Keratoconus

keratoconus, eye conditions, symptoms, cause, diagnosis, treatment, cure,

LaserVision surgeons are at the forefront of corneal and refractive surgery, making us proud to offer a range of advanced treatment options for keratoconus patients which are listed below.

LaserVision’s consultant surgeons have considerable expertise in the field of Keratoconus treatments such as Dr Arun Brahma who has introduced several new techniques over the years to the region, including collagen cross linking, Kera-rings, INTACs and topographic guided laser. He has also pioneered numerous corneal transplant techniques in Manchester and is regularly referred patients from across the country and overseas.

Keratoconus treatments are recommended based on individual circumstances taking into account the stage of progression, age and patient lifestyle amongst many other factors. New technology continues to push forward new and updated treatments for keratoconus with LaserVision boasting experts in this field.

It is estimated to affect 1 person in 2000. Therefore keratoconus is not uncommon. Read about the symptoms, cause and diagnosis here.


For a solution to keratoconus, your LaserVision consultant surgeon can expertly guide you through the best treatments for you. Each treatment is personalised to achieve the best results.


 

What are the options when glasses no longer provide functional vision?

Lenses 

Rigid Contact lenses. Rigid (hard) gas-permeable (RGP) contact lenses can greatly improve vision when glasses are no longer effective. These are the most common method of improving the vision for patients with keratoconus. Supported by the natural tears in the eye, the irregular surface of the cornea is reshaped allowing for better vision. The development of special keratoconus RGP contact lens designs has increased the usage of RGP lenses over the years. However, RGP contact lenses cannot be worn by everyone. Many people will experience unacceptable discomfort. Therefore they are only partially successful, especially for patients with low production of tears, as an adequate supply of tears is needed to provide adequate lubrication to buffer the RGP lens. Piggyback or Hybrid lenses. If RGP contact lenses are not tolerated, piggyback lenses are sometimes used, where the hard contact lens is placed on top of a soft contact lens making wear more comfortable. This superimposed method, although more awkward, may sometimes be better tolerated than an RGP contact lens alone. Another option is the use of a hybrid lens (hard centre and soft edge), which is rarely satisfactory as a long-term solution. Scleral lenses. In very advanced cases of keratoconus, a well fitted scleral contact lenses may offer visual correction.

What are the other treatment options?

Corneal Segments (Intacs. Kerarings, Ferrara Rings)

Corneal segments are clear small, semicircular plastic rings of various thicknesses, which are inserted within the cornea at its outer edges. There are three main types on the market currently – Intacs, Kerarings and Ferrara Rings. The insertion of corneal segments flattens the central area of the cornea and corrects myopic refractive errors. A major advantage of this procedure is that no tissue is removed and there is no ablation or incision across the visual axsis. They have been proven to stop or slow down the progression of keratoconus, although often glasses or contact lenses will be required. The insertion of corneal segments is a surgical procedure and at LaserVision, we use the accuracy of the Femtosecond Laser to insert them within the cornea. Intacs

A NICE and FDA approved option for keratoconus delaying the need and sometimes avoiding the need for corneal transplant. Intacs corneal inserts or implants are a minimally invasive surgical option used primarily for the treatment ofkeratoconus. Originally FDA-approved in 1999 for the surgical treatment of mild myopia (-1.0D to -3.0D), Intacs are two tiny, clear crescent-shaped pieces of a plastic polymer that are inserted into the cornea to reshape the front surface of the eye. The FDA in July 2004 granted Intacs a Humanitarian Device Exemption for use in the treatment of keratoconus largely because of Intacs’ safety record and because only a few treatment options, such as corneal transplants, were available for keratoconus. The approval allows Intacs to be marketed for reduction or elimination of myopia and astigmatism in keratoconus patients where functional vision is no longer obtained with contact lenses or glasses. In early January 2006, the FDA formally acknowledged that Intacs implants are therapeutic devices that can be described in company literature as corneal implants, rather than prescription inserts. Read more about Intacs here.
  Kerarings
Keraring intrastromal corneal ring segments are implantable precision devices used to correct corneal surface irregularities and reduce refractive errors associated with keratoconus and other corneal ectatic disorders. Unlike other intracorneal rings, Keraring was specifically designed to treat corneal ectasia, providing better and greater corneal surface regularization and refractive correction. Read more about Kerarings here.
  Ferrara Rings - The Original Ring for the Surgical Treatment of Keratoconus
The Ferrara Ring is a minimally invasive surgical option designed to correct ectatic corneal diseases in order to reduce the corneal steepening, reduce the irregular astigmatism and improve the visual acuity. The Ferrara ring is a surgical alternative to at least delay, if not eliminate, the need of lamellar or penetrating keratoplasty. Read more about Ferrara Rings here.

Corneal Collagen Cross-Linking – CXLink™

Cross-linking is not a new technique and has long been used as a medical interventional technique in other areas such as dentistry. However, in recent years it has gained momentum in the treatment for stabilising keratoconus. First performed in 1997, it is now being used by a number of prominent ophthalmic surgeons here in Europe. It is a non-surgical method utilising a UVA light source, which is delivered onto the cornea, together with a chemical mix largely made up of riboflavin for strengthening the collagen fibres within the corneal structure. The combination of the UVA light and the riboflavin creates a joining or bonding of the chemical structures within the cornea. The effect is similar to the change we commonly see when toasting bread. A fine slice of bread bends easily and has little strength but after toasting, the bread results in being stronger and slightly more compact. This comparatively simple procedure has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and subsequently strengthen the cornea. Read more about Cross-Linking here.

LaserLink™ – Topographic guided customised ablation laser surgery

Advanced Topographic Guided Laser Treatment (T-CAT) is one of the most precise methods of reducing higher order abberrations in patients with keratoconus. Following sequential precise mapping of the cornea, the laser treatment is customised to follow the topography to gently remove the ‘peaks’ of corneal tissue in the most irregular areas. The cornea is then cross linked to stabilise it and ‘lock in’ the changes. Read more about LaserLink™ here.

Corneal graft surgery

Corneal graft, corneal transplant,For patients in whom other methods of correction are not suitable, corneal transplant is an excellent option. This operation has been carried out for over 100 years, however in recent years this technique has been greatly improved. The technique involves removing the misshapen corneal tissue and replacing it with healthy corneal tissue. It is a very successful technique with 90% of patients obtaining a great improvement in vision. Read more about corneal graft surgery here.

Beyond transplant

If the vision is still not clear after a corneal transplant do not give up hope of good vision. There are still many options available. The vision is often blurred due to long sight, short sight or astigmatism which can be regular or irregular. All these conditions can be corrected using all the techniques discussed previously. If glasses or contact lenses are unacceptable, procedures such as INTACS, topographic guided laser treatment, intraocular lens implants are all possible methods of further correcting vision.

 


For a solution to keratoconus, your LaserVision consultant surgeon can expertly guide you through the best treatments for you. Each treatment is personalised to achieve the best results.



In association with:
Sheffield Teaching Hospital NHS Foundation Trust, Greater Manchester University Hospitals NHS Foundation Trust