Keratoconus cannot be cured or treated with medications. The cornea cannot be restored to a healthy condition with any treatment. However, several treatments may significantly improve vision, allowing most individuals to function normally in their everyday lives.
Treatment options for keratoconus
Keratoconus treatment options to manage symptoms and improve vision include:
- When keratoconus first develops, you may be recommended eyeglasses that correct your eyesight, but generally, they help only for a short time. It's good to have glasses that are adjusted for your prescription at all times.
- Contact lenses
- Keratoconus is most commonly treated using contact lenses. There is no single lens that performs best; each has its own merits and limitations.
- Soft lenses can be used in the early stages to suppress the symptoms of corneal abnormalities. When soft lenses are insufficient, gas-permeable (GP) lenses can be used; they cover a wider region of the cornea (about 75 percent).
- If the person with keratoconus is unable to tolerate the GP lenses, piggyback lenses can be employed. The person is initially fitted with a soft contact lens, and then a GP lens is made to fit over the soft lens.
- Scleral contacts are more commonly utilized for therapy than GP contacts. Their center bulge vaulting effect is significant and more comfortable than GP lenses.
- Most people have excellent vision when contact lenses are used daily. Continuous lens usage improves the uneven shape of the cornea while also reducing photophobia and visual deficiencies.
- Corneal collagen cross-linking with riboflavin (C3R)
- C3R is a permanent treatment and is the only approach to halt the advancement of keratoconus. It is based on collagen cross-linking with ultraviolet A (365 nm) and riboflavin (vitamin B2, a photo-sensitizing agent).
- This modifies the cornea's basic biomechanical characteristics, boosting its strength by over 300 percent. This increase in corneal strength has been demonstrated to halt the advancement of keratoconus and, in some cases, reverse it altogether.
- An ophthalmologist performs corneal cross-linking by applying drops of riboflavin (Vitamin B) to the cornea and then exposing the region to regulated ultraviolet radiation. This strengthens and reinforces the cornea, preventing it from bulging into a cone shape and avoiding the need for a corneal transplant.
- Cross-linking procedures are typically conducted on people with keratoconus at the time of early diagnosis (20 years) and in the case of rapid loss of eyesight in older individuals.
- Excimer laser operation
- It is a rare procedure in which the cornea is carved into a normal shape, eliminating the necessity for a continuous lens. This procedure reshapes deformed corneal regions, and corneal cross-linking or CXL therapy is necessary before surgery.
- Intracorneal ring segments
- A corneal ring is a C-shaped implanted plastic ring to flatten the cornea. This improves the vision of people with keratoconus and preserves their cornea from further bulging or damage. A corneal ring can also make wearing contact lenses more comfortable.
- Cataract surgery
- Older individuals with chronic keratoconus who require cataract surgery owing to clouding of the natural lens may be fitted with a customized lens that corrects a visual disturbance in the cornea.
- Corneal transplants
- May be required in severe cases of keratoconus where previous treatments have failed.
- There are several types of corneal transplants; two of them are as follows:
- Penetrating keratoplasty (PK or PKP): The bulging cornea is completely removed and replaced with donor corneal tissue.
- Deep anterior lamellar keratoplasty (DALK): The anterior damaged layers of the cornea are removed and replaced with identical layers from a healthy donor cornea.
When compared with PKP, visual recovery with DALK is frequently faster. Although a small percentage of people with corneal transplants have excellent uncorrected vision and do not require contact lenses or glasses, vision correction is usually required following surgery.
What are the stages of keratoconus?
Keratoconus progression differs across people of different ages. Progression is considered to be faster when the age of onset is young. The progression continues until approximately the age of 40, after which it tends to stabilize.
Keratoconus can be classified into the following four stages:
- Early keratoconus
- This is an incredibly early stage that can only be spotted via the topography eye test. The person has no keratoconus symptoms and progression is slow. Glasses or contact lenses may be recommended at this stage.
- Moderate keratoconus
- The cornea begins to display corneal abnormalities at this stage. It may also be detected clinically using a slit lamp.
- The quality of vision is compromised, which can be corrected with specific lenses. The corneal strengthening technique is relatively successful at this point.
- Advanced keratoconus
- Significant corneal deformation is detected, coupled with poor vision quality and other keratoconus symptoms.
