At Ophthalmology Associates of Bay Ridge, we offer a variety of treatments for keratoconus, a disease of the cornea that causes blurry and distorted vision that progresses during the young adult years. The cornea is the clear curved window in the front of the eye that allows light into the eye and helps focus light onto the retina. In people with keratoconus, the fibrous tissue that makes up the cornea is weaker than in those with normal corneas. This can cause the cornea to bulge out and change shape over time, assuming a cone-like shape. This process typically starts in the early 20’s and progresses through the 30’s and sometimes later into life. While the cornea is changing shape, the vision becomes very blurry. People with keratoconus have high amounts of nearsightedness and irregular astigmatism which typically cannot be corrected well with glasses. When patients are discovered to have a large eyeglass prescription change during their initial exam with us, our technicians usually perform additional testing to determine if keratoconus is present. Keratoconus is followed by obtaining a corneal topography, which shows the amount of corneal distortion that is caused by the disease.
What Causes Keratoconus?
The cause of keratoconus is not completely understood. We know that people who have a family member with keratoconus are more likely to develop the disease. Severe eye allergy is often associated with keratoconus, although the connection between these conditions is not clear. Many people who suffer from both keratoconus and eye allergies rub their eyes frequently. Eye rubbing is thought to possibly worsen keratoconus because the increased eye pressure might cause the cornea to bulge out more rapidly. Keratoconus patients are told to avoid rubbing their eyes for this reason.
Rigid Gas Permeable (RGP) Lenses for Keratoconus
The treatment for keratoconus depends on the severity of the condition. Patients with mild to moderate keratoconus will typically see well with the placement of a special kind of contact lens called a rigid gas permeable (RGP) lens. Our onsite optometrist, Dr. Felicia Donnolo, specializes in RGP contact lens fitting for keratoconus. Patients who were unable to tolerate contact lenses in the past are encouraged to see Dr. Donnolo because recent advances in contact lens technology have allowed patients with even more advanced stages of the disease to tolerate contact lenses. A well-fit contact lens can give outstanding vision far superior to that achievable with eyeglasses.
Surgical Treatments for Progressing Keratoconus
When contact lenses do not give adequate vision or are difficult to tolerate due to severe corneal distortion, several surgical treatments are available at Ophthalmology Associates of Bay Ridge. Our fellowship-trained corneal specialist, Dr. Elias Aliprandis, performs the only FDA-approved collagen cross-linking treatment for keratoconus and post-LASIK corneal ectasia using Avedro’s Photrexa® Viscous, Photrexa® and KXL® System. Dr. Aliprandis also performs INTACS corneal ring placement and corneal transplantation for advanced keratoconus patients.
Collagen Cross-linking for Keratoconus
Corneal cross-linking is a recently FDA-approved procedure that helps prevent keratoconus progression by strengthening the cornea. Collagen cross-linking is particularly useful for young, recently diagnosed patients, as they are the patients most likely to experience keratoconus progression. The cross-linking procedure has been performed for many years in Europe with tremendous success in slowing keratoconus progression and avoiding the need for corneal transplantation. Ophthalmology Associates of Bay Ridge is on the forefront in providing this cutting edge technology to our patients. We are one of the first practices in Brooklyn to offer corneal cross-linking using Avedro’s FDA-approved Photrexa® Viscous, Photrexa® and KXL® System. The procedure is done on site in our Bay Ridge office with only topical anesthesia and minimal patient discomfort.
At Ophthalmology Associates of Bay Ridge, we use a multi-disciplinary approach to obtain the best vision possible for our keratoconus patients. With proper care and followup, keratoconus patients can enjoy a lifetime of excellent vision.
INTACS Intrastromal Corneal Ring Segments for Keratoconus
INTACS are small, curved plastic rings that are placed inside the cornea at the mid-periphery to flatten the cone shape and improve the ability to tolerate contact lenses. INTACS can help avoid the need for corneal transplant surgery in some keratoconus patients. INTACS placement is a 15 minute outpatient procedure. Numbing drops are the only anesthesia needed. Dr. Aliprandis uses a special laser called a femtosecond laser to create a pocket in the middle of the cornea tissue to allow insertion of the INTACS rings. After the rings are positioned, one thin suture is placed at the end of the procedure which is removed in the office after one month. After INTACS placement, patients are followed for several months to allow the cornea to assume its new shape. In some cases, the INTACS will restore the cornea to its normal shape so that the patient can see without glasses or contacts. In other cases, a contact lens is still required after INTACS placement, but a patient will be much more comfortable with the lens due to the improved fit.
Corneal Transplantation for Keratoconus
In some patients with advanced keratoconus, INTACS fitting is not possible because there is a central corneal scar or the corneal tissue is too thin to allow the rings to be placed. The corneal shape is so distorted that contact lenses do not fit properly. These patients will often require a corneal transplant. This one-hour procedure is performed as an outpatient. A numbing injection is given behind the eye. Dr. Aliprandis will remove the central part of the cornea and replace it with donated corneal tissue. The corneal transplant is held together using very thin sutures that are the size of a human hair. Over the course of 3-12 months, the transplant heals and the vision stabilizes. Dr. Aliprandis will occasionally remove sutures to achieve better vision. After one year, a corneal transplant patient may benefit from glasses or contact lenses to improve the vision. Because the cornea has a more normal shape, patients are better able to tolerate contact lenses after a corneal transplant.