Keratoconus is a progressive disease of the outer transparent layer of the eyeball (cornea) affecting young adults mostly in their twenties. It is characterized by progressive thinning of the normally round cornea causing it to bulge forward & assume a cone like shape. This irregularity in the cornea results in the formation of a distorted image of objects on the retina & gives rise to blurred vision.
Symptoms & signs of Keratoconus
- Keratoconus causes myopia or nearsightedness & astigmatism.
- Frequent change in glasses prescription with fluctuation in vision.
- Glare & sensitivity to light especially during night.
- In advanced stage of Keratoconus corrective prescription glasses do not help patient to see clearly & they have to switch to using hard or semi-soft contact lenses.
- Keratoconus can be diagnosed at an early stage with detailed eye examination which includes Retinoscopy,
- Slit lamp examination & sophisticated tests like Topography to check the shape & curvature of cornea & Pachymetry to determine the thickness of the cornea.
Exact causes of Keratoconus is not known but latest research suggests that the cornea becomes weakened due to an imbalance of enzymes within the corneal tissue. Young patients produce high levels of free radicals which cause oxidative damage to the cornea in absence of protective enzymes causing thinning & bulging of the cornea.
Keratoconus also shows some genetic predisposition. It may transmit from parent to children & affect more than one family member. It is also associated with excessive rubbing as it is more common in allergic conjunctivitis patients who have itching & tend to rub their eyes more frequently.
Other risk factors are overexposure to ultra violet rays, chronic eye irritation & improperly fitting contact lenses.
In early stages, when the cornea is still regular, corrective prescription glasses or soft contact lenses can help the patient. As keratoconus advances, the corneal surface becomes increasingly irregular & these options do not help adequately. In intermediate & advanced stage, various other treatment options & different types of contact lenses are available.
Rigid Gas permeable contact lenses : provide a smooth refractive surface replacing the irregular cone like surface of the cornea, thus enabling the patient to see clearly. Lens fitting in Keratoconus can be demanding & time consuming process. RGP lenses are not as comfortable as soft contact lenses.
Piggybacking Contact Lenses : a soft contact lens is first placed on cornea to give it a cushion like effect & RGP lens is fitted over it. Best features of both lenses are combined – makes the wearer comfortable & at the same time gives crisp & clear vision. The fitting should be perfect to ensure good oxygen permeability to the cornea as the patient will be wearing two lenses. However, with newer high oxygen permeable lenses this is not a problem.
Hybrid Contact lenses : uniquely designed wherein the central visual portion is made up of high oxygen permeable rigid material & peripheral anchoring portion is of soft hydrogel material. Maximizes the best features of both lenses & improves wearers comfort as well as visual performance in keratoconic eyes.
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