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Keratoconus is a progressive eye disease characterized by the thinning of the cornea and its forward protrusion into a cone shape. This condition prevents the eye from properly focusing light onto the retina, thereby leading to serious impairments in visual quality. During the development of keratoconus, the structural integrity of the cornea weakens, causing it to thin and become irregular. This process typically progresses along with refractive errors such as astigmatism and myopia. Additionally, patients often experience symptoms like double vision, light scattering, halos, and difficulty seeing, especially at night.
Keratoconus usually begins during puberty and becomes more pronounced in later years. As the disease progresses, eyeglass prescriptions can change rapidly, and the use of contact lenses may become necessary. The treatment for this condition involves different approaches depending on the stage of the disease, and early diagnosis is critically important in preventing permanent vision loss.
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Stages of Keratoconus
Keratoconus is a progressive eye disease characterized by the thinning and steepening of the cornea. The course of the disease is generally examined in four stages:
- Stage 1 (Mild Keratoconus): At this stage, patients may experience symptoms like mild astigmatism and blurred vision. Eyeglasses or soft contact lenses are usually sufficient. The first sign of keratoconus is blurred vision.
- Stage 2 (Moderate Keratoconus): As the disease progresses, the thinning and deformation of the cornea increase. At this stage, eyeglasses may become inadequate, and patients may require rigid gas permeable (RGP) contact lenses.
- Stage 3 (Advanced Keratoconus): In this stage, where the cornea is significantly thinned and steepened, surgical interventions such as rigid contact lenses, intracorneal ring segments (ICRS, e.g., Intacs), or corneal cross-linking (CXL) to halt the disease’s progression may be necessary.
- Stage 4 (Very Advanced/Severe Keratoconus): In the most advanced stage of the disease, the cornea is severely deformed, and vision loss becomes significant. In this situation, surgical interventions such as a corneal transplant (keratoplasty) may be considered.
The progression of keratoconus can be controlled at every stage with appropriate rehabilitation methods and regular eye examinations.
Symptoms of Keratoconus
Keratoconus typically begins during adolescence and manifests with various symptoms as it progresses over time. The main symptoms of keratoconus include:
- Blurred or Double Vision: The irregular shape of the cornea prevents light from focusing correctly on the retina, causing blurred or double vision (diplopia). This negatively affects the patient’s ability to see clearly.
- Light Sensitivity (Photophobia): Individuals with keratoconus may experience increased sensitivity to bright lights. This photophobia can be uncomfortable, especially when exposed to sunlight or bright artificial light sources.
- Difficulty with Night Vision: As the disease progresses, the ability to see in low-light conditions decreases. It can become difficult to discern details, especially when driving at night or in dimly lit environments.
- Frequent Changes in Eyeglass Prescription: The progression of the corneal deformity leads to constant changes in refractive errors. Therefore, patients may feel the need to frequently update their eyeglass or contact lens prescriptions.
- Halos and Glare: Seeing halos or glare around light sources is a common symptom of keratoconus. This becomes particularly noticeable around lights at night.
- Headache and Eye Strain: Due to the visual impairment, the eyes exert more effort, which can lead to eye strain (asthenopia) and headaches. These symptoms may increase, especially after prolonged reading or screen use.
These symptoms can worsen as keratoconus progresses and can negatively impact the daily quality of life. The progression of this eye disease can be controlled with early diagnosis and appropriate vision rehabilitation methods.
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What Causes Keratoconus?
While the exact cause of keratoconus is not fully known, it is thought that a combination of genetic and environmental factors plays a role. The main answers to the question, “What causes keratoconus?” are:
- Genetic Predisposition: The likelihood of the disease is higher in individuals with a family history of keratoconus. This indicates that genetic factors play a significant role in its development.
- Constant Eye Rubbing: Frequent and vigorous rubbing of the eyes can contribute to the progression of keratoconus by applying mechanical stress to the cornea. This risk is increased in conditions that cause itching, such as allergic conjunctivitis.
- Improper Use of Contact Lenses: The use of ill-fitting contact lenses or poor hygiene can lead to corneal irritation and micro-traumas, increasing the risk of keratoconus.
- Eye Allergies: Allergic reactions can cause itching and irritation in the eyes. This may increase the patient’s urge to rub their eyes, creating a predisposition for keratoconus development.
- Exposure to Harmful UV Rays from the Sun: Prolonged and unprotected exposure to UV rays can cause oxidative stress in the cornea, potentially triggering the development of keratoconus.
In addition to these factors, hormonal changes, connective tissue diseases, and other environmental factors may also play a role in the development of keratoconus. The progression of the disease can be controlled with early diagnosis and appropriate treatment methods.
How Does a Person with Keratoconus See?
Patients with keratoconus experience visual disturbances in various ways. This occurs because the irregularity of the cornea causes light to be refracted at different angles onto the retina. Here are the details of keratoconic vision:
- Blurry or Wavy Vision: Images are distorted due to the corneal deformity and take on a curved, wavy appearance.
- Double Vision (Diplopia): It is common to see the same object as double, either overlapping or side-by-side.
- Difficulty with Night Vision: At night or in low-light conditions, lights appear more scattered and reflective.
- Halos Around Lights: Glare or halos are noticed, especially around light sources like headlights and street lamps.
- Light Scattering (Starbursts): Light entering the eye is scattered by the irregular cornea, creating an intense sensation of glare.
- Distortion of Colors: Due to the light refraction issues, color transitions may appear mixed or be perceived differently.
- Focusing Problems: It becomes difficult to focus on images, and clarity cannot be achieved when looking at near and distant objects.
