Keratoconus is an eye condition whereby the corneas (the central clear part of the front surface of the eye) become curved in an irregular manner. The first signs of this syndrome usually can be detected around the age of puberty and the progression of this curving effect to the cornea keeps advancing into the patient’s 30’s.This bulging of the cornea creates a distortion to the vision that can often only be partially corrected by the use of a standard spectacle prescription. Usually contact lenses have to be fitted in order to provide some sort of structure to this unstable surface, or as a sort of second artificial surface that is providing more regular focusing of the light rays on the retina.
This can be a very difficult task and most often times a specialized rigid contact lens is necessary to best correct the vision. However, keratoconic patients in the San Joaquin Valley are often battling allergic conditions and a severe amount of airborne particulates—fire smoke, peat dust, etc. making hard contact lenses more difficult to manage for the 16-hour day that is required.
There is currently a much higher level of research on keratoconus with world collaboration on the possible causes, prevention and management of the condition. Three genes have been identified as associated with keratoconus, but with varying levels of presentation. That is why it seems like some families are heavily cursed with the syndrome, whereas other patients may experience a rate of only 1 in 10 family members being affected.
There are also varying degrees of progression from one person to another depending on the genes affected and the behavior of the patient. Some mild forms never progress much after the age of 20 and are managed well by the use of some form of a soft contact lens design. Between 40 and 50% of keratoconic patients are reported to be “eye rubbers”. A majority of patients with keratoconus have atopic reactions to certain sensitivities. These allergies, along with the blurred and distorted vision, cause a reactionary eye-rubbing pattern that further softens the collagen fibers in the corneas and allow for the internal fluid pressure inside the eye to further cone the patient’s cornea. Often one eye progresses to a much further point than the other. You can imagine that as this stretching continues, the cornea becomes more difficult to fit even with specialized lenses, too much scar tissue can build up, and the patient must undergo a corneal transplant surgery.
Techniques for these surgeries have drastically improved the likeliness for a very good outcome when the new cornea is healed. Many cases would benefit from a procedure called corneal cross-linking. This procedure has been proven in studies to halt the progression of the disease and in some cases reverse it. The Corneal Cross-Linking procedure has now gained FDA-approved status. There have also been advancements in hybrid contact lenses like SynergEyes, a combination of a rigid gas permeable central lens with a soft lens skirt around the perimeter. Scleral lenses are also a new design for specialty rigid lens fittings.
More information can be found in the enclosed link to a national foundation database: visit the National Keratoconus Foundation.