Keratoconus occurs when the cornea does not have the proper enzyme and anti-oxidant mixture to protect the internal scaffolding that gives the cornea it’s shape.  The scaffolding is made of collagen fibrils that are constantly bombarded by oxidative free radicals as part of the cornea’s metabolic process.  Normally, the corneal enzymes and anti-oxidants protect the collagen fibrils, but without them, the fibrils become damaged, weaken, and the cornea deforms, resulting in a bulged shape.

The main risk factors for keratoconus are:

  Genetics: Patients have a higher risk of developing keratoconus if they have the following genetic conditions:

• a family history of keratoconus
• certain ocular conditions such as: retinitis pigmentosa, Leber’s congenital amaurosis, retinopathy of prematurity, Fuchs’ corneal endothelial dystrophy, and posterior polymorphous dystrophy.
• chromosomal abnormalities such as Down syndrome
• connective tissue disease such as Ehlers-Danos syndrome and Marfan syndrome
• skeletal conditions like Apert syndrome and Crouzon syndrome
• atopic disease like asthma or hay fever

  Chronic eye inflammation: Chronic inflammation, which can produce corneal damage resulting in keratoconus.

 Eye rubbing: Chronic/vigorous eye rubbing is associated with developing/progressing keratoconus. 

  Age: Keratoconus is often discovered in the teenage years and continues to progress into the mid-thirties.

Keratoconus occurs in approximately one in 2,000 individuals.

  Frequent prescription changes

  Sudden worsening or clouding of vision

   Glare and halos around lights

   Difficulty seeing at night

    Eye irritation or headaches associated with eye pain

     Increased sensitivity to bright light

Treatment for keratoconus depends upon its severity.

Early Stages: In the early stages, glasses and soft contact lenses can be used to treat the blurred vision.

Intermediate Stages

• Vision correction options: Glasses and soft contacts may no longer be sufficient to provide clear vision.  Patients may need to move to a hybrid (which has a hard center and soft skirt), rigid gas permeable (hard), or scleral lens.  Usually these options provide patients with lines of improvement in visual acuity.  Dr. Januskey is comfortable fitting these types of lenses.
• Corneal cross linking: Corneal cross linking is strongly recommended.  This procedure became approved by the FDA in 2016.  A riboflavin solution (vitamin B mixture) is applied to the cornea and then exposed to ultraviolet light for 30 minutes.  This strengthens the bonds between the collagen fibrils within the cornea, causing the deformation to slow, stop, or in some cases, slightly reverse.  The benefits of the procedure may take three to twelve months to occur.

Advanced Stages

• Corneal Intacs: Corneal Intacs are C-shaped plastic rings that are surgically implanted into the cornea to help flatten it.  In some cases, they provide better vision on their own.  In other cases, they improve contact lens tolerance.  The implantation procedure takes about 15 minutes.
• Corneal transplant: If the cornea becomes to scarred or distorted, a corneal transplant may be necessary.  In this procedure, a donor cornea replaces the patient’s cornea.  It is usually about a one hour procedure that is performed on an out-patient basis.  The vision is significantly blurry for the first three to six months post-operatively, after which glasses or contacts will become necessary.  People who receive a corneal transplant will need to take anti-rejection medication for the rest of their lives.