Keratoconus is a condition in which the front window of the eye (the cornea) becomes thinner and more steeply curved (cone shaped). As the curvature gets steeper the vision gets worse with short sightedness (myopia) and astigmatism. Most patients develop early symptoms in their teenage years but they may not get diagnosed until some years thereafter.  Vision usually worsens slowly (months or years) but rapid and painful loss of vision can occur in severe cases. 

Keratoconus is partly genetic (inherited) and partly environmental. It is much more likely to occur and progress in people who rub their eyes which is why it is common in patients with skin conditions and allergies that cause their eyes to itch. 

Diagnosis

Keratoconus is diagnosed by an Ophthalmologist using a combination of techniques including retinoscopy and corneal topography (a specialised scan of the cornea that maps out how steeply curved it is). The next step is to evaluate whether there has been progression of the cornea and this often requires information regarding contact lens or glasses prescriptions and multiple corneal measurements at least 6 months apart.

Ways to improve your vision if you have keratoconus:

• • Glasses or soft contact lenses are sometimes enough for mild keratoconus but once the disease gets more advanced the cornea will become too irregular and glasses or soft contacts won't correct your vision sufficiently.
  • Hard (rigid) contact lenses: these are excellent for mild keratoconus through to advanceded keratoconus because they counteract the irregular curvature of your cornea. Your optometrists must be experienced in fitting hard contact lenses and they may refer you to another optometrist who specialises in this area. As the disease gets very advanced, you may require a special type of large contact lens that vaults over the whole cornea. This sounds crazy but it is usually very well tolerated and provides excellent vision when fitted correctly. 
  • Corneal graft: This is required in patients with advanced disease who can no longer achieve good vision using contact lenses. 

Ways to stop or at least slow down keratoconus:

#1: Stop rubbing your eyes! Your optometrist or ophthalmologist should be able to advise you on ways to reduce itch and discomfort so that you no longer feel the need to rub your eyes.  

#2: Collagen Crosslinking (CXL): this is now well accepted as a treatment to slow or stop this progression in most patients. Some patients also experience an improvement in their vision or in the fit of their contact lenses; these beneficial effects may continue to improve for 12 months after treatment, but it is not expected that the vision will improve enough for the patient to be completely free from glasses.  

#3: Corneal graft: this is not done to stop progression but removing the thin and abnormal cornea does tend to stabilise the cornea for many years. It is usually required in patients with advanced disease who can no longer achieve good vision using contact lenses.