KERATOCONUS TREATMENT OPTIONS

Before talking about keratoconus treatment, you should know what exactly happens if you have this eye condition. Keratoconus is a progressive eye disease with a thinning of the cornea that causes a distortion of images and decreased vision.

Normally, your cornea, the clear outer lens of your eye, has a round shape. However, in the case of keratoconus, the structure isn’t strong enough, so it gets cone-shaped and bulges outward.

As the shape of your cornea changes, the smooth surface also becomes wavy, causing irregular astigmatism, aka blurred vision. Also, as the front expands, your vision becomes near-sighted, and you get myopia.

The patient may have difficulty performing activities, such as driving, writing, reading, or watching television. Glare and light sensitivity are pretty common symptoms too.

Most cases are diagnosed during adolescence or early ’20s. It can develop only in one eye, although it is almost always bilateral.

At present, there is no total cure for keratoconus. The usual treatments manage to slow its evolution. But early detection is of utmost importance to prevent the disease’s advance and the need for a cornea transplant.

Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on October 19, 2021

Keratoconus Causes And Diagnosis.

What Solutions Are Currently Available?

Contact Lenses.

Corneal Collagen Cross-Linking (CXL).

Intracorneal Annular Segments (Keraring or SAI).

Cornea Transplant For Severe Cases.

How Much Does Keratoconus Surgery Cost?

FAQ About Keratoconus Treatment.

WHAT ARE THE CAUSES OF KERATOCONUS?

The cause of keratoconus is unknown. New research suggests the cornea could be more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Apparently, the weakening of the corneal tissue that leads to keratoconus could be secondary to an imbalance of enzymes within the cornea. If antioxidants levels are low, the collagen weakens, and then the cornea bulges.

Risk factors may include genetics, explaining why it could affect more than one member of the same family. Keratoconus also is linked to overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses, asthma, eczema, and chronic eye irritation.

To diagnose keratoconus, your ophthalmologist will review your medical and family history. He will also perform a thorough eye exam to evaluate your visual acuity, corneal shape, and thickness.

What is Keratoconus

What Solutions Are Available for Keratoconus Treatment?

Keratoconus treatment depends on the severity of the condition and how quickly it progresses. Generally, there are two approaches: slowing the progression of the disease and improving your vision.

In mild cases, good vision can be achieved with glasses or soft contact lenses. Vision correction surgery is contraindicated in this case.

When this is not enough and keratoconus surgery is necessary, there are effective modern techniques that avoid keratoplasty (cornea transplant).

DO CONTACT LENSES STOP KERATOCONUS?

Normally, if glasses or soft contact lenses are not enough, gas permeable contact lenses (GP) are the next step.

GP lenses vault over the cornea, flatten it and restore its shape (up to a certain point). They are designed to create a uniform refracting surface and improve vision.

Since fitting GP contact lenses over a cone-shaped cornea can be challenging, some eye doctors advocate “piggybacking.” With this method, you place a soft contact lens over the eye and then fit a GP lens over the soft lens. This approach increases the patient’s comfort because the soft lens acts like a cushion between your cornea and the rigid GP lens.

Your doctor will monitor closely the fitting of “piggyback” contact lenses to ensure enough oxygen reaches the eye’s surface.

Also, there are scleral and semi-scleral lenses. These are large-diameter gas permeable contacts. Scleral lenses cover a wider portion of the sclera and are more stable than conventional GP contact lenses. Instead of sitting directly on the cornea like traditional contact lenses, scleral lenses rest on the white part of the eye and arch over the cornea without even touching it.

Whether using rigid or scleral contact lenses, you will need regular check-ups to determine if the fitting is satisfactory. An ill-fitting lens can damage your cornea and worsen keratoconus!

WHAT IS CORNEAL COLLAGEN CROSS-LINKING (CXL)?

Corneal collagen cross-linking (CXL) is usually indicated in the early stages of keratoconus disease or to complement the rings (Keraring / SAI).

This modern surgery technique offers a high success rate, slowing progression and improving corneal smoothness. It is a simple, safe and effective treatment.

However, this treatment does not reverse keratoconus. It stabilizes the cornea early in the disease and helps to reduce the risk of progressive vision loss.

Visual improvement after treatment occurs in up to 50% of cases. However, after the treatment, you will still need to wear glasses or contact lenses.

With this technique, the cornea is saturated with riboflavin (a type of B vitamin) eye drops with subsequent exposure to a low-power ultraviolet light. This process strengthens the cornea by increasing the number of “anchors” that bond collagen fibers together.

Thus, corneal crosslinking increases the stiffness of the cornea, weakened by keratoconus.

The procedure lasts approximately 1 hour, and it is not painful. It is performed with topical anesthesia as an outpatient procedure that does not require an overnight stay in the hospital.

The postoperative period is usually a little annoying the first 3 or 4 days. The use of contact lenses helps to reduce any discomfort and promotes healing. Recovery time is about one week, although it could be longer for some patients.

Specialists recommend cross-linking in patients who do not tolerate contact lenses. It can flatten the cornea and make it easier to wear contact lenses.

WHAT ARE INTRACORNEAL RING SEGMENTS?

Another keratoconus surgery option is implants of “intra-stromal rings” or intracorneal annular segments (Keraring or SAI). These are rigid, transparent plastic (PMMA), arc-shaped corneal ring inserts that are surgically introduced within the peripheral cornea.

The SAIs reshape the front surface of the cornea. They reduce the topographical irregularity and off-centering caused by the cone while flattening the center of the cornea.

Patients with intracorneal rings get better visual acuity than before surgery because they keep the central area of the cornea clear and intact. The rings slow or stop the progression of keratoconus by avoiding a cornea transplant. They improve tolerance to contact lenses too.

