Insidious eye disease keratoconus can be stopped using the modern method

The importance of eyesight in a person’s life is impossible to overestimate. It is not surprising that when asked about what they think about blindness people define it as devastating. Full or partial blindness has been always viewed as the greatest tragedy in life, as the person with the condition is separated from the rest of the world by a wall of darkness. “These days vision problems affect so many people, that it is more unusual to come across someone who doesn’t have them. However, some eye conditions are especially hard to diagnose. At the initial stages, due to the absence of distinct symptoms, patients do not feel a thing, and doctors are confused as the basic equipment does not allow them to see any changes in the eye,” says Dr. Paulius Rudalevičius, ophthalmologist and head of the Ophthalmology Centre at the Medical Diagnostic and Treatment Centre. We are talking to him about one of the most insidious eye diseases – keratoconus, which today can be successfully stopped with the help of modern treatment methods.

The disease causes damage to the cornea

Keratoconus is a particularly insidious pathology of the eye causing damage to the cornea. Ophthalmologist Dr. P. Rudalevičius provides a poetic description of the cornea, calling it the eye’s window to the world. It is a clear, protective layer, directing the light rays into the eye and helping to focus them on the retina; it acts as a natural lens.

Keratoconus is a progressive non-inflammatory disease of the eye, in which the dome-shaped cornea thins and begins to bulge into a cone-like shape.

The untreated condition can damage eyesight

Keratoconus usually develops in 20-30-year-olds, but its onset may occur considerably earlier.

The younger the patient is when thinning of the cornea begins, the faster is the progression of the disease. The condition keeps deteriorating until approximately the age of 38. Untreated keratoconus can irreversibly damage the eye. In especially neglected cases cornea transplant surgery is required.

The exact causes are unknown

The exact causes of keratoconus are not known. Several research studies link the development of keratoconus to frequent and hard rubbing of the eyes. According to the doctor, it is obvious that the cornea can be damaged even more and the progression of keratoconus can be aided if we rub or cause trauma to it in other ways when it has already been weakened.

Several factors can trigger keratoconus. These are the most likely ones:

• Adverse ecological environment caused by serious pollution
• Endocrine system metabolic disorders
• The trauma of the eye

Inheritance is also a significant factor. It is known that 10% of cases are hereditary, therefore people whose family members have been diagnosed with keratoconus must have regular eye check-ups and corneal topography tests from the beginning of adolescence.

Dr. Paulius Rudalevičius says that 500 out of 100 000 patients are diagnosed with keratoconus world-wide. It is slightly more prevalent in men, but the difference is insignificant.

Ophthalmologists have observed a notable increase in keratoconus cases in the last decade. On the one hand, this can be explained by better diagnostic opportunities, but on the other – it is a clear signal of the deteriorating state of our ecological environment.

Diagnosis can be inaccurate

Due to similar symptoms, it is quite common for early keratoconus to be confused with near-sightedness or astigmatism. When keratoconus affects the eye, the distorted cornea causes uneven refraction of light rays, which results in reduced visual acuity (the same as with near-sightedness), the quality of vision keeps changing and it takes time for the image to get focused (the same as with astigmatism), and the eyes become tense and tired even after a short period on the computer.

Deteriorating vision, which is still thought to be a symptom of near-sightedness or astigmatism, makes the patient go to the doctor and get glasses. A short while later, the patient starts to feel that they are not helping him anymore and obtains a new pair. Later he swaps glasses for contact lenses. This sequence of events may be a reason to suspect keratoconus.

If progressive deterioration of eyesight and keratoconus-linked topographical corneal changes are established in a young, i.e. 16-30-year-old patient, the procedure to increase corneal strength using the CROSS-LINKING method will be recommended.

Patients who had their condition detected at the age of 35–40, will be placed under observation, and have corneal tests performed, but it is very likely that in their case keratoconus has already stopped progressing or the progression will be negligible.

Accurate diagnosis of the eye disease is only possible following a thorough examination of the optical system of the eye which is performed using modern diagnostic equipment.

Symptoms of keratoconus:

• Difficulty in seeing far away from developing in 20-25-year old patients with previously good vision
• Difficulty in choosing correct glasses or contact lenses
• Progressively deteriorating eyesight, i.e. progressing near-sightedness or astigmatism
• Blurring of vision when looking at the distance, similar to near-sightedness
• In advanced cases, the cornea may thin to the point where a hole develops in the thinnest part, which suddenly causes vision to worsen even more, and then scarring appears in the center

The progress of keratoconus in each eye is usually not the same. Practice shows that at the beginning more damage is sustained by one of the eyes, but later corneal changes start developing in the stronger eye. When the progression of the disease is different in each eye, the patient may find it difficult to realize that their vision is getting worse because for a while bad vision in one eye is compensated by a better vision in the other.

