Contact Lenses for Keratoconus

Keratoconus is an eye condition that is more common than many realize. This progressive eye disease leads to the thinning and bulging of the cornea, the clear, dome-shaped surface that covers the front of the eye, into a cone-like shape. This distortion can significantly impact vision and quality of life.

Optometrists will often prescribe specialized contact lenses for keratoconus management when the condition is at a mild to moderate stage.

Hello, I’m Martin Robinson, the proud owner and principal optometrist of Martin’s Eyecare, in Glenorchy, just north of Hobart. At my practice, we place immense value on giving each patient our undivided attention. Our optometrists make it a point to listen to your concerns and understand your unique eye care needs. Your eye health is our top priority, and we are committed to exceeding your expectations every time you walk through our doors.

If you or someone close to you is suffering from keratoconus, we’d like to help. In this article I’ll explain how we use contact lenses as an essential part of our management strategy for the early stages of the condition. I’ll also present some alternatives for treating keratoconus which don’t involve contact lenses.

What is Keratoconus?

Keratoconus is an eye condition that typically begins during a person’s teenage years or early adulthood. The cornea becomes progressively thinner and starts to bulge into a cone shape. This deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. The condition often progresses over a decade or more.

Common symptoms of keratoconus include blurred vision, increased sensitivity to light, frequent changes in eyeglass prescriptions, and in advanced stages, a noticeable thinning of the cornea. These symptoms can often be mistaken for other vision problems, making regular eye examinations crucial.

Key Risk Factors in Children and Young Adults

In our experience at Martin’s Eyecare, we’ve found that early detection of keratoconus is crucial, especially in children and young adults. One aspect that often goes overlooked but is vital in assessing the risk of developing keratoconus is the patient’s history of atopy, such as asthma or eczema.

The Link Between Atopy and Keratoconus

Atopy refers to the genetic tendency to develop allergic diseases. It is characterized by heightened immune responses to common allergens, especially inhaled allergens and food allergens. Children and young adults with atopic conditions like asthma and eczema are more prone to eye rubbing due to itchiness and discomfort. This consistent, often aggressive, eye rubbing can lead to the distortion of the corneal shape, increasing the risk of astigmatism and ectasia, a group of conditions including keratoconus where the cornea becomes progressively thinner and changes shape.

Why Focus on Young Kids?

The importance of monitoring young kids, particularly those with a history of atopy, cannot be overstated. Their eyes are still developing, and the continuous pressure and trauma from rubbing can accelerate the progression of keratoconus. Early detection and intervention can be the key to preventing or slowing down the progression of this condition. As part of our comprehensive eye examination at Martin’s Eyecare, we pay special attention to these risk factors in our younger patients.

What Can Parents Do?

Parents should be vigilant about their children’s eye health, especially if they have a history of atopic conditions. Here are a few tips:

Monitor for frequent eye rubbing: Be aware of how often your child rubs their eyes, especially if they have allergies, asthma, or eczema.
Regular eye exams: Ensure that your child undergoes regular eye examinations, where optometrists can look for early signs of keratoconus.
Manage allergies effectively: Proper management of allergic conditions can reduce eye rubbing, thus decreasing the risk of keratoconus.

Early eye examinations serve as a proactive approach to safeguarding ocular health. These exams are not just about correcting vision with glasses or contact lenses but are essential in detecting early signs of eye conditions that could escalate if left unaddressed. For children and young adults, these tests are even more critical as their eyes are still developing.

We recommend making eye examinations a routine part of healthcare, particularly for individuals with a history of allergies or atopic conditions. It’s not just about responding to vision problems as they arise but about taking a proactive stance on eye health. Regular eye exams allow for early detection and management of potential issues, reducing the risk of long-term damage.

How Do Optometrists Check for Keratoconus?

Optometrists use a variety of diagnostic tools to check for keratoconus. This typically includes a detailed eye exam, corneal topography which maps the shape of the cornea, and pachymetry to measure corneal thickness. These tests help in detecting keratoconus in its early stages.

One of the advanced tools for keratoconus detection which we have at Martin’s Eyecare is the Oculus Keratograph 5M. In keratoconus, as the cornea progressively thins and bulges, the Keratograph 5M helps in accurately assessing the degree of corneal distortion and irregularity. It provides detailed keratometric and topometric data that are essential for diagnosing the extent of the condition and monitoring its progression over time.

This device also aids in the customization of contact lenses for keratoconus patients. The Oculus Keratograph 5M enables our optometrists to design and fit specialized contact lenses to correct the irregular vision caused by keratoconus. Its non-invasive, detailed diagnostic capabilities make this equipment an invaluable tool at Martin’s Eyecare for providing optimal care to patients with complex corneal conditions.

How Do Contact Lenses for Keratoconus Work?

Currently, there is no cure for keratoconus, but if detected early and properly managed, most people can lead a normal life without significant vision impairment. Treatments are aimed at slowing progression and improving vision, but regular monitoring by an eye care professional is also essential.

Keratoconus can be managed through various types of eyewear. Your optometrist will be able to advise you on the best approach.