Keraring / SAI surgery lasts 15 to 20 minutes using topical anesthesia. As in the case of cross-linking, it is an outpatient procedure that does not require an overnight stay in the hospital.

The Keraring / SAI technique allows quick visual rehabilitation. It is a minimally invasive procedure that allows patients to return to their daily activity in 48-72 hours under normal conditions.

However, corneal stabilization ends at 12 weeks. Thus, it is normal for visual recovery to be slow.

It is a reversible surgical procedure and can be combined with corneal crosslinking. If the rings are removed, the cornea remains as it was initially.

WHAT IS CORNEA TRANSPLANT FOR SEVERE KERATOCONUS?

When vision has been reduced significantly, the only solution is keratoplasty or corneal transplant in the most severe cases.

It is applied when visual impairment is irreversible, and keratoconus cannot be corrected with other procedures. This is the case for 20-25% of advanced keratoconus patients.

During a cornea transplant, the surgeon removes the diseased cornea from the eye and replaces it with the healthy cornea of a donor.

Nowadays, the transplant can be performed by selectively replacing the affected layers of the cornea and preserving the healthy tissue. This is called partial thickness or Deep Anterior Lamellar Keratoplasty (DALK).

How Much Does Keratoconus Surgery Cost?

Keratoconus surgery cost depends on the performed technique. Please, fill in the contact form. If you have any medical reports or examination results from other centers, we would appreciate it if you could send these tests to us by email so we can offer you the solution that best suits your needs.

You can be sure that this information will always be treated with maximum confidentiality.

FAQ ABOUT KERATOCONUS TREATMENT

How many days should I stay hospitalized after keratoconus treatment?

Both procedures, corneal cross-linking or ring implants (Keraring / SAI), are performed on an outpatient basis and do not require medical hospitalization.

However, if a cornea transplant is performed, the patient should remain in the clinic for two or three days.

How long should I stay in Barcelona after the intervention?

The average length of stay in Barcelona (Spain) after crosslinking or ring surgery (Keraring / SAI) is ten days, depending on the patient’s progress.

In cases of cornea transplant, the patient’s stay in Barcelona will be between 15 and 30 days.

I am a foreign patient. Will the medical staff speak my language?

Qualified personnel is placed at your disposal, and they will advise you in your language and accompany you during the hospital process. If the doctor does not speak your language, a personal interpreter can accompany you throughout all your visits.

BEST KERATOCONUS SPECIALISTS IN SPAIN:

Doctor Rafael I. Barraquer

Doctor Rafael I. Barraquer

Bachelor of Medicine and Surgery (Universidad Autónoma de Barcelona, 1979). Specialist in Ophthalmology (1982). Doctorate in 1987 with the qualification of “Cum Laude”. Founder and director of the Ocular Oncology Unit. He maintains a significant teaching role as Associate Professor at the Faculty of Medicine at the Universidad Autónoma de Barcelona and in the Teaching Commission for the training of the COB MIR residents, of which he is President. He stands out for his capacity as a researcher and he is the chair holder of the “UAB Research Chair in Ophthalmology Joaquín Barraquer” since its foundation. Deputy Medical Director and Ophthalmologist at the Barraquer Ophthalmology Centre.
Languages: Spanish, Catalan, English.
Association number: 13.964

Doctor José Lamarca Mateu

Doctor José Lamarca Mateu

Bachelor of Medicine (University of Lleida, 1996-2002). Ophthalmology residency at the Barraquer Ophthalmology Centre. Masters in “Retinovascular Pathology, Inflammation and Intraocular Tumours”, “Corneal and Ocular Surface Pathology “,” Pathology and surgery of the Macula, Vitreous and Retina” and “Diagnosis and Treatment of Cataracts and Glaucoma” certified by the Universidad Autónoma de Barcelona (2003-2007). Coordinator of the Barraquer Institute. Tutor in the Department of Educational Surgery. Member of the executive committee of the Research Committee of the Institut Universitari Barraquer. Professor at the International University of Catalonia.
Languages: Spanish, Catalan, English
Association number: 37491

External links – Bibliography

Intrastromal corneal ring segments: how successful is the surgical treatment of keratoconus? Alio JL, Vega-Estrada A, Esperanza S, Barraquer RI, Teus MA, Murta J.Middle East Afr J Ophthalmol. 2014 Jan-Mar

Corneal biomechanical changes after intracorneal ring segment implantation in keratoconus. Piñero DP, Alio JL, Barraquer RI, Michael R.Cornea. 2012 May

Intracorneal ring segment in keratoconus: a model to predict visual changes induced by the surgery. Peña-García P, Vega-Estrada A, Barraquer RI, Burguera-Giménez N, Alio JL.Invest Ophthalmol Vis Sci. 2012 Dec

Modification and refinement of astigmatism in keratoconic eyes with intrastromal corneal ring segments. Piñero DP, Alió JL, Teus MA, Barraquer RI, Michael R, Jiménez R.J Cataract Refract Surg. 2010 Sep

Impact of contact lens wear on epithelial alterations in keratoconus. Sorbara L, Lopez JCL, Gorbet M, Bizheva K, Lamarca JM, Pastor JC, Maldonado López MJ, Hileeto D.J Optom. 2021

Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics. Alió JL, Piñero DP, Alesón A, Teus MA, Barraquer RI, Murta J, Maldonado MJ, Castro de Luna G, Gutiérrez R, Villa C, Uceda-Montanes A.J Cataract Refract Surg. 2011

Internal, corneal, and refractive astigmatism as prognostic factors for intrastromal corneal ring segment implantation in mild to moderate keratoconus. Peña-García P, Alió JL, Vega-Estrada A, Barraquer RI.J Cataract Refract Surg. 2014 Oct

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