Were you recently diagnosed with Keratoconus? If so, then you are likely on a quest to learn as much about the disease as you can, and more importantly, what kinds of treatments are available for it. And while learning that you have Keratoconus is not good news, there is a lot of good news about the treatment of this progressive eye disease, and many reasons to be optimistic about your future.
Here at the California Keratoconus Center (CKC), we specialize in non-surgical treatment of Keratoconus. There are many Keratoconus doctors, especially here in the Los Angeles area, who want to get you onto their operating table as quickly as possible for a corneal surgery of one type or another, but what we find is that most patients can be treated non-surgically and enjoy a happy, normal life.
There is a difference between elective and necessary Keratoconus surgeries.
In very severe cases of Keratoconus, the cornea becomes very thin, very steep, scarred or intolerant to contact lenses and there is little choice but to have a corneal transplant. During a corneal transplant, the central part of the cornea is removed and a donor cornea is sewn into place. But in 15-20% of Keratoconus cases, after all non-surgical alternatives have been explored, a corneal transplant may be necessary.
The great majority of Keratoconus cases are less severe and a corneal transplant is not necessary. In these cases, some doctors like to treat Keratoconus with plastic corneal implants called Intacs. These semi-circular devices are placed underneath the cornea to form a raised circle on the cornea.
During the procedure, a small incision is cut into the cornea with a laser. The incision is widened with a metal instrument, and channels are created under the cornea — one above the pupil and the other below — to make space for the Intacs devices. The Intacs are then routed through the channels with very small tweezer-like instruments. Once the Intacs are in place, the incision is sewn together with a single stitch, which remains in the eye for about 6 weeks. You can watch a video of an Intacs procedure here.
Because Keratoconus results in a usually irregular cone-like shaped cornea, the goal of the Intacs ring is to help restore the more symmetrical shape of the cornea, and therefore improve the patients’ vision.
This kind of Keratoconus surgery is elective, and one of several Keratoconus treatments a patient can choose from.
Every type of treatment has advantages and disadvantages. Here at the California Keratoconus Center, we believe that if you have a choice between a surgical and a non-surgical Keratoconus treatment, then avoiding surgery is preferable. According to WebMD, among the disadvantages of Intacs surgery are:
We also note some additional disadvantages, such as:
But among the most disappointing disadvantages of Intacs is that even if the surgery goes well, the patient may still need to wear corrective lenses, either contact lenses or glasses. And, if contact lenses are necessary, the design and fitting of the lenses becomes far more complex, and the visual outcome is not as good, mostly due to distortion and high order aberrations.
Since our non-surgical CKC treatment is so effective, we seldom see a need for surgery with our Keratoconus patients. Intacs became popular many years ago partially because the technology to properly design and fit a contact lens on an irregularly shaped cornea had not yet been perfected.
The results of these ill-fitting contact lenses often include: dry eyes, teary eyes, red eyes, itchy eyes, mild to severe discomfort, streaks, halos, glare, blurry vision, difficulty driving at night, and the inability to wear the contacts for more than a few hours.
However, the advanced technology in our lab and treatment center, combined with the techniques we have developed here at the California Keratoconus Center, results in lenses that can often create clear 20/20 vision, are comfortable, can be worn all day long, and come with absolutely none of the complications or disadvantages of surgery.
New patients at the California Keratoconus Center are usually extremely happy when we meet them because they know that their vision and their lives are about to change. This is what typical non-surgical Keratoconus Treatment looks like.
Every eye is different, and we need to be fully aware of the health of your eyes before we can begin any treatment.
Using the Marco OPD III we gather information about the corneal shape, contour map, size (together, called the topography) of your eye.
Our Zeiss OCT shows us the thickness of the cornea throughout, and highlights the most vulnerable, thinnest parts, which is where the most progression of Keratoconus is found, as well as being the cause of distortions. We track the results of your Corneal Topography and Global Pachymetry in order to determine the rate of progression of your Keratoconus.
The Marco OPD III accurately measures the low and high order aberrations.
The Eaglet Eye Surface Profiler is the star of our process. Older technology could only measure about 100,000 points on your eye, covering only one half to two thirds of your cornea. The Eaglet can measure 350,000 points on your eye, including the entire Cornea, and most of the sclera (the whites of your eyes) as wide as 20 mm. These measurements are critical in order to design an accurate and comfortable Scleral contact lens for you.
The type of contact lenses (Scleral, Hybrid or RGP) we design for you depends on your unique situation. We also will choose the best lab and manufacturer (ZenLens, BostonSight, AccuLens, Digiform, OneFit Med, and many others), each of which has its strengths and best applications. Once we’ve made those decisions we will use the information from all of our technology to design a contact lens that’s perfect for you.
The millions of pieces of data that we’ve collected about your eyes will be sent directly to the contact lens laboratory, along with special instructions from us, from which your contact lenses will be made.
One of my favorite appointments is when we get to fit new lenses on a patient with Keratoconus. They know what life has been like with KC, and the difference is often life-altering. We’ll test-fit your new lenses and show you how to put them on and take them off, and even how to clean them with the proper solutions (we recommend Coopervision OneStep).
We then examine your new lens on your eye. With our Zeiss OCT, we can examine the lens right on your eye, and see how well it fits with the precision of a single micron.
We examine the lens on the eye using a high powered microscope to look at the relationship of the lens to the sclera and cornea.
In the past, a successful Keratoconus treatment would take 4 to 5 fittings, each with different lenses, sometimes days or weeks apart. Today, with our CKC method, we have a First Fit Success rate of 52%, and a Second Fit success rate of 85%…and it’s getting better all the time.
I was originally diagnosed with Keratoconus back in 1985, and have been treating patients with Keratoconus ever since. I can remember how difficult it was to treat Keratoconus back then, and I marvel at how far the technology — some of it developed right here at the CKC — has advanced. My greatest joy is to help patients see as clearly and comfortably as I do now.
If you believe, as we do, that Keratoconus surgery carries risks and disadvantages for most Keratoconus patients that aren’t worth the cost, come see what we can do for you here at the California Keratoconus Center. Make an appointment by calling us at 818-891-6711, or make an appointment online. Either way, we look forward to helping you see comfortably and clearly, without surgery!