Understanding and Managing Keratoconus

Corneal collagen cross-linking (CXL) is widely recognized as an effective method for halting the progression of keratoconus. This minimally invasive procedure works by strengthening the corneal tissue. During the process, our cornea specialist applies riboflavin (vitamin B2) to the cornea, which is then activated by ultraviolet (UV) light to form new bonds between collagen fibers. This reinforcement helps stabilize the corneal structure and can even lead to improved corneal shape.

There are two primary variations of this procedure. In the epi-off method, the outer corneal layer (epithelium) is removed before applying riboflavin, allowing for deeper penetration of the treatment. Alternatively, the epi-on method leaves the epithelium intact, reducing discomfort and the risk of complications. Both methods have shown high success rates, with studies reporting that progression is halted in the vast majority of patients treated with the standard epi-off approach.

Key benefits of CXL include:

• Corneal stabilization: The primary goal is to stop the thinning and irregular steepening of the cornea.
• Improved corneal shape: Many patients experience a flattening of the previously steepened cornea.
• Enhanced visual acuity: Both uncorrected vision and vision with correction (using glasses or contact lenses) can show noticeable improvement.

It is important to note that while the majority of patients require just one session, those with aggressive forms of keratoconus might need future treatments. These treatments are typically carefully tailored and monitored to ensure optimal outcomes.

For many individuals with keratoconus, achieving clearer vision often involves the use of specialty contact lenses. Standard soft contact lenses are usually not effective because they conform to the irregular shape of the cornea, which can worsen visual disturbances. Instead, custom-designed lenses cater specifically to the unique needs of keratoconus patients.

The two most commonly recommended types are:

• Rigid Gas Permeable (RGP) Lenses: These lenses are made from a firm material that maintains its shape on the eye, creating a new, smooth optical surface that compensates for corneal irregularities. RGP lenses are particularly suitable for patients in the early to moderate stages of keratoconus.
• Scleral Lenses: Designed to vault over the cornea and rest on the white part of the eye (sclera), these lenses create a fluid-filled chamber that not only provides exceptional vision correction but also helps keep the cornea hydrated. Scleral lenses are ideal for patients with more advanced keratoconus where the corneal irregularities are more pronounced.

Additional benefits of these specialty lenses include increased comfort and the potential for sharper, more stable vision. Although the fitting process for these lenses requires precision and expertise, the outcome often results in a significant improvement in quality of life. If traditional glasses or soft lenses aren’t delivering clear vision, a consultation with our cornea specialist can identify whether one of these specialized options might be right for you.

In some cases, a single treatment may not address all aspects of keratoconus. For patients who have both stabilization and visual clarity concerns, our cornea specialist often considers combining therapies to provide a more comprehensive solution. Combining corneal collagen cross-linking (CXL) with tailored contact lens fitting can simultaneously halt further progression and improve vision.

Some of the combination strategies include:

• CXL with Custom Soft Contact Lenses: This approach is effective for those with mild keratoconus who experience gradual changes in their corneal shape.
• CXL with Scleral Lenses: Patients with moderate to severe keratoconus often benefit from this combination, as CXL stabilizes the cornea while scleral lenses correct visual distortions.
• CXL Prior to Scleral Lens Fitting: Stabilization of the cornea before initiating contact lens therapy ensures that subsequent visual corrections remain effective over time.

This multi-modal approach ensures that patients have the best chance at achieving stable and clear vision. It also provides flexibility in managing the condition over time, as adjustments can be made based on regular follow-up assessments.