Living With Keratoconus:
Everything You Need to Know
By Dr. Millicent M. Grim
If you have recently been diagnosed with an eye condition called keratoconus, you probably have many questions about how it is going to affect you. Many people worry about whether they will be able to continue driving, stay in their career long-term, or even enjoy everyday life.
Here, we provide the answers to many frequently asked questions and seek to reassure you that this is usually a very manageable condition.
What is Keratoconus?
Keratoconus is a condition where the cornea (the round, clear window part of the eye) gradually thins. This weakening allows the eye to bulge outwards, which then impairs the eye’s ability to focus properly.
Keratoconus can cause varying degrees of visual impairment, from mild to more serious. There are various potential symptoms: blurred or smeared vision, halos, ghosting or double vision, and increased sensitivity to light. Some people with keratoconus may also suffer from headaches or eye pain.
Keratoconus is often diagnosed in young people (from puberty onwards) and may worsen with time, especially if left unchecked. Risk factors can include genetics and a family history of the condition, frequent eye-rubbing during childhood due to allergies, and vernal conjunctivitis.
Can it cause blindness?
No, keratoconus does not cause blindness. Even in advanced cases of keratoconus, vision can almost always be significantly improved using contact lenses or another treatment method.
How will it affect my vision?
In its very early stages, keratoconus has very little effect on a person’s vision. You may not have even known you had it until it was detected by your eye doctor.
Your vision will be affected while the cornea changes shape. This varies from person to person. The now distorted shape of the cornea may affect how light is reflected onto the retina, causing blurred vision. This is known as “irregular astigmatism.” Keratoconus may also cause near-sightedness (myopia), meaning objects nearby appear clearly, whereas those further away appear blurred.
You may also find bright light uncomfortable because the uneven cornea scatters more light than normal. You may also see halos around lights. This will probably affect your ability to drive safely after dark unless your vision is corrected.
What are my treatment options?
The good news is that there are several treatment options for those with keratoconus. These will make living with keratoconus manageable, and your everyday life much easier.
Your eye doctor will recommend the best treatment for you based on your eye exam and on how far advanced your condition is. Here are the options typically available:
For people with blurred vision (from either mild astigmatism or myopia) caused by the early stages of keratoconus, glasses usually offer a solution. If your keratoconus worsens, you may find that you need a stronger prescription than glasses can provide.
- Contact Lenses
Keratoconus is a condition that affects different people in different ways. However, there are many different types of contact lenses that can potentially be used. This means contact lenses are often the best option for patients with mild to moderate keratoconus.
The right lenses will be chosen to provide maximum comfort alongside improved vision. There are even lenses designed to accommodate the distorted shape of the eye that comes with keratoconus, so there’s no need to assume that contact lenses would be uncomfortable.
Often, soft lenses suit keratoconus patients with the early stages of the condition. If the condition worsens, they may need to switch to Rigid Gas Permeable lenses or Hybrid lenses.
- INTACs or Ferrara/Kera Rings
These are corneal implants, or Intra-Corneal Ring Segments. They are thin, semi-circular Perspex “plastic” rings that are inserted into the mid-layers of the cornea with the aim of flattening it or altering its shape.
INTACs cannot cure keratoconus, but they can help the patient enormously. The procedure can make the blurred vision from keratoconus easier to correct with glasses or contact lenses. Because it alters the shape of the cornea, it can also allow a more comfortable fit for contact lenses.
- Corneal Collagen Crosslinking (CXL or C3R)
Crosslinking is a procedure that can slow down or even halt the progression of keratoconus. It works by strengthening or tightening the collagen fibers in the front to mid-layers of the cornea. This added strength can prevent the corneal bulge from worsening, and benefits the shape as well.
Corneal Collagen Crosslinking is a surprisingly simple 30-minute treatment. Riboflavin eye drops are applied to the eyes during the procedure to saturate the cornea. The cornea is then illuminated by ultraviolet light of specified parameters and time.
- Corneal Transplants
Only a small proportion of advanced keratoconus patients ever need to have a corneal transplant. It can be the right option for those no longer able to correct their vision with contact lenses. If everyday life is becoming more difficult and you have explored other options with your eye doctor, they may recommend a corneal transplant.
With this surgical procedure, damaged corneal tissue is removed and replaced with healthy donor tissue. This may be a partial or full-thickness replacement. The new corneal tissue will be held in place with tiny stitches/sutures, which are removed only once the grafted tissue settled in well.
While there is some aftercare involved to prevent the body from rejecting the transplant, and a small risk of complications, corneal transplants typically work very well.
Life with Keratoconus
The range of keratoconus treatment options available to patients means that it is a manageable condition. In most cases, the use of contact lenses or glasses will be sufficient enough for everyday life to continue as normal. In the minority of cases where this is not true, there are other options to explore.
Nearly all keratoconus patients are able to drive, use a computer and live life as normally and as freely as before. There really is no great cause for concern if you have recently been diagnosed. It’s best to talk to a trusted eye specialist who can provide helpful information and insight.
Dr. Millicent M. Grim, Specialist Ophthalmologist & LASIK Specialist, is the Medical Director of Gulf Eye Center in Dubai. Since 2002, Gulf Eye Center's highly qualified ophthalmologists and optometrists/ODs have been successfully treating a wide range of eye conditions using advanced techniques. They also provide comprehensive eye care and vision restoration procedures for people of all ages.