Keratoconus is a slowly progressive, non-inflammatory ectatic corneal disease that affects the corneal collagen structure and organization. Though the exact reason for keratoconus is still unclear, it usually appears at early puberty and might be progressive until the 3rd or 4th decade of life. Keratoconus is usually bilateral, but progression could be asymmetrical. Ocular allergies and eye rubbing secondary to atopy are believed to be associated with a higher incidence of keratoconus, along with other few systemic and ocular disease conditions.
In a South Asian country like Bangladesh, awareness and logistics of keratoconus diagnosis are very important. Because not all patients have the classical signs of keratoconus. So, when a young patient comes with myopic astigmatism, has a history of repeated change of glass power in the recent past, and vision cannot be refracted to 20/20, there should always be screening for keratoconus for that patient.
Once keratoconus is diagnosed, the treatment will depend on the progression and severity. So, determining if this is progressive or non-progressive is the first part of the management. Also, patients need to be empathetically counseled about the disease and should be convinced for long-term follow-up. Patient age, ocular allergies, eye rubbing, corneal steepening and its location, and best corrected vision all play a role in understanding the progression.
When there is a high risk of progression, it is advised to go for Collagen Cross Linkage (CXL) first. Studies show that CXL stops the progression in 90% of cases. This is for mild to moderate keratoconus, but CXL has limitations in advanced cases and also won’t work when hydrops or any scar is present in the cornea.
In low risk of progression cases, when patients have good vision with glasses or contact lens, we observe the patient and advise for regular follow-up. Scleral contact lens is always better for keratoconus patients for visual rehabilitation.
CXL only stops the progression, while scleral contact is the first choice for visual rehabilitation for post-CXL or low risk progression patients. Patient education for proper using and storing of scleral contact lens is also an important part to consider.
Topography guided PRK with CXL can be considered in patients who have no documented progression and have significant higher order aberrations not corrected with contact lens.
Toric Implantable contact lens is another option for visual rehabilitation with careful measurement of corneal toricity and best corrected vision, in no progression cases.
In early to moderate keratoconus, Intra Corneal Ring Segment (ICRS) is one option of treatment when corneal thickness is 450 microns in the central 6 mm zone. In the very thin cornea, in hydrops or post-hydrops scar, planning for cornea transplantation is the treatment. Deep Anterior Lamellar Keratoplasty (DALK) is the choice for keratoconus management, but Penetrating Keratoplasty (PK) is always an option depending on the status of host cornea. Many times, keratoplasty induces unpredictable toricity and needs to be adjusted with scleral contact lens.
Early diagnosis and management are the key to preserve vision and enhance the quality of life for those living with keratoconus.
In Bangladesh, there are few ophthalmologists and hospitals where you get Keratoconus treatment facilities. Dr. Ashraful Huq is one of them who does every treatment protocol of Keratoconus. He is trained in Keratoconus treatment from abroad and participated many courses, conferences on Keratoconus. At the Keratoconus Clinic Dr. Ashraful Huq has all the latest technology for your Keratoconus treatment.