Keratoconus is a non inflammatory, degenerative disease of the cornea(the outer layer of the eye). The Hallmark characteristic is the development of a localized, cone shaped ectasia (bulge), that is accompanied by thinning of the cornea in the area of the cone. This leads to irregular corneal surface, irregular cylindrical power and poor quality of vision. It is a progressive condition of the cornea especially in the younger age.
Yes, Arresting the progression of Keratconus is of paramount importance as it can lead to a progressive decline in vision. Keratconus can be arrested by a treatment called “CROSS LINKING”.
Cross linking is a method for increasing the rigidity of the cornea by a combination of a Riboflavin drops and a specified ultraviolet light. This increase the cross links in the cornea therby increasing rigidity of the cornea and arresting the progression of keratoconus. To read more on cross linking click here. At The Eye Foundation, we use an advanced “Avedro Accelerated Cross Linking” which is the latest development in cross linking and provides a rapid, efficient and pain free treatment to arrest keratconus.
In the early stages of Keratoconus vision can be improved using spectacles or contact lenses. But in the more advanced cases we have to resort to using Intra Corneal Ring Segments or Corneal Transplantaion.
Intra Corneal Ring Segments (ICRS) are specialized and customized arc like segments which are inserted into the cornea using a sophisticated femtosecond laser. These segments improve vision by converting a conical cornea into a more natural spherical shape. It is a simple day care procedure that provides immediate and gratifying results.
Though traditional LASIK is not possible in patients with Keratoconus, a new technology that has recently become available is “Topography Guided Treatment” which is a specialized laser based treatment which greatly enhances vision in patients with moderate Keratoconus by smoothening the weakened protruding conical part of the cornea. This topography guided treatment in combination with cross linking has become the procedure of choice for improving vision when Keratoconus is diagnosed early.
Toric Implantable Contact Lens(TICL) is capable of providing good correction in cases of stable Keratoconus or after stabilization of the cornea by collagen cross linkage(C3R). TICL works similarly to a contact lens. The difference is that the lens is placed inside your eye, rather than on the surface. You can neither see nor feel the lens once it is inside your eye. The lens is meant to remain permanently in the eye. Because TICL is tiny and soft, it can be folded so small that it can be injected painlessly into your eye in seconds through a tiny opening in your cornea. Once injected, TICL unfolds into position in the liquid between your iris and your natural lens. The lens is easily accepted by our body. Implanting TICL is considered an outpatient procedure and takes about 15 minutes. A few hours after the treatment you will be able to leave the clinic and resume most of your activities. TICL provides high quality of vision, is a highly precise and predictable treatment and provides exceptional satisfaction.
When Keratconus has advanced to a certain degree where it can be corrected by the aforementioned refractive modalities, we will have to resort to corneal transplantation. At The Eye Foundation, we perform transplantation for Keratoconic patients using a specialized and technically demanding surgery called Deep Anterior Lamellar Keratoplasty or (DALK)wherein only the diseased layers of the cornea are selectively removed leaving behind the remaining health layers of the patient. This greatly enhances the success rate of transplantation by markedly reducing rejection. Read more on Corneal Transplantation.
Till recently there were no means to stop the progression of this potentially sight threatening disease. Fortunately, we now have a procedure called C3R, that can stop Keratoconus from progressing.
C3R is the first and only proven method that has prevented further loss of vision & halted corneal steepening in patients with Keratoconus deterioration. The Biomechanical strength of the cornea in Keratoconus is considerably reduced compared to a normal cornea. Keratoconus is more common in younger patients.
The means of achieving corneal collagen crosslinking from the C3R procedure is via a specialized Riboflavin solution, that is absorbed into the cornea, which is simultaneously exposed to a controlled amount of Ultra Violet A (UV A) rays using a special radiator system and this procedure directly leads to thicker collagen fiber & more crosslinking, between adjacent collagen fibers.
Once the collagen of the cornea has absorbed Riboflavin solution, Ultra Violet A light is required to activate Riboflavin’s strengthening effect on the corneal collagen fibers. This structurally reinforces the cornea, much like enhancing weakend steel beams in a building that is tilting. The enhanced collagen integrity also makes the treated area of the cornea resistant to inflammatory & melting process.
The entire procedure used to take more than 1 hour and is done under topical eye drops without injection. But now with the advanced “Avedro Accelerated Cross Linking” we can now perform the treatment in less than 10 minutes achieving rapid and early recovery.
After the procedure, patient is discharged home. It usually takes 3-4 days for full recovery. The cross linking process starts immediately but continued improvement is seen over the course of the next 6 months and then the refractive error becomes stable.