Advanced Keratoconus Treatment Options
Keratoconus cannot be cured, but its symptoms can be managed by an experienced ophthalmologist such as Dr. Andrew Holzman. He offers several types of keratoconus treatment at his Washington, D.C.-area practice to mitigate symptoms and improve vision. These include prescription eyewear, corneal implants, and cross-linking, a relatively new approach that uses a combination of medication and ultraviolet light to strengthen corneal tissues. In extreme cases, Dr. Holzman can provide corneal transplant surgery. Whenever necessary, Dr. Holzman may also recommend special combinations of treatments. During an in-depth consultation at one of his five conveniently located offices, Dr. Holzman can determine which treatment or combination of treatments is the best way to restore your vision.
Treating keratoconus begins by first assessing the extent of the disease and resulting vision impairment. Based on this data, Dr. Holzman will recommend the least aggressive treatment option possible for meeting your needs. We offer a “treatment ladder” of increasingly intensive solutions to help correct your vision. Dr. Holzman may recommend any of these based on your past treatments and current vision needs.
This simple solution is often the first line of treatment for keratoconus. Glasses or contacts will counter the altered contour of the cornea to correct vision.
Custom Soft Contact Lenses
Contact lenses will correct light refraction so that light focuses correctly on the back of your eye. Custom lenses have a wider diameter, so they will be a better fit for your conical-shaped cornea. Most patients also find them to be more comfortable than standard rigid contact lenses. Although custom contacts cost more than standard lenses, your insurance may cover all or part of the cost.
Gas Permeable Contact Lenses
Gas permeable (GP) contact lenses are rigid, so they can easily span the unusually long shape of your cornea. Additionally, GP lenses typically allow for better vision in low contrast situations, such as dusk, poorly lit environments, and fog. However, like some patients, you may not tolerate wearing gas permeable lenses all the time. In these cases, Dr. Holzman may recommend a combination of rigid and custom soft contacts.
“Piggybacking” Contact Lenses
With the unusual shape of your cornea, you may find it uncomfortable to wear a gas permeable lens. To increase your comfort, Dr. Holzman may recommend “piggybacking” lenses, or placing them one on top of the other. The soft lens will act as a cushion over your eye, while the rigid contact will fully ensure your sharp vision.
Hybrid Contact Lenses
Hybrid contact lenses were designed specifically for keratoconus patients. The rigid center will allow the contact to clear the conical shape of your eye. At the same time, the soft outer edge will increase comfort while you are wearing the lens. Hybrid contact lenses come in a wide range of sizes to provide a near-perfect fit.
Scleral and Semi-scleral Lenses
Scleral and semi-scleral lenses are another option if the unusual shape of your eye makes it uncomfortable to wear contacts. With this type of lens, the outer edge will rest on the sclera, or the white of your eye. Scleral lenses cover more of this area, while semi-scleral lenses cover only a part of your sclera. These lenses are also more secure than GP lenses and will move less when you blink.
Corneal Implants (Intacs®)
Intacs® (intracorneal ring segments) are ultra-thin medical-grade glass devices that are implanted beneath the outer edge of the cