Have you recently been diagnosed with Keratoconus (KC)? For many patients, they are relieved to finally have a name for their eye condition that has made it impossible to see clearly for years or decades, regardless of their glasses or contact lens prescription. For other patients, a Keratoconus diagnosis is a scary thing: it’s a disease they have probably never heard of. Either way, along with the diagnosis you probably also received a recommendation for Keratoconus treatment. But before you begin any treatment, you should get a Second Opinion about your Keratoconus diagnosis or treatment.
Here at the California Keratoconus Center, our staff have been treating Keratoconus for nearly 40 years, so we know a thing or two about Keratoconus and how to treat it. In this article, we’ll explain…
- What is Keratoconus
- Types of Keratoconus
- Why you need a Second Opinion About your Keratoconus Diagnosis
- Keratoconus Treatment Alternatives
- Where To Get A Second Opinion About Your Keratoconus
What is Keratoconus
The cornea is a clear, thin tissue that covers the middle parts of the eye — specifically the iris, lens and pupil — and is typically shaped like a symmetrical dome. In healthy eyes, light enters through the cornea, and then through the lens. In a healthy eye, the cornea has a minimal detrimental effect or no effect on the path of the light entering the eye.
But a cornea with Keratoconus causes the cornea to thin, warp, and bulge outward, often in the shape of a cone. This bulging is often not symmetrical, and so a cornea with Keratoconus can be somewhat “bumpy.” Looking through it is much like looking through wavy or cut glass. Light that passes through the cornea gets bent differently based on the angle it hits the eye, and that is what makes it so difficult to treat with glasses or conventional contact lenses.
Types of Keratoconus
When your eye doctor told you that you have Keratoconus, did he or she also tell you the type of Keratoconus? To an Optometrist or Ophthalmologist experienced in treating Keratoconus, the differences are significant, and you certainly have a right to know.
- Forme Fruste Keratoconus — the mildest form of KC. It rarely causes the headaches, itchy eyes, dry eyes or other typical KC symptoms, but does result in vision problems. Fortunately, this kind of KC can be treated with special glasses or soft contact lenses.
- Nipple Cone Keratoconus — This type of KC has the most cone-like shape. The bulging is often concentrated in a small area near the center of the cornea.
- Oval Cone Keratoconus — This type of KC causes a larger portion of the cornea to bulge into an oval shape, often most severely at the bottom or outer part of the cornea (towards the ear).
- Globus Cone Keratoconus — Among the most severe forms of KC, Globus Cone KC causes a large area (75% or more) of the cornea to become thin and bulge.
- Pellucid Marginal Degeneration — PMD causes a narrow band of thinning on the bottom half of the cornea, which causes the cornea to bulge out, often in the shape of a bell.
- Corneal Hydrops — Up to now we’ve referred to the cornea as a single type of tissue, but it is actually made up of several layers. With Corneal Hydrops, fluid can build up between the layers, which causes it to swell and become cloudy white. CH can sometimes be painful.
If your doctor didn’t tell you what kind of Keratoconus you have, you should get a second opinion about your Keratoconus. You might not even have Keratoconus at all!
Why You Need a Second Opinion About Your Keratoconus
You need a second opinion about your Keratoconus for the same reason you should get a second opinion about any serious medical diagnosis. Generally speaking, you want to be sure you have the right diagnosis. After that, you want to be sure that you will receive the right treatment for your specific diagnosis.
Accuracy of Diagnosis
One of the early symptoms of Keratoconus is that your vision prescription is often very hard to create and changes more often than the prescriptions of eyes without Keratoconus. Once a doctor suspects Keratoconus, determining the type of Keratoconus requires modern, high precision instruments that can measure your eyes down to the micron, such as the instruments we use in the cKlear Method™. Without the proper instruments and training, your eye doctor can’t create an accurate diagnosis or prescribe the right treatment for you.
Proper Keratoconus Treatment
Many eye doctors prefer treating Keratoconus with surgery, but there are several types of treatments for Keratoconus, many of which do not require surgery. In fact, the vast majority of cases — 80% to 85% — corneal transplant surgery is not required.
