Keratoconus is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal gradual curve. This causes patients to have serious visual problems that cannot be completely corrected with glasses and contact lenses. Keratakonus is a progressive disease, but it does not cause blindness. Keratoconus treatment (compensation) in each phase is possible.

Signs include a decrease in visual quality that cannot be corrected with glasses, with patients often squinting in order to obtain better vision. Keratoconus patients are also very sensitive to bright lights, have difficulty reading, complain of double vision, and experience headaches. In its early stages, eyeglasses may partially help correct poor vision. Patients who come to our office say they have multiple prescriptions from different opticians.

Thanks to new technologies, with a careful eye examination and additional screenings, the disease can now be diagnosed in its early stages. And with corneal topography mapping technologies, keratoconus can also be detected without any clinical sign. Many times, the disease can be seen in both eyes, though it can appear in just one eye as well. Kerataconus generally starts to develop in the eye during adolescence and progresses until around age 40. However, keratoconus may appear earlier or later. It is possible to have keratoconus after LASIK treatment. For that reason, potential LASIK patients should be examined carefully, and a treatment plan should be developed by a highly experienced specialist. Patients who have myopia and need to change glasses frequently because of a rapid increase in diopter should also visit a cornea specialist for an examination.

Unfortunately, the cause of keratoconus is not known. It may be genetic or caused by allergy-related eye diseases, traumas, or frequent rubbing of the eye, but a definitive cause has not been determined.

There is no standard treatment for keratoconus. Different treatment plans are created for different patients. Treatment only halts the disease. It is not possible to return the cornea to its former condition, though it can be partially corrected and progress of the disease stopped.  

Step 1: Contact lenses
Step 2: Corneal crosslinking
Step 3: Corneal rings (Intacs)
Step 4: Corneal transplantation (keratoplasty)

Contact lenses: This option can be used on early stage keratoconus patients, but it does not stop the progress of the disease. With this treatment, patients wear lenses that are specifically designed for the disease. And while there are many types of lenses, patients typically experience discomfort when using them. However, the lenses help patients maintain better vision. In advanced stages of keratoconus, patients cannot use lenses, as they would slip and make patients even more uncomfortable.

Corneal crosslinking: Crosslinking is the only treatment that stops the progression of the disease. For this reason, crosslinking has now become the first level in treatment planning.

The cornea is a transparent, dome-like structure that is about 12 mm in diameter. The collagen fibers that cross the cornea constitute its roof. In corneal crosslinkling, the main objective is to send UVA rays to the cornea, thereby strengthening the U-shaped collagen fibers.

The surface layer of the cornea (epithelial tissue), which measures 8.5 mm in diameter, is removed with a spatula. In order to increase the effect of the laser beam, yellow-colored 0.01 riboflavin eye drops are added every three minutes during the approximately 20-minute procedure. Afterward, UVA is applied to the cornea for 30 minutes, and riboflavin applications continue every five minutes. At the end of the treatment, the eyes may be closed or a protective contact lens may be placed, and antibiotic drops are used. Eyes may become infected after the procedure, so care should be taken on a daily basis to prevent an infection. The full effect of the crosslinking procedure takes six to nine months.

Corneal rings are two small transparent half circles. These rings are made from special plastic materials that are compatible with corneal tissue. They are inserted into tunnels that are created with special incision instruments. In our clinic, however, we use an Intralase laser, which is a femtosecond laser that makes very precise incisions. Corneal rings significantly correct the irregular shape of the cornea. The rings come in different shapes and sizes, and patients should look for a practitioner with significant expertise before deciding on corneal rings. The surgery, which is completed in about 15 minutes, is done with anesthetic drops so patients do not feel pain. Within a few days, patients may experience symptoms such as burning and itching in the eye. Patients are prescribed drops to use for 30 days after surgery.