Keratoconus: Symptoms, Diagnosis, and Treatments

What is Keratoconus: A Disease of the Cornea

Keratoconus is a progressive, non-inflammatory eye disease that affects the cornea, the clear, dome-shaped front part of your eye. Normally, the cornea has a regular spherical shape, much like a football, which allows light to focus precisely on the retina to form a clear image. In a person with keratoconus, the cornea gradually thins and bulges into an irregular cone shape. This distortion alters how light is refracted, leading to vision that can become very troublesome.

There is no single, clearly identified cause of keratoconus. It is thought to result from a combination of genetic and environmental factors. About 10 to 20% of people with the condition have a family member who also has it, suggesting a hereditary predisposition. Certain factors like frequent and vigorous eye rubbing, or chronic eye allergies, might contribute to its onset or worsening. Keratoconus usually appears during adolescence or in young adults and can progress for about ten years before stabilising. It is important to note that keratoconus generally affects both eyes, but often asymmetrically, meaning one eye may be more severely affected than the other.

Recognising the Symptoms: When to Worry?

The symptoms of keratoconus evolve as the disease progresses. In the beginning, they are often subtle and can be confused with common vision problems. That is why an accurate and early diagnosis is crucial.

Blurry and distorted vision, a warning sign

The most common symptom is blurry and distorted vision that does not improve significantly with standard glasses. You might feel that objects are stretched, doubled, or have halos around them, especially at night. Astigmatism, a very common vision problem, is also characterised by distorted vision. This is why keratoconus is often first diagnosed as a rapidly worsening astigmatism that requires very frequent changes in prescription. Other signs may include increased sensitivity to light (photophobia), glare, poor night vision, or eye irritation. If you or a loved one experience these symptoms and glasses no longer seem to provide the usual correction, it is essential to consult an eye care professional.

In more advanced stages, vision becomes increasingly difficult, even with glasses, impacting daily life: reading, driving, and recognising faces. It is at this stage that more specific solutions are considered.

Treatment Options for Keratoconus: from Simple to Advanced

The diagnosis of keratoconus is made by an ophthalmologist, often using an examination called corneal topography, which maps the surface of the cornea to detect its deformation. Once the diagnosis is confirmed, several treatment options are available, the choice of which will depend on the stage of the disease and its progression.

Keratoconus lenses: a custom correction

In the early stages of the disease, when the distortion is mild to moderate, glasses can still provide some improvement. However, the optics of glasses cannot perfectly correct the irregular shape of the cornea. This is where keratoconus lenses come in. These contact lenses, often rigid gas permeable (RGP), have the ability to create a new, regular optical surface over the irregular cornea, thereby significantly improving vision. There are also larger scleral lenses that rest on the white part of the eye and not on the cornea itself, offering increased comfort and better stability for more fragile corneas. The selection and fitting of these lenses require specialised follow-up by a contact lens fitter.

Cross-Linking: stopping the progression of the disease

For cases where keratoconus is actively progressing, "corneal cross-linking" is a procedure aimed at strengthening the cornea. It involves applying riboflavin (vitamin B2) drops to the eye, then exposing it to ultraviolet A (UVA) light. This combination causes new bonds to form between the collagen fibres of the cornea, making it more rigid and often halting the progression of the disease. It is a sight-saving intervention that can prevent further vision deterioration and, in some cases, the need for a transplant.

Corneal transplant in Africa: a solution for advanced cases

When keratoconus is at a very advanced stage, vision is severely impaired, and other treatments have not been sufficient, a corneal transplant in Africa (keratoplasty) may be considered. This is a surgical procedure where the damaged part of the cornea is replaced with healthy corneal tissue from a donor. Several types of grafts exist, depending on the thickness of the affected cornea. Although this surgery is more complex and requires a longer recovery time, it often offers a significant improvement in vision for eligible patients. The availability of grafts and access to surgery can vary depending on the country and healthcare systems in Africa, but efforts are being made to expand this care option.

Living with Keratoconus: Support and Follow-up

Living with keratoconus means taking a proactive approach to your eye health. Regular follow-ups with your ophthalmologist are essential to monitor the disease's progression and adjust treatment as needed. It is important not to rub your eyes, an action that, although seemingly harmless, can worsen the corneal distortion.

Keratoconus can be a frustrating disease, but medical advances offer increasingly effective solutions to preserve and improve vision. Information and awareness are the first steps toward better management.

If you have any doubts about your vision, if you notice a gradual decline or distorted vision that does not improve with your current glasses, it is crucial to seek a consultation. At Lapaire, present in several African countries, we invite you to come for a free vision test at one of our stores. Our opticians can assess your situation and, if necessary, refer you to an ophthalmologist for a more in-depth diagnosis. Don't wait for your vision to worsen, act now for your eyes.

This article is for informational purposes. For a personalized diagnosis, consult a Lapaire optician.