Keratoconus is a deformation of the dome-like cornea, the outer layer of the eye. The collagen fibres in the cornea bend and give it a ‘prolate’ shape: it is steeper in the centre and flatter at the ‘poles’. However, in some people, the steepness distends beyond the point of structural and functional stability. In patients with keratoconus, the bonds between these collagen fibers begin to weaken, and the cornea thins and bulges outward into a cone. 

Keratoconus is an eye condition usually found in young people. It begins to show in teenage, worsens, and finally stops progression in most people by their 30s. For many young people, it impacts their productivity as keratoconus impairs vision. 

The causes behind this condition are unknown. However, a genetic predisposition, family history, and some behavioural habits seem to trigger its progression. Some of the risk factors are:

• Eye rubbing, with some associated allergies
• Hypothyroidism
• Any other genetic condition, like Down’s syndrome or retinitis pigmentosa
• Hormonal impact of pregnancy

Keratoconus is commonly found in young people. Some of the possible symptoms are:

• Bilateral (both eyes) but asymmetric refractive error
• Steep astigmatism
• Corneal thinning
• Rings and other markers on the cornea

In LVPEI data, more men seem to be seeking treatment for keratoconus (though that can just be selection effect: lesser women may be seeking care). [1]

There is no cure for keratoconus. However, some therapy is available to arrest its progression and ensure that patients lead a full life. These include:

• Contact lenses: While very early stages can benefit from soft toric contact lenses, patients are prescribed hard, gas-permeable contact lenses to negate the steep astigmatism of keratoconic corneas with significant improvement in vision. In patients with irregularly shaped corneas, Rose-K and PROSE contact lens are ideal options. Speak to your contact lens specialist at LVPEI for options that suit you best.
• Collagen cross-linking: Collagen cross-linking (CXL) is the only known surgical technique which induces chemical bonds that strengthen the weakened collagen fibres of the cornea. The procedure uses ultraviolet-A light to stimulate a photosensitizer like riboflavin (Vitamin B2) added to the cornea. The activated riboflavin molecules induce new chemical bonds between the collagen fibers, stiffening the tissue. CXL has become a standard of care for keratoconus.
• Corneal transplant: If the cornea is unstable and all other options fail, a corneal transplant, where the damaged cornea is replaced with donor tissue, is considered.