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Keratoconus is a condition where the cornea gradually becomes thin and bulges out, taking on a cone shape (hence the name). The abnormal shape of the cornea (referred to as astigmatism) brings light rays entering the eye out of focus. This leads to distorted and blurry vision.
Most people develop keratoconus in childhood. They experience blurring of their vision and may initially may be told they simply are nearsighted or have astigmatism and are given glasses to see better. Later on, as the corneal bulge increases, the astigmatism becomes so great that only contact lenses, not glasses, can improve vision. Night vison becomes increasingly difficult as well. In more severe cases the cornea bulges so much that it becomes very thin and may partially rupture at the apex of the bulge. This typically causes sudden, intense blurring of vison, light sensitivity, and pain.
The exact cause of keratoconus is unknown but thought to be genetic. The greatest risk factors for keratoconus are family history and frequent eye rubbing (often associated with allergies, asthma, and eczema).
Unfortunately, keratoconus is commonly missed in its early stages if a detailed map the corneal shape, known as topography, is not performed during the eye exam. At InVision we routinely perform topography on our patients so we tend to pick up this disease at an earlier stage.
We now offer our patients a newly developed genetic test to determine their risk of developing keratoconus, ensuring early diagnosis and treatment if necessary. This is performed by Dr. Ragam in our office by means of a simple cheek swab. Patients with a family history of keratoconus or corneal transplantation, rapidly changing glasses or contact lens prescriptions, and those who have been told they may not be candidates for laser vision correction should strongly consider undergoing this genetic test.
While we cannot fully reverse the cone shape of the cornea once it has developed, we can improve a patient’s vision with glasses in milder cases and contact lenses in more advanced cases.
There is a newly FDA-approved in-office procedure called corneal collagen cross-linking which can successfully halt the progression of keratoconus. This procedure is performed by Dr. Ragam and her staff in right here in our office at InVision Eye Care. It involves applying riboflavin (vitamin B) drops combined with UV light directly onto the eye to form collagen bonds that strengthen the cornea. The goal of this procedure is to lock the cornea in its current shape and to prevent it from continuing to thin and bulge out further. However, many patients also experience some improvement in vision after recovering from this procedure.
If keratoconus is left untreated for too long, the cornea may become so thin and distorted in shape that only a corneal transplant (called a Penetrating Keratoplasty or PKP) will improve vision. This is a major eye operation that may require up to year for best vision to result. For this reason, it is critical to undergo routine topography in our office so we can monitor for progression and intervene with collagen cross-linking before a transplant is necessary.
Should you need corneal transplant surgery, it will be performed by Dr. Ragam at our state-of-the art ambulatory surgery center, Seashore Surgical Institute.
Dr. Ragam is experienced in all facets of corneal surgery and has published on collagen-cross linking. We are fortunate on the Jersey shore to have such a talented and caring corneal specialist.