Corneal Crosslinking

Recently, the FDA has approved the use of corneal crosslinking for the treatment of keratoconus in the U.S.A. In general, a B vitamin and UV light is used to stiffen the cornea of the keratoconic eye. The exact specifics are still evolving. The important point is that crosslinking doesn’t eliminate the keratoconus but it does stabilize it! Early diagnosis is more important now than ever. If progression can be halted, glasses may be used to improve vision in early stages. Contact lenses will improve vision in moderate stages, as well as in severe stages when extreme scarring is not present. It is hoped that corneal crosslinking will eventually eliminate the need for corneal transplant surgery in the treatment of keratoconus.

Posted In: Keratoconus

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Corneal Transplant Surgery

When keratoconus progresses to end stage, corneal transplant surgery is the only way to restore sight. The central area is removed from the cornea of a keratoconic eye and a central “button” from the donor eye is then sewn on in its place. In large part due to the fact that keratoconus is non-inflammatory, corneal transplant surgery is very successful for treatment of end stage keratoconus. Even when successful, however, this surgery is not a cure. Post-surgical care is continuous and may be needed forever to maintain the health of the transplant and avoid rejection. If the transplanted cornea comes out to be irregular, contact lenses may still be necessary for clear vision. This poses a whole new set of fitting difficulties but results can be very good.


The question is: when is surgery necessary? As far as I am concerned, as long as the central cornea is clear, contact lenses should be used, not surgery. This is even if the keratoconus is severe, with extreme thinning and bulging of the cornea. Some people experience scaring of the central cornea. If the scaring is dense and centrally located, contacts cannot improve the vision because the central cornea is no longer transparent. This is the only time that surgery should, be considered. It is a treatment of last resort.

Posted In: Keratoconus

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Don’t Be a Chicken

Over the years we have noticed that people with keratoconus often make and confirm an appointment for an initial evaluation and then don’t show up. That’s curious. The people that could benefit most are least likely to show up. I have to wonder why. I think that the idea of having an eye exam is just too scary – they are afraid to hear the bad news. When you think about it, it’s hard to blame them. Every day they are reminded of their eye problem by their poor vision, and glasses don’t help. Many can’t even hold a job, and those that work, have to struggle through the day.


If this sounds like you, I just want to say – don’t be a chicken. Chances are I’ll be able to restore your good vision with contact lenses. It might take some time initially but, once fitted your keratoconus is just a minor inconvenience. I have succeeded with many patients who were told they can’t be fitted. We have so many choices of different lenses and techniques that I have almost never had to refer a patient for surgery. So take a deep breath, make your contact lens evaluation appointment, and show up. Get ready to hear the good news!

Posted In: Keratoconus

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