What is keratoconus?
Keratoconus is a degenerative condition of the cornea characterised by progressive bulging and thinning. Patients are often first detected when their glasses prescription is getting stronger with a more irregular shape.
Who gets keratoconus?
Keratoconus is estimated to occur in around 1 in 1000 people in the general population. Men and women seem to be equally affected. In the majority of cases it becomes apparent between the ages of 16 and 35. After this time progression often slows or stops. It is usually in both eyes though often is worse in one eye.
What causes keratoconus?
The cause of keratoconus remains poorly understood and there are likely genetic and environmental factors. One in ten patients have an affected relative. Eye rubbing is known to be an important factor and you should avoid this as much as possible.
If Left untreated, can keratoconus cause blindness?
Keratoconus does not lead to complete loss of vision, though untreated and if advanced it can lead to severe visual loss enough for patients to be classified as legally blind. With early detection and treatment however, patients generally do very well and their vision can be preserved.
How is keratoconus treated?
The two main issues in the treatment of keratoconus are preventing the condition from getting worse and also improving vision.
If the keratoconus is worsening, corneal collagen cross-linking is the procedure of choice. The operation uses riboflavin and ultraviolet light to stiffen the cornea and prevent worsening vision. This can be combined with a laser procedure to help improve your vision at the same time.
Improvement of vision may initially be with glasses alone. As the power of the cornea increases and more irregularity appears, rigid contact lenses can give the best vision. Implantation of intracorneal ring segments can improve the vision at this point also. If the cornea is scarred or vision cannot be improved with previous measures, a corneal transplant is required to improve vision.
What does corneal cross-linking do?
Cross-linking works by increasing the number of molecular ‘cross-links’ to increase the strength of the cornea and slow the progression.
How does corneal cross-linking work?
Cross-linking works by increasing the number of molecular cross-links between collagen fibres to increase the strength of the cornea and slow the progression. This is achieved by treatment with Riboflavin eye drops followed by delivery of ultraviolet light to cause chemical reactions that create covalent bonds between the collagen fibrils.
What happens during the procedure?
The procedure is near painless. Local anaesthetic eye drops are applied and the surface cells from the eye are gently removed. Riboflavin drops are applied for 10 minutes, then a UV light is used for 10 minutes. You can relax and not worry about blinking as a very small speculum is used to keep your eyelids in the correct position. After the procedure is finished, antibiotic drops and a contact lens are inserted.
What is the recovery time for this procedure?
Patients may have some pain and discomfort for the first few days after the procedure as the surface of the eyes heal. Dr Gunn can perform the procedure on a Thursday in his Brisbane surgery, and you could return to work or study on the next Monday.
Are there government rebates available for the surgery?
The government has now added corneal cross-linking to the medicare rebate system which has significantly cut costs for the procedure whether you have private insurance or not.