Oman- Keratoconus is a chronic visual disease that develops gradually and threatens visual acuity, especially in young people and adolescents. It is difficult to detect in its early stages because its symptoms are not clear at first.
Both genetic factors and environmental factors, such as allergies and frequent eye rubbing, play an important role in the emergence and acceleration of the disease.
Medical advances in diagnosis and treatment, such as corneal cross-linking and lens or corneal implants, give patients the opportunity to preserve their vision and improve their quality of life. Therefore, awareness and early detection, in addition to following preventive behaviors such as avoiding rubbing the eyes, represent the key to controlling the disease and reducing its complications.
What is keratoconus?
Ophthalmology specialist Dr. Diaa Al-Batoush says that keratoconus is a disease that affects the cornea of the eye, and leads to thinning and an increase in the curvature of part of it, causing weak vision that sometimes does not improve even with the use of glasses.
Al-Batoush explained that this change in the shape of the cornea affects the refraction of light inside the eye, and leads to blurred vision that may worsen over time if early diagnosis and treatment are not done.
Al-Batoush confirmed that studies indicate that keratoconus is a common cause of poor vision in the Middle East. The prevalence of the disease varies between studies, and some indicate that the infection rate may reach about 1.7% of the population, which is considered a relatively high percentage.
Al-Batoush added that this percentage is expected to increase in the future, as a result of the availability of more accurate diagnostic methods and increased health awareness among people, which allows cases to be detected in their early stages.
Al-Batoush explained that adolescence and early young adulthood are among the age periods most vulnerable to keratoconus, but at the same time he stressed that the disease may also appear in childhood, especially in children who suffer from chronic allergic diseases or have a family history of the disease.
Al-Batoush pointed out that early detection of the disease during these age stages greatly helps improve the chances of successful treatment and preservation of vision.
Why do some people get keratoconus?
Al-Batoush stated that there is no clear and certain cause for keratoconus, but it is believed that there is a group of genetic and environmental factors that contribute to the emergence of the disease.
He added that only about 10% of cases are linked to genetic factors, but without a specific or clear genetic pattern.
He indicated that there are some diseases and syndromes that are associated with an increased risk of contracting the disease, such as chronic allergic diseases, including eye allergies and asthma, in addition to some syndromes such as Down syndrome and connective tissue disorders.
Al-Batoush confirmed that rubbing the eyes frequently is one of the factors that may contribute to the development of keratoconus, and even increases the speed of the disease’s exacerbation if it is present.
Al-Batoush said that one of the important signs of the disease is the constant change in eyeglass sizes, especially after the age of 20, or the presence of high degrees of myopia or astigmatism from an early age, which may indicate the possibility of keratoconus.
He pointed out that failure to improve vision sufficiently when using eyeglasses may indicate the presence of an organic cause such as keratoconus, and if there is more than one affected person in a family, it is preferable to conduct a comprehensive examination of the rest of the family members to discover the disease in its early stages before it develops.
Psychological and functional burden
Al-Batoush confirms that the effect of keratoconus on the patient’s quality of life varies depending on the severity of the disease and the extent of early therapeutic intervention.
He explained that in simple cases, the patient may suffer from blurred vision that can be corrected with glasses, but in advanced cases it may be difficult for the patient to carry out his daily activities normally, such as driving a car, reading, or using electronic devices, which imposes a psychological and functional burden on him.
Al-Batoush added that this effect also extends to the financial aspect, especially if the treatment requires surgical interventions, such as corneal stabilization or corneal transplantation in advanced cases, which require careful periodic follow-up, which increases the financial and psychological burden on the patient.
Al-Batoush stressed the importance of early diagnosis and treatment, which contributes to improving vision outcomes and quality of life in general, stressing the necessity of seeing a doctor when signs appear that may indicate the presence of keratoconus or increase the risk of developing it.
Diagnosis and treatment of keratoconus
Consultant ophthalmologist, Dr. Muhammad Al-Khasawneh, says that the examination begins with measuring visual acuity, and in the event of a deviation in vision, or what is known as astigmatism, it is recommended to take an image of the corneal topography using the corneal topography technique, which allows accurate diagnosis of the disease, determining the thickness of the cornea, and detecting it early before clinical symptoms appear.
He pointed out that the accurate diagnosis of keratoconus depends mainly on the image of the corneal topography, as this technology provides important information about the shape and thickness of the cornea and also helps detect the disease in its early stages.
Al-Khasawneh stated that the treatment currently available includes performing a corneal stabilization procedure, or what is known as crosslinking, which aims to slow or stop the progression of the disease.
He noted that this operation is performed immediately after the case is diagnosed when there are indications that the disease is progressing, and it can also be performed as a preventive measure in young patients even if they do not yet show clear signs of development.
Al-Khasawneh explained that its aim is to improve eyesight only, and it is not a treatment for the disease itself, nor does it stop its development. He explained that scleral lenses regulate the surface of the cornea by applying pressure on it and are usually used in moderate to severe cases that do not improve with glasses.
Al-Khasawneh added that hybrid lenses are suitable for patients who cannot tolerate hard lenses, as they combine clarity of vision and comfort of use.
He pointed out that large scleral lenses are used in very advanced cases and cover the entire cornea and provide comfortable vision even when there is scarring or clouding on the cornea.
Al-Khasawneh stressed that contact lenses can be used for life as long as they give the patient good visual acuity and do not cause him any complications.
He added that keeping lenses clean and committing to visit an ophthalmologist periodically are essential for their continued use without problems.
Corneal transplant
Regarding corneal transplantation, Dr. Al-Khasawneh said that he resorts to this option when all attempts to improve vision fail, whether by using glasses or contact lenses of various types.
Al-Khasawneh explained that there are cases that require transplantation, including the presence of scars, central opacities, or severe deformities on the surface of the cornea that make the lenses ineffective or cannot be installed.
He said that corneal transplantation is one of the very successful operations, as the success rate reaches between 90-95%, and vision may improve significantly after the operation, reaching 6 out of 9 or better in some cases.
Al-Khasawneh pointed out that there are recent developments in techniques for treating keratoconus, the most prominent of which are stabilizing the cornea, implanting rings inside the cornea, and modifying its shape.
He added that options also include laser-guided vision correction with corneal stabilization, and the implantation of special lenses inside the eye behind the iris.
Al-Khasawneh stated that there are future technologies that are still under study, such as transplanting stem cells taken from the patient’s own fat with the aim of increasing the thickness of the cornea and strengthening it. He pointed out that there is also advanced research that uses artificial intelligence to analyze images of the cornea and predict the timing of the deterioration of the condition, which helps in timely therapeutic intervention.
Al-Khasawneh warned that it is necessary not to rub the eyes because this leads to accelerating the development of the disease. Allergy symptoms such as itching, burning, and redness must be treated, in addition to treating dry eyes to reduce discomfort and aggravation of symptoms. He also recommended that the installation process be carried out when needed and not postponed.
He stressed the importance of using artificial tear drops to treat dehydration and seeing an ophthalmologist periodically. He also recommended not delaying the stabilization procedure if a decline in vision is noticed, and examining the rest of the family members, especially young people, if there is an infected person in the family.
He pointed out the importance of wearing glasses that protect against ultraviolet rays, and using safety glasses when playing or working to avoid any direct eye injuries.