These visual disturbances vary depending on the stage of the disease and the severity of the corneal deformation. While blurred vision is mild in the early stages, double vision, light scattering, and loss of focus become more pronounced in advanced stages. These symptoms caused by keratoconus can seriously complicate daily activities such as driving, reading, and using digital screens. Keratoconic vision is significantly different from the clear vision of a normal eye.
Keratoconus Treatment
Keratoconus surgery is a surgical intervention applied in advanced stages and aims to not only stop the progression of the disease but also to improve visual quality. These surgeries improve the patient’s visual function by correcting or completely replacing the shape of the cornea. Each surgical method is selected based on the patient’s corneal structure, the stage of keratoconus, and overall eye health. The main types of surgery are:
- Corneal Transplant (Keratoplasty): Performed in advanced stages where the cornea is extensively damaged. A donor cornea is placed in place of the damaged tissue, ensuring that light is refracted correctly. There are different types, such as full-thickness (penetrating) or partial-thickness (lamellar) keratoplasty.
- Intracorneal Ring Segment (ICRS) Implantation (e.g., Intacs): Small plastic rings are placed within the corneal tissue. This procedure reduces the curvature of the cornea, allowing light to focus more evenly. It can also slow the progression of the disease by increasing the structural integrity of the cornea.
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Keratoconus Laser Treatment
Laser treatment for keratoconus is a method applied especially in early and moderate stages, aiming to improve visual quality by regularizing the corneal surface. This treatment reduces the irregular curvatures of the cornea, allowing light to focus more evenly on the retina. Laser therapy can be an effective alternative, especially for patients who have difficulty using contact lenses. These laser treatments can slow the progression of keratoconus and significantly improve visual quality, particularly in mild to moderate stages. The most suitable method is selected by considering the patient’s eye structure, corneal thickness, and the degree of keratoconus progression. The main types of laser treatment for keratoconus are:
- No-Touch Laser (TransPRK): A treatment method performed without direct contact with the cornea, offering a short recovery time. This method is preferred because it reduces the risk of infection and offers a less painful healing process.
- Topography-Guided PRK: Provides a personalized laser treatment by creating a detailed map of the corneal surface. It is highly effective for keratoconus patients with irregular astigmatism.
- Transepithelial PRK: A surface laser treatment method that offers rapid healing, performed by automatically removing the epithelial layer.
After Keratoconus Surgery
After keratoconus surgery, it is important to take certain precautions to support the healing process and prevent complications. Here are the main points to consider:
- Regular Use of Eye Drops: In the postoperative period, you must regularly use the antibiotic and corticosteroid eye drops prescribed by your doctor to reduce the risk of infection and control inflammation.
- Eye Hygiene and Avoiding Rubbing: You should wash your hands before cleaning your eyes and be in a hygienic environment. It is critical to avoid rubbing or scratching your eyes, especially in the first few days, to prevent damage to the corneal tissue.
- Use of Sunglasses: In the postoperative period, it is recommended to use sunglasses to protect your eyes from the sun’s harmful UV rays. Protect your eyes from UV rays by wearing sunglasses, especially on sunny days.
- Regular Follow-up with the Ophthalmologist: It is recommended to have check-ups on the first day, one week after, and monthly during the first year. These check-ups are important for monitoring the corneal healing process and detecting potential complications early.
- Physical Activities and Exercise: Heavy lifting, intense physical activities, and exercises should be avoided during the healing process. It is important not to exercise without your doctor’s approval.
- Use of Eyeglasses or Contact Lenses: In the postoperative period, the use of eyeglasses or contact lenses as recommended by your doctor can help improve your visual quality. It is important to follow your doctor’s instructions regarding the appropriate choice and use of lenses.
During the postoperative period, adhering to all of your ophthalmologist’s instructions and immediately contacting a healthcare professional if you notice any abnormalities is essential for a healthy recovery process.
Keratoconus Exercises
Keratoconus exercises can help strengthen the eye muscles and slow the progression of the disease. Regular eye exercises can increase visual comfort, especially in the early stages:
Main Keratoconus Exercises:
- Near-Far Focus: Hold a pen or your finger at a distance of 30 cm and focus on it for 10 seconds. Then, switch to a distant object to exercise your eye muscles. This exercise helps to increase the flexibility of the ocular lens.
- Figure-Eight Exercise: Keeping your head still, draw a large horizontal figure 8 in the air with your eyes. This movement improves visual control by keeping the eye muscles flexible.
- Palming: Warm your hands by rubbing them together and then gently place them over your eyelids. Keeping your eyes closed, take deep breaths for a few minutes. This technique reduces eye strain and helps the muscles to relax.
- Eye Shifting: Move your eyes to the right, left, up, and down. This movement is recommended for strengthening the eye muscles.
- Focus Switching: Focus on a near object for a short time, then on a distant object for a longer time. This exercise enhances the ability to change focus and strengthens the eye muscles.
Does Keratoconus Cause Blindness?
The question “Does keratoconus cause blindness?” is frequently asked. If left untreated, it can lead to severe vision loss in advanced stages. However, with early diagnosis and correct treatment, the risk of blindness can be prevented.
What Should Keratoconus Patients Pay Attention To?
- They should avoid rubbing their eyes.
- They should use UV-protective sunglasses.
- They should pay attention to eye hygiene.
- They should go for regular eye examinations.
This content has been prepared by Dr. Hatice Semrin Timlioğlu İper to provide information about keratoconus disease and its treatment methods. It is important to consult an ophthalmologist without delay when symptoms of keratoconus are noticed.
The text and images on our site are for informational purposes only. They do not substitute for diagnosis and treatment, nor do they carry any legal responsibility.