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Keratoconus Treatment in London

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The term keratoconus originates from the Greek ‘keras’ meaning cornea, and ‘conus’ meaning cone. Keratoconus causes progressive thinning of the cornea. It usually affects both eyes, although one eye is usually affected more than the other. If there is delay in detection or treatment of keratoconus, it can result in significant deterioration of vision.

Key facts about keratoconus:

  • Causes progressive thinning of the cornea, resulting in astigmatism.
  • Symptoms include blurred vision, double vision and imbalance between the eyes.
  • Affects both eyes, although one eye is usually more significantly affected than the other
  • More common in certain ethnicities, e.g. Asians and Middle Eastern populations
  • Cause is unknown, although likely to be multifactorial
  • Occurs in in late childhood to early adulthood, and often (but not always) stops progressing by the age of 35 years.
  • Progression of keratoconus can be halted by cornea collagen cross-linking.
  • Treatment of keratoconus is stepwise:
    • Spectacles or soft contact lens
    • Hard contact lens 
    • Laser refractive surgery combined with cornea collaged cross-linking
    • Cornea transplantation

What are the causes?

Keratoconus is a corneal disorder of the eye leading to its thinning and subsequent bulging. While a normal cornea appears round, Keratoconus leads in a cone-shaped cornea, thus is called so. It usually onsets in early adulthood and, depending on its type, progresses for another ten years or more. Genetic and Hereditary factors contribute to a great extent to Keratoconus. But frequent rubbing of eyes and prolonged use of contact lenses has also been proved to be the reasons for cornea thinning and, subsequently, Keratoconus. Once you start to notice the symptoms, it is better to plan Keratoconus treatment as soon as possible.

Early symptoms

You will start to notice its early symptoms in terms of blurred vision with light sensitivity and frequent changes in power. The steep cornea-induced irregular astigmatism can result in problematic night vision along with sudden blurring of vision on the rupture of the steep cone. It is bilateral and is more common in women than men. Thus, one must start Keratoconus treatment as soon as possible because it takes a lot of effort for Keratoconus cure if not started early.

Diagnosis process

The initial step in Keratoconus treatment includes vision evaluation with an auto-refractometer. A visual acuity test to assess the amount of astigmatism is crucial before planning for Keratoconus treatment.

A thorough slit lamp examination to identify the thinning and irregular surface of the cornea with a retina evaluation to assess for secondary retinal disorders would be the second step. But the most important of them all is the Corneal Topographic Machine that will give you a clear idea about the level, area and thinning present.

This is crucial while evaluating modalities for the Keratoconus cure. However, these modalities may differ a bit from one clinic to another in London.

Keratoconus treatment modalities

There are a number of Keratoconus cure modalities available, but doctors will decide the best one for you after evaluating your condition.
Glasses and soft contact lenses
Spectacle correction and contact lenses are the initial measures of Keratoconus treatment. Though effective initially, refractive error more than -3D when presented in the form of irregular astigmatism does not make glasses a very reliable option. Though marginally more effective, soft toric contact lenses do not work in steep corneas because of the steepness-induced irregular fitting. Additionally, regular changes in prescriptions initiate the search for more effective Keratoconus treatment modalities.
Hard contact lenses
Though initially uncomfortable, hard contact lenses can cause immense improvement in vision due to their improved fitting. Piggyback lenses and hybrid lense- a combination of hard and soft contact lenses- may be considered effective Keratoconus treatment modalities are providing equal measures of vision and comfort. For advanced cases of Keratoconus treatment, scleral lenses are advised. But these lenses need careful handling with frequent visits to the clinic for follow-ups. The need for a permanent Keratoconus cure comes with surgical treatment modalities.
Laser refractive surgery
Lasik is often contradicted in Keratoconus owing to the risk of further thinning of the already thin cornea. Procedures like LASIK and PRK operate by removing tissues from the eye to regulate the refractive error. Taking out tissue in an already thin eye in the case of Keratoconus will worsen the symptoms and threaten the cornea’s integrity. That’s why it is rarely considered as an ideal Keratoconus treatment modality. But, in this regard, Keratoconus cross-linking comes as an ideal bet under any circumstances.
Collagen Cross linking (Keratoconus cross-linking)
Keratoconus cross-linking involves an application of riboflavin solution and corneal radiation combined with UV radiation. The purpose of Keratoconus treatment is to improve the bonds between the collagen fibrils of the cornea. This, in turn, results in an increased corneal strength with reduced cone progression, thus drastically improving the vision. Keratoconus cross-linking can be done on its own or in combination with other refractive procedures like laser ablation or lens-based surgeries.
Keratoconus Corneal Transplantation

Keratoconus corneal transplantation is advised when the cornea becomes dangerously thin or the scarring too prominent for enabling any vision. It involves replacing the thin conical cornea surgically with a normal donor cornea for improving the previously impaired vision.

People with advanced Keratoconus damage or with severely impaired vision following complications after a Keratoconus treatment are ideal candidates for Keratoconus corneal transplantation. Additionally, people ineligible to wear any contact lens due to an extremely steep cornea or people with ulcerative keratitis due to infection with contact lenses are also eligible for Keratoconus corneal transplantation. You can be more sure about your eligibility for the procedure by talking to an expert doctor at Harley Vision, London. 

Two types of Keratoconus corneal transplantation, namely Penetrating Keratoplasty (PK) and Deep Anterior Lamellar Keratoplasty (DALK) are indicated depending on the severity of the condition. It is a fairly successful procedure involving 1 out of every four transplants. It is performed under general anesthesia. The cornea is sutured after the surgery and monitored closely for two weeks, followed by weekly follow-ups. Such Keratoconus corneal transplantation provides a lasting benefit for Keratoconus patients and is amongst the most popular Keratoconus treatment modalities to date.