- At this point, strengthening is vitally necessary, and GP lenses can help enhance vision quality to some extent.
- Severe keratoconus
- Doctors may detect extensive corneal scarring and thin as well as dramatic corneal deformation.
- Vision is usually nonfunctional and cannot be corrected with regularly used equipment such as contact lenses. Scarring in the middle of the cornea necessitates a corneal transplant.
Corneal cross-linking is the best cure for keratoconus. Although it will not completely reverse keratoconus and restore the cornea to its original shape, it will prevent it from developing and causing visual problems. People with keratoconus have a method to greatly enhance their eyesight when paired with special contact lenses that artificially improve the shape of the cornea.
How can I prevent keratoconus?
Keratoconus is an eye disorder that changes the curvature of your cornea and causes visual distortion over time. Keratoconus is a progressive condition, and you should contact an eye specialist as soon as possible if you notice symptoms such as blurred or foggy vision.
Tips to prevent keratoconus or slow down keratoconus include:
- Load up on antioxidants
- Keratoconus may be caused or exacerbated by oxidative stress, which occurs when free radicals affect the vision.
- A diet rich in antioxidants is usually recommended for people with keratoconus. Leafy green vegetables, berries, citrus fruits, carrots, seafood, and chicken and tea are all high in antioxidants.
- Vitamins C and E, carotenoids, selenium, and zinc are some of the most significant antioxidants. You should be able to receive enough antioxidants to support your eyes if you eat a healthy, balanced diet.
- Omega-3 fatty acids are essential for eye health and can be used to treat keratoconus. Vitamin B, vitamin D2, and vitamin K2 supplementation are part of keratoconus treatments.
- Bilberry and lutein benefit general eye health and can help with keratoconus therapy.
- Maintaining a healthy, balanced diet that monitors and restricts carbohydrate intake can help prevent the problem from worsening.
- Wear 100 percent ultraviolet (UV) blocking sunglasses
- UV rays can harm your eyes and exacerbate your keratoconus. Wear 100 percent UV-blocking sunglasses to keep your condition from worsening.
- If you use corrective lenses, you will almost certainly want prescription sunglasses as well. Otherwise, your eyesight will be blurry.
- If you are unsure about the appropriate types of sunglasses, consult with your ophthalmologist (eye doctor).
- Avoid scratching or rubbing your eyes
- Any harm to your eye might aggravate your keratoconus. Chronic eye-rubbing is a typical technique for people to inadvertently harm their eyes.
- If you use power tools, clean, play sports, use chemicals, or do anything else where your eyes may be exposed, wear goggles or other eye protection.
- Keep your allergies under control
- Seasonal allergies can irritate your eyes, causing you to rub or scratch them. If you have allergies often, use antihistamine drugs and avoid irritants such as pollen.
- Consult an allergist if you have difficulty controlling your allergies. You may require allergy injections to minimize your sensitivity.
- Use artificial tears
Remember that none of these home remedies is a substitute for professional therapy, so if your eyesight worsens at any stage, contact your ophthalmologist.
What does the future research suggest about keratoconus cure?
Although there are numerous therapies available now, keratoconus is still intensively investigated, and there are many exciting breakthroughs taking place, such as:
- A different procedure with limited side effects
- Instead of doing a full corneal transplant, one research used donor tissue from the Bowman layer (the second layer of the cornea) to replace the middle layer. The results were positive, with disease development stopped in 90 percent of individuals.
- However, the trial was limited, and it would need to be replicated with a bigger group, but the less invasive nature of the treatment, absence of postoperative problems, and excellent results may be worth investigating.
- Eye drops
- A group of researchers investigated the use of eye drops containing low doses of steroids and growth factors to increase collagen formation and thereby strengthen and stimulate the cornea.
- Although animal studies are promising, human trials are still pending in this research
- Stem cells
- In Japan, an ophthalmologist is repairing corneas with reprogrammed stem cells known as induced pluripotent stem cells. Although it has resulted in improved eyesight, larger trials may be required before this can be used as part of keratoconus therapy.
For many years, ophthalmologists have been researching cures for keratoconus, but a solution has remained elusive. Researchers are investigating an even less invasive way to flatten the bulge of corneas in keratoconic eyes, similar to the corneal cross-linking operation.
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