure, glasses or contact lenses specific for keratoconus are recommended. If the patient is still not satisfied with their vision quality, other treatment methods may be suggested.
Another treatment option is the application of a corneal ring. In this method, the aim is to enhance the patient's visual quality. It is preferred in patients who are not suitable for contact lenses. While the channel creation procedure in the past was performed through surgical incision, today it can be accomplished using femtosecond laser technology. The channel is created in about 10 seconds with a femtosecond laser, and fitting the ring takes 1-2 seconds. This surgery uses drop anesthesia and takes a total of 3-4 minutes. The patient can resume their social life the same day, and there is no need for the eye to be covered.
In selected and limited patients, different surgical procedures can also be performed, including intraocular lens applications.
Post-operative Care for Keratoconus
Since a surgical intervention has taken place, patients are primarily expected to use their medications regularly. The patient must avoid rubbing or scratching their eyes. Due to increased sensitivity to sunlight after the procedure, sunglasses should definitely be worn in daylight. It is advised to stay away from microbial environments.
What Happens If Keratoconus Is Left Untreated?
As with any condition, early diagnosis and identification are crucial in this disease. Sometimes, the disease can progress to an advanced stage. If the cornea becomes excessively steep, bulged, and opaque, a corneal transplant may be necessary. The progression of the disease can be halted with Cross-linking. This aims to prevent the disease from reaching advanced stages that would require a corneal transplant.