INTACS

INTACS or IntraCorneal Rings Segment consists of 2 rings implanted over the stroma. Made of polymethyl methacrylate, these rings help improve vision, thereby acting as an ideal Keratoconus cure model in the long term. Additionally, they provide a comfortable position for the contact lenses to rest on, thereby improving their tolerance. Apart from making the cornea more durable, they open the scope of laser application on the cornea, which was not possible before their insertion. In short, they convert the cornea into a vision-rehabilitation platform that can be used for enhancing the BCVA (Best Corrected Visual Acuity). If you are confused about these terms or Keratoconus treatment modalities, feel free to contact any expert at Harley Vision, London.

Factors leading to Keratoconus treatment

Various risk factors like rubbing your eyes frequently due to allergic conditions and improper contact lens fitting may lead to corneal thinning and subsequently result in Keratoconus. That’s why avoiding rubbing eyes by managing the allergic conditions and doing a regular contact lens evaluation will ensure you don’t require any Keratoconus treatment in the long term.

Sometimes genetic conditions like a family history of Keratoconus with conditions like Retinitis Pigmentosa and Ehlers-Danlos Syndrome may lead to Keratoconus treatment. Early evaluation and diagnosis and timely management is the best solution compared to any other Keratoconus treatment modalities.

Frequent asked questions (FAQs):

Risk factors for keratoconus include modifiable and non-modifiable risk factors. Modifiable risk factors are eye rubbing and eye allergy. Treating eye allergies helps minimise eye rubbing, although the latter can also be a habit not related to eye rubbing.

The gold-standard treatment to stop keratoconus getting worse is cornea collagen cross-linking. If there is evidence of progressing keratoconus, this treatment should not be delayed.

Cornea collagen cross-linking is performed using the latest technology at the Harley vision clinic, reducing the treatment time from 45 minutes to 15-20 minutes.

If keratoconus is mild, then patients can see well with spectacles or soft contact lenses. Some patients see well without visual correction. In moderate to severe keratoconus, the options are:

  1. Rigid gas permeable contact lens
  2. Hybrid contact lens
  3. Semi scleral or scleral contact lens
  4. Cornea transplantation (partial or full thickness)

You will be assessed by an advanced contact lens optometrist for specialised contact lenses, and the cornea specialist will explain the management options that are suited to your case.

There are numerous research studies showing an association between eye rubbing and keratoconus. It is advisable that eye rubbing is avoided or at least minimised by the patient. Treating eye allergies is an important aspect of keratoconus treatment, and will help you avoid rubbing of the eyes.

Yes, keratoconus can be treated with laser that is combined with cornea collagen cross-linking. However, there is a lack of robust long-term trials of the effectiveness of this treatment and risk of long-term worsening of keratoconus. At the Harley Vision, this treatment is not performed because of the poorly established long-term safety profile.

At the Harley Vision, we use OCT-based cornea tomography. This is the latest and most robust technology enabling extremely high definition actual measurements of each corneal layer. This technology is available in few clinics around the world. Furthermore, AI is utilised to aid in clinician diagnoses.

Artificial Intelligence (AI) is utilised by the Harley Vision to improve keratoconus assessment. Mukhtar Bizrah is working with the AI faculty of Imperial College London to develop improved keratoconus assessment methods using AI. 

 

An ophthalmologist keratoconus specialist performs any surgical Keratoconus treatment, including Keratoconus cross-linking, INTACS and Keratoconus corneal transplantation procedures. If you face trouble finding an ideal keratoconus specialist, let Harley Vision, London be your ideal guide.

Keratoconus cross-linking and INTACS are emerging as the best keratoconus treatment modalities because of their high success rate and subsequent improvement in vision. Keratoconus corneal transplant is also a popular treatment option enabling the patient to have improved vision along with giving a new life to his eye via transplantation.
As Keratoconus cross-linking treatment is a medical emergency, most insurance companies in London cover the cost for collagen cross linking along with the diagnostic procedures required for the surgery. Even if you don’t have insurance, clinics in London nowadays are tied up with many financing companies to process loans without any hassle. You can talk to your clinic for the finance options to get some help.

The exact cost of your surgery in London will depend upon a lot of factors. For example, it depends upon the level of ectasia or corneal thinning caused by the Keratoconus, the surgical technique used by the surgeon, the possibility of any additional refractive procedures required during the process, etc. Also, if the clinic is present in one of the busiest streets of London and has the best surgeons to serve the patients, the price will go up. In this regard, you can contact Harley Vision, London to get an approximate cost of your treatment in advance.

Though not complete blindness, Keratoconus in its advanced stage can cause serious scarring leading to severely impaired vision. Since it occurs in both eyes, an advanced Keratoconus can seriously impact your life if not treated in time. Consult a keratoconus specialist as soon as you see the early symptoms and plan your keratoconus treatment plan accordingly.
Keratoconus is not a disease but a chronic disorder that needs lifelong intervention to monitor its progress once diagnosed. Even with successful keratoconus treatment modalities, regular follow-ups are quintessential in checking the factors associated with Keratoconus and its effect on visual acuity.
Though studies have shown that Keratoconus plateaus by the age of 30-40, the corneal degeneration may or may not stop at that age. It depends on the genetic condition and management of risk factors regarding the progression of the degeneration. Talk to your keratoconus specialist for more information about your present condition.
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