Corneal transplant surgery is only necessary in a small percentage of cases, and that is usually only with a diagnosis of Globus Cone Keratoconus, or when the cornea is scarred, cloudy or physically damaged.
Other types of surgery include Intacs implants, which are semi-circular plastic arcs that are placed inside the cornea with the goal of forcing the cornea into a flatter, more uniform shape. The surgery involves making small incisions in your cornea into which the Intacs implants are placed, and then pushed through the incision. Usually two implants are used to form a full circle.
But all surgery comes with risks, and should be avoided unless truly necessary.
Among the disadvantages are high cost (Intacs can be $12,000 or more for both eyes), mandatory recovery time, risk of infection and other complications common to all surgeries.
But by far the worst disadvantage of Intacs is that it may actually make your Keratoconus worse, trading one set of symptoms for another, and often causing Halos, Glare and High Order Aberrations, which cannot be fixed with additional surgery.
At the California Keratoconus Center, we have seen many patients with unsatisfactory results from Intacs implants. We use our Non-Surgical Keratoconus treatment methods to treat them, and they report much greater satisfaction and clearer vision as a result.
Before you agree to any surgery, you should get a second opinion about your Keratoconus. Even if you have Keratoconus, there’s a good chance that you don’t need surgery at all.
Keratoconus Treatment Alternatives
Each type of KC — in fact, each patient’s individual eye — requires different Keratoconus Treatment, so it’s important to explore your Keratoconus Treatment Alternatives before choosing one with your doctor. Part of the cKlear Method involves a complete and exact diagnosis of your condition, followed by a recommendation for a preferred Keratoconus treatment.
In some cases of very mild Keratoconus, eyeglasses or off -the-shelf soft contact lenses might be sufficient to fix your vision problems. But, you’ll still need to have periodic eye exams, since Keratoconus is a progressive disease, which means your corneas can change shape over time.
Custom Contact Lenses
If your Keratoconus is more advanced, you might need custom contact lenses to fix your vision problems. There are several different types of custom contact lenses, including:
Hard contact lenses
Also called rigid gas permeable (RGP) lenses, hard contact lenses are durable, and they maintain their shape on your eye. They also let oxygen pass through, allowing your eyes to “breathe,” but they won’t dry out your eyes. RGP lenses are often the next step after soft contact lenses for treating progressive Keratoconus. They can be custom made to fit your corneas.
Not everyone can tolerate hard contact lenses because they can irritate the eyes. Hybrid lenses are rigid in the center and soft around the outer part of the lens, which is more comfortable for some people.
These lenses are useful for people whose corneas have a very irregular shape because of more advanced KC. Scleral lenses don’t sit directly on the corneas. Instead, they sit on the white part of the eye (called the sclera) and vault over the cornea without touching it.
Of course, within each of these categories are products by many lens laboratories, each with their specialties and strengths. A second opinion about your Keratoconus from one of our doctors will reveal which is the right type of treatment or lens for you.
Get A Second Opinion About Your Keratoconus
Dr. Barry Leonard is the Clinical Director of the California Keratoconus Center and is frequently asked to give Second Opinions about a Keratoconus diagnosis and treatment plan. He is uniquely qualified among Keratoconus Doctors because he was diagnosed with Keratoconus in the mid 80’s while in Optometry school and has been living with Keratoconus ever since. Dr. Leonard has dedicated the bulk of his practice to the advancement of Keratoconus Treatments and the care of Keratoconus patients. He also works closely with Keratoconus Lens Laboratories and the makers of Optometry equipment used in the diagnosis and treatment of Keratoconus, and trains other eye doctors in how to diagnose Kerataconus, too.
If you are looking for a second opinion about your Keratoconus diagnosis, make an appointment today at the California Keratoconus center using our online appointment form or by calling us at 818-891-6711. If you live far from the CKC’s Los Angeles office, remote appointments can also be made.