What is keratoconus?
Keratoconus (KCN) is a corneal degeneration characterized by progressive thinning and deformation of the cornea. These changes lead to a gradual decline in visual acuity.
In keratoconus, the thinning is localized in the central part of the cornea. In another condition—Pellucid Marginal Degeneration (PMD)—the thinning occurs at the periphery of the cornea. These degenerations form a continuous spectrum of stages and disease progression.
Do you “search” for a sharp image by changing your viewing angle?
There are two distinct forms of keratoconus: “forme fruste” (a rarer, latent, and inactive form) and “keratoconus” (the full-blown symptomatic form).
Keratoconus presents with characteristic visual symptoms:
How do we diagnose and treat keratoconus?
Accurate corneal diagnostics and proper patient qualification are the “clue” to effective treatment and excellent, predictable results.
The foundation of keratoconus diagnostics lies in corneal tomography and hysteresis.
TOMOGRAPHY IS A THREE-DIMENSIONAL MAP OF THE CORNEA, WHILE HYSTERESIS IS AN EXAMINATION OF CORNEAL ELASTICITY, WHICH CHANGES, AMONG OTHER CONDITIONS, IN KERATOCONUS.
In our treatment, we leverage the fact that the combined action of different therapies produces a much more effective clinical outcome (synergy) compared to using each method separately.
Vigilance is essential!!!
The early symptoms of keratoconus can easily be overlooked or ignored if you are not familiar with them. On the other hand, knowing them may help a patient notice signs of the disease at a very early stage, giving them a chance to stop its progression early.
Do not ignore the first symptoms of keratoconus:
Can you live a normal life with keratoconus?
Keratoconus is not a sentence and not a diagnosis that pushes you to the sidelines of life. Proper treatment gives you a chance for better vision and an improved quality of life. Keratoconus impairs vision by causing an irregular shape of the cornea. An irregular corneal shape leads to an irregular refractive error in the patient’s eye (irregular astigmatism). Irregular refractive errors cannot be effectively corrected with optics. All treatment efforts in keratoconus aim to convert an irregular refractive error into a regular one that can be corrected optically.
You have a significant impact on the progression of your disease
You must understand what causes the disease to progress. In its current state, your eye can be compared to a football where the inner tube is bulging out because one of the outer panels has been removed. This “inner tube” is the weakest part of your cornea, which must not be subjected to physical deforming factors.
You also cannot allow the pressure inside your eyes to increase.
Until you secure your eyes against the progression of the disease with the appropriate procedure, you must avoid the following:
Action or disability? The choice is yours…
Laser corneal
epithelium removal
Up to 10 seconds
Riboflavin corneal
saturation
12–18 minutes
Corneal UV irradiation
5–30 minutes
Corneal
stabilization
4–5 months
Change your fate while you still can
Intracorneal Ring Segments (ICRS) are implants made of a highly biocompatible polymer (PMMA). ICRS rings offer patients with advanced keratoconus a chance to avoid an invasive corneal transplant in the future. It is an opportunity for such patients to achieve functionally good vision without the burden of transplantation, which is sometimes complicated by graft rejection and results in uncertain or unpredictable postoperative visual acuity.
Intracorneal ring segments work by being implanted along the periphery of the cornea (intrastromally), which leads to a controlled flattening of the central part of the cornea they are centered around. If the ICRS are centered relative to the sector severely deformed by the disease, the interaction between the implant and the elastic tissue will reshape that sector toward a more optically favorable curvature.
In order of importance, the goals of the procedure are:
Creation of
the corneal channel
12 seconds
Intracorneal cross-linking
(optional)
30 minutes
Ring segment implantation
into the channels
1 minute
Corneal
stabilization
12 – 14 months
Is laser vision correction contraindicated in cases of keratoconus?
For many years, keratoconus was listed as an absolute contraindication for laser vision correction. After years of research and significant progress in diagnostics and treatment, in the current era of modern ophthalmology, we know that for some patients, a carefully calculated and appropriately selected vision correction yields very good and predictable results. In addition to removing or significantly reducing the refractive error, it has a therapeutic effect by improving the regularity of the keratoconic corneal surface. Even a slight smoothing of the corneal surface can lead to a significant improvement in visual acuity.
Astigmatism and myopic astigmatism are the most common vision defects found in patients with keratoconus. In many cases, these defects can be partially or even completely corrected using
laser vision correction technology. Depending on the laser used, two specific treatment protocols are available: the Athens Protocol and the Aztec Protocol.
Improvement in corneal
topographhy
Minimization of the
refractive error
Procedure time
15-20 minut
Corneal
stabilization
12-18 months
Epi-off, Epi-on
Standard CXL involves the removal of the corneal epithelium (epi-off type). CXL can also be performed without removing the epithelium (epi-on). Epi-on CXL is less invasive and causes less discomfort, but it can only be used in selected cases. Beyond its standard application, CXL can be performed in corneal channels or in a corneal pocket. Irradiation can be carried out using a standard or a gradient approach.
We handle the most challenging cases, including complications following refractive surgeries performed elsewhere.
The widest selection of procedures in refractive surgery and keratoconus treatment.
Creator of original, proprietary surgical methods for refractive surgery and keratoconus, including ex-im and biman.
In partnership with the world's leading corneal researchers.
Are you struggling with keratoconus and want to effectively treat this eye condition? Contact us to determine the treatment method best suited to your case.
The corneal cross-linking procedure can strengthen the cornea up to threefold, and its effect is most significant in the anterior (front) part of the cornea. The cornea is reinforced through the formation of additional bonds between successive layers of collagen (cross-links). The procedure initiates the process of creating these additional bonds, and the induced cross-linking continues to develop for several months after the treatment.
Intracorneal Ring Segments (ICRS) work by flattening and tensioning the central cornea. Due to this flattening effect, they are able to significantly reduce nearsightedness (by up to 5–6 diopters). The tensioning effect, in turn, may help stop the progression of an active keratoconus. The thickness of an ICRS is only a fraction of a millimeter (between ⅛ and ¼ of a millimeter). ICRS are implanted once for a lifetime; the implants do not require replacement.Intracorneal Ring Segments (ICRS) work by flattening and tensioning the central cornea. Due to this flattening effect, they are able to significantly reduce nearsightedness (by up to 5–6 diopters). The tensioning effect, in turn, may help stop the progression of an active keratoconus. The thickness of an ICRS is only a fraction of a millimeter (between ⅛ and ¼ of a millimeter). ICRS are implanted once for a lifetime;
the implants do not require replacement.
Vision correction in keratoconus serves a dual purpose. The first, and most desired by the patient, is to eliminate or reduce the refractive error. The second is to improve the patient’s best-corrected vision (the maximum vision achievable without contact lenses or glasses). This second, purely medical objective of the procedure plays a significantly greater role in improving the patient’s quality of life.
