Were you recently diagnosed with Keratoconus? If so, then you are likely on a quest to learn as much about the disease as possible and, more importantly, what kinds of treatments are available. And while learning that you have Keratoconus is not good news, there is a lot of good news about treating this progressive eye disease and many reasons to be optimistic about your future.
Here at the California Keratoconus Center, we specialize in the 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 we’ve found that a corneal transplant may be necessary in only 15-20% of Keratoconus cases after exploring all non-surgical alternatives.
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.
A small incision is cut into the cornea with a laser during the procedure. 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 tiny 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 six weeks. You can watch a video of an Intacs procedure here.
Because Keratoconus usually results in an irregular cone-like shaped cornea, the goal of the Intacs ring is to help restore a more symmetrical shape of the cornea and therefore improve the patient’s 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 become far more complex, and the visual outcome is not as good, mostly due to distortion and high-order aberrations.
Since our non-surgical 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 their vision and lives are about to change. This is what typical non-surgical Keratoconus Treatment looks like. Our non-surgical treatment is known as the cKlear MethodTM, and you can read about it in detail here. For your convenience, we provide a synopsis of the process below.
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 detailed information about the corneal shape, contour map, and size. We then combine his data to create 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 advanced progression of Keratoconus is found, as well as being the cause of distortions. We track the results of your Corneal Topography and Global Pachymetry to determine your Keratoconus’s progression rate.
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. Today, 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 to designing an accurate and comfortable Scleral contact lens.
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 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 our favorite appointments is when we get to fit new lenses on a patient with Keratoconus. They know what life has been like with the disease; the difference is often life-altering. We’ll test-fit your new lenses and show you how to put them on, remove them, and even 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 to a 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 unique non-surgical 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 California Keratoconus Center — has advanced. Our 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 that aren’t worth the cost for most Keratoconus patients, 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!