Eyeglasses or Soft Contact Lenses: In the initial stages of keratoconus, the corneal distortion is relatively mild, and the vision changes it causes can often be effectively managed with eyeglasses or soft contact lenses. During this phase, the cornea’s shape hasn’t significantly altered to the extent that it can’t be corrected with standard vision correction methods.
Hard Contact Lenses: Rigid gas permeable (RGP) lenses, a.k.a. “hard lenses”, play a pivotal role in the optical management of keratoconus, particularly as the condition progresses beyond the earliest stages. RGP lenses are beneficial because their rigid structure allows them to maintain their correct shape on the eye, unlike soft lenses that conform to the cornea’s conical bulge.
Scleral and Semi-Scleral Lenses: These lenses are distinctively larger than standard contact lenses, with a diameter large enough to cover the entire corneal surface and extend onto the sclera, the white part of the eye. The key to the effectiveness of scleral lenses lies in this ‘vaulting’ capability. They are designed to vault over the cornea without actually touching it.
Hybrid Contact Lenses: Hybrid contact lenses feature a combination of a rigid gas permeable center and a soft outer ring, manufactured as a single lens. They are ingeniously designed to provide the best of both worlds in terms of vision correction and wearing comfort. This rigid center is key for correcting vision, especially in conditions like keratoconus where a stable, consistent refractive surface is necessary to achieve clear vision. With hybrid lenses, wearers don’t have to compromise between the sharp vision provided by rigid lenses and the comfort offered by soft lenses, making them a versatile and effective choice.

Non-Contact Lens Treatments for Keratoconus

While optometrists can manage the ocular discomfort that leads to eye-rubbing, and vision with contact lenses, sometimes ophthalmological intervention is required, whether to help with reducing the progression of keratoconus, or treat severe keratoconus.

Corneal Cross-Linking (CXL): The procedure of CXL involves two primary components: the application of vitamin B2 (riboflavin) drops to the cornea and the subsequent exposure of the cornea to ultraviolet (UV) light. The interaction between the UV light and riboflavin causes the formation of bonds between collagen fibers within the cornea, known as cross-linking. These new collagen bonds significantly strengthen the corneal structure. By increasing the rigidity of the cornea, CXL helps to prevent further thinning and bulging associated with keratoconus.
Topography-Guided Conductive Keratoplasty (TG-CK): A sophisticated eye procedure designed to reshape the cornea, TG-CK can particularly beneficial for individuals with certain types of corneal irregularities such as those seen in early-stage keratoconus or astigmatism. This procedure utilizes controlled release of heat to gently and precisely reshape the cornea, improving its overall curvature and thereby enhancing vision. The TG-CK procedure is relatively quick and minimally invasive compared to other corneal surgeries. It does not involve cutting or removing corneal tissue, which results in a quicker recovery time for patients.
Corneal Transplant: In severe cases of eye conditions like advanced keratoconus, corneal scarring, or other degenerative diseases where the cornea becomes excessively thin, scarred, or misshapen, traditional vision correction methods such as glasses, regular contact lenses, or even specialized procedures like corneal cross-linking or conductive keratoplasty may no longer be effective. Under these circumstances, a corneal transplant, also known as keratoplasty, becomes a necessary intervention. This surgical procedure involves replacing the damaged or diseased cornea with a healthy cornea from a donor.

Each treatment option offers different benefits, and the best choice depends on the individual case of keratoconus. Regular monitoring and consultations with an optometrist are essential for managing this condition effectively.

Frequently Asked Questions

What happens to untreated keratoconus?
Some people, where there is no intervention, may lose sight to the point of becoming legally blind. At such a progressed state the only way to overcome the loss of vision is through a complete corneal transplant.

Can LASIK fix keratoconus?
Most eye care professionals will not recommend laser eye surgery as a solution for keratoconus. This is a degenerative disease that weakens and thins the cornea. Laser refractive surgery like LASIK could potentially weaken the cornea further.

Can eye drops help with keratoconus?
There are medicines which can improve the metabolic processes of the cornea. Such drops do not stop or reverse keratoconus but can slow the onset of the condition.

At what age does keratoconus stop progressing?
For most people, the condition stops getting worse in their mid-30s or early 40’s

Does keratoconus affect both eyes?
Keratoconus is a bilateral disease, meaning it affects both left and right eyes. However, usually one eye will be more severely impacted than the other.

What should I avoid if I have keratoconus?
You should avoid rubbing your eyes. Excessive rubbing can cause micro-damage to the collagen fibers of the eye. The enzymes which your body naturally releases to repair the damaged tissue may induce keratoconus to advance even faster.

Conclusion

If you or someone you know is experiencing symptoms or has been diagnosed with keratoconus, it’s important to seek professional advice. In Tasmania, there are optometrists and eye care specialists equipped to provide comprehensive care for keratoconus patients.

Remember, early intervention is key to managing this condition effectively. So come see us at our optometry practice in Glenorchy, just north of Hobart. We can discuss your condition and offer advice on the best approach to maximizing your vision.