Keratoconus Eye Condition

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What is Keratoconus (KCS)?

Keratoconus (KCS) is a degenerative condition of the cornea which may have an inherited component. It affects around 1 in 1500 people in the UK but the incidence can be as high as 1 in 450 people in some populations. The disease process is one of corneal thinning called ectasia, which usually starts in teenage years and stabilizes in the late 20’s to 30’s but can be highly variable. Keratoconus is often associated with allergic conditions such as eczema, asthma or hay fever and is made worse by eye rubbing. 

The cornea is the transparent dome of collagenous tissue that forms the front protective coat of the eye. It is very nearly round in shape and is responsible for about two thirds of the optical power, or focusing power of the eye. Thinning of the cornea causes it to lose its natural curvature and bow out of shape, this irregular astigmatism results in light being focused in many different directions which causes blur and reduced visual quality.

At night our pupils get bigger so that our eyes can use all available light to see. As the cornea in KCS is irregular, more poorly focused light enters a larger pupil leading to increased light scatter which is perceived as glare or starburst and visual quality falls further. This can cause particular problems e.g. driving at night.

Patients will often be aware that they cannot see as sharply as they are used to, particularly when using screens but because KCS typically affects one eye much more than the other, the overall vision may remain quite good and diagnosis of KCS is often made late because routine sight tests may not be requested. Opticians are good at detecting KCS because they notice abnormal reflexes when examining the eye, these are described as ‘oil drop’ or ‘scissoring’. They will also measure astigmatism and will expect to correct vision fully in both eyes so the presence of high astigmatism, changing astigmatism or reduced vision will prompt referral.

What is Keratoconus (KCS) Animation

Keratoconus Treatments

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There are two main aims of treatment:

  1. Stabilize KCS and halt progression – Therapeutic treatment
  2. Improve vision – Refractive treatment

These treatments may be combined or performed separately, therapeutic treatment is always the first priority.

Keratoconus causes complex changes in the visual system and treatment is highly individual, particularly when improving vision because each treatment protocol is customized for the eye of that particular patient. If you don’t find the answers you’re looking for, please get in touch – we are happy to help.

Therapeutic Treatment to Stabilise Shape

Corneal Collagen Cross-Linkage (CXL)

Corneal collagen cross-linkage (CXL) is the first and most effective treatment shown to stabilise KCS, it was developed in Switzerland in the late 90’s and was approved by NICE in the UK in 2009. It has been extensively investigated and epi-off CXL is considered the gold standard in treatment.

David Anderson has been performing CXL since 2010 and uses the Avedro KXL system which is considered to be the most advanced platform for treating KCS with more than 400,000 treatments to date.

You can learn more about CXL here.

Corneal Collagen Cross Linking Animation

Refractive Treatments to Improve vision

Intracorneal Ring Segments

Think of the cornea as a transparent rubber ball anchored around the edge where it meets the white part of the eye (the sclera). Bending or stretching the cornea in one direction causes an equal change in the opposite direction. Using the Visumax laser to create a tiny channel in the cornea 1mm in width, thin plastic semi-circular intra-corneal ring segments (ICR’s) are painlessly inserted into the channel to flatten the steeper parts of the cornea and steepen the flatter making the overall shape rounder.

You can learn more about this procedure here

ICRS Treatment Animation

Other Treatments

Trans-epithelial phototherapeutic keratectomy

Trans-epithelial phototherapeutic keratectomy (PTK) is a surface laser procedure using the Mel90 excimer laser designed to remove a very small amount of tissue immediately prior to CXL. As the cornea in KCS is steeper and more irregular in shape than normal, the use of a regular beam profile can help smooth the cornea a little at the same time that CXL is performed. As the corneal epithelium needs to be removed for each procedure individually, combining the two, reducing healing time.

Topography-guided photorefractive keratectomy (PRK)

Topography-guided photorefractive keratectomy (Topo-PRK) is an excimer laser treatment designed to reshape the cornea to a rounder or more natural shape and reduce the distortion caused by KCS. Detailed measurements are made of the cornea using two different specialist non-contact measurement devices, the Pentacam HR and the CRS-Master. From these readings the corneal shape can be analysed and a custom treatment designed for that individual cornea and applied using advanced surface ablation.

Advanced Surface Ablation / LASEK / PRK Animation

Implantable collamer lens surgery

Implantable collamer lens surgery (ICL) is a surgery that can be used either as a primary measure to improve vision in KCS in stable disease or following CXL or other refractive treatments designed to reduce irregular astigmatism e.g. ICR surgery or topo-PRK.