Several methods to help patients

Ophthalmologist Dr. Paulius Rudalevičius says that patients with keratoconus may be helped in different ways. The best method is selected on the basis of the stage of the disease and the age of the patient.

The first step is spectacles. They help to see better but in no way do they stop the progression of the disease and can only be used as a temporary measure.

When the glasses are not helping anymore, vision may be corrected with contact lenses. In the beginning, the patient is prescribed soft lenses, and later, with the advancement of the disease – hard lenses. Lenses also have advantages and disadvantages. Although the person may see well, the lens is constantly pressing against the eye, the cornea cannot breathe properly, corneal micro-trauma becomes inevitable, and the risk of infection increases. With the advancement of the disease, the lens can no longer stay in the eye, and we have to resort to another method in order to save the cornea, i.e. implantation of a donor cornea.

It was previously thought that corneal transplant was the only possible treatment for keratoconus, and many transplantations were performed. However, patients and doctors encountered a number of problems, such as shortage of donors, donor and recipient age difference, superstitious views of the family and unwillingness to donate the cornea of a deceased person, possible development of post-surgery astigmatism, and other conditions. Moreover, the risk of donor tissue rejection remains relevant even many years after transplantation. In such cases, the cornea needs to be re-transplanted. Notwithstanding all the above, if advancing keratoconus causes a tear and cloudy appearance in the cornea, transplantation is viewed as quite a successful keratoconus treatment method.

With the advancement in technology and rapid progress in many fields of medicine, new keratoconus treatment methods have been developed, intracorneal ring segments being one of them. Like any other treatment method, this surgical intervention may not be suitable for everyone. The main requirement for the patient is adequate corneal thickness, as otherwise, the ring may not stay in place. The procedure may be reversed, i.e. the inserted ring may be removed. Unfortunately, optimal visual acuity results are not always achieved with the insertion of intracorneal rings.

Innovative methods help to save vision

Corneal cross-linking, the corneal tissue strengthening surgery, is a safe method to stop the progression of keratoconus and protect the cornea from tearing and becoming cloudy.

This corneal strengthening procedure, called CROSS-LINKING in the international practice, has been successfully applied for 15 years. Its aim is to halt bulging and thinning of the cornea, increase tissue stability, and preserve good vision as a result. The procedure has been recognized worldwide and is also performed in Lithuania, at the Medical Diagnostic and Treatment Centre.

Every patient’s case is different. Before deciding which treatment method to apply, the doctor needs to assess the condition of the patient. A mandatory condition for CROSS-LINKING is a minimum corneal thickness of 400 μm.

The procedure is performed using a special laser. The outer layer of the cornea (epithelium) is removed and liquid riboflavin is allowed to penetrate the tissues, following which UV light of individually selected intensity is applied for several minutes. New links between collagen fibers within the cornea are created and the cornea is stabilized. The bulging of the cornea is halted as it has become more stable.

Technologies that are applied at the Medical Diagnostic and Treatment Centre enable full or partial surgical elimination of the refractive error caused by keratoconus. This surgery is individual eye preserving laser correction. The method helps to achieve better visual acuity results and to halt the disease.

The patient doesn’t need any special preparation before the procedure. It takes about 30 minutes, then antibiotic eye drops are administered and a therapeutic contact lens is applied. It is removed several days later and the drop administering schedule is then changed.

Modern laser technology aids healing

Following corneal strengthening surgery patients are placed under observation for 12 months. Previously the operated eye felt painful for 3-4 days. Thanks to our current laser, post-operative discomfort has significantly reduced, and a slight tingling sensation or dryness is the only sings felt on the first day following the surgery. Right after the surgery, the patient feels like he is looking at things through a fog. However, vision significantly improves over the next few days. Patients can return to work 4–5 days after the surgery but still need to look after their eyes well and avoid dust and straining the eyes too much.

Some patients claim that their eyesight hasn’t improved much after the surgery. Dr. Paulius Rudalevičius accepts such a reaction but calls it illogical if surgery was performed when keratoconus was advanced. Improvement of vision can be expected when the CROSS-LINKING procedure to strengthen the cornea is performed when the disease is in stages 1 or 2, or when the changes are not very advanced and additional partial refraction error correction may be carried out. The aim of surgery in cases of advanced keratoconus is to stop the disease from progressing. If the disease does not progress any further in the 12 months when the patient is under observation, it means that the procedure was successful.

With advances in medicine, keratoconus is no longer a blindness sentence. We now have a number of methods to stop the disease and give patients a chance to live their life to the full, enjoying all of its colors. It is important to recognize the disease in good time and find a solution.