ICL surgery is covered more completely in another section of the website, please find the link here.

5-Star Keratoconus Treatment Reviews

Dan
All Round Excellent Experience
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I underwent insertion of an intracorneal ring combined with corneal crosslinking in my left eye with Anderson Eye Care in September 2019. The procedure is entirely painless and does not take long, all you feel is pressure on your eye. There was moderate discomfort from around 2 hours post procedure until around 12 hours post procedure, however you are provided with painkillers and numbing eye drops which keeps everything under control. I woke up the morning after with no discomfort whatsoever, which was surprising to say the least. From my initial consultation with David through to my procedure and followup appointments, I found David and the other staff at the Nuffield facility to be professional and polite. I would rate my experience with Anderson Eye Care as exceptional and would not hesitate to consult with David again should I need treatment in my other eye. --Daniel Rogers
Oliver
Corneal Cross-linking
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I was referred to Mr Anderson last year for treatment for keratoconus and underwent corneal cross-linking on both eyes. I am 24 years old and have been seeing various opticians and eye doctors since 2015. Mr Anderson was knowledgeable and very helpful in explaining the process to me and I felt confident in him going into the procedure. There were no problems with the surgery and I was well-prepared for the discomfort I experienced in both eyes while recovering over the following couple of days, with advice, eye drops and pain relief. Having both eyes done at the same time meant that I couldn't see properly for most of that recovery period, but it also meant both eyes recovered in the same time frame and I only had to go in for surgery once. I have no regrets about choosing to have the treatment this way. Mr Anderson and his staff were very professional, helpful and kind both when I went in for the procedure and when I returned for follow up appointments. I would have no hesitation in recommending him to others.
Suki
Removal of Scar tissue- Superficial Keratectomy
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I have been under the care of Mr David Anderson for my Keratoconus for many years so when he recommend that i needed a procedure to remove scar tissue- superficial keratectomy, i did not hesitate. HIs calm, relaxed, professional manner reassured me every step of the way from the initial consultation to the post op follow up appointment. i felt fully informed and the information was on a comprehensible level so i never felt overwhelmed by the specialist medical terminology. His efficient and professional team were caring and considerate and their approachable manner put my mind at ease. i was confident i was in good hands throughout. I highly recommend Mr David Anderson without hesitation. In fact i have to have the same procedure on my other eye in the near future and am completely at ease in the knowledge that Mr Anderson will be my surgeon. Thank you to all the team.
Mrs Helen
Corneal Cross Linking
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I live in Guernsey and was referred to Mr Anderson for help with my condition known as Keracatonus. I met David who from the offset knew what he was able to offer me. His knowledge of eyecare was incredible something I had not experienced before, I'm 31 years old. I agreed to have Corneal Cross Linking done. At first it was very daunting as I did my research but when it came to the procedure I was looked after very well. The procedure was over and done with in over 30 minutes. There is discomfort for a few days after but rest is the key. Eye drops and pain killers benefit as well as sunglasses and goggles for the shower. Overall the experience was worthwhile as my corneas are now fantastic and I'm working at improving my vision with the help of my optician and continued support from David and his team. I would highly recommend Anderson Eyecare to anyone considering procedures especially Corneal Cross Linking.
Jack
Corneal Cross Linking
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Diagnosed with advanced Keratoconus at the age of 19, I was referred to Dr Anderson at the Nuffield Hospital in Chandlers Ford, Eastleigh. My initial meeting with Dr Anderson left me feeling encouraged and in safe hands. I had the condition explained to me in depth and was guided through the Corneal Cross Linking procedure which would halt the thinning of my corneas. The operation itself was not painful. Dr Anderson's consideration towards my comfort was excellent. The after care and follow-up appointments are a constant reminder of the exceptional quality of his practice as my vision is stable and healthy. I understand having corneal treatment at a young age is daunting, but Dr Anderson's professionalism, expertise and care towards his patients left me feeling calm and confident. I would highly recommend Dr Anderson's practice to anyone.
Lynn
Cross linking
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My son (19) was diagnosed with keratoconus following a trip to emergency department with hydrops. We were referred to Mr Anderson regarding care and plan for future treatment Mr Anderson and his team have been exellent from start to finish. Cross linking was advised (on his good eye ) and this was completed very quick within 5 days of seeing Mr Anderson his PA Lisa Kept us informed and was very professional. my son recovered within a week and I can not thank the team enough. Once again thank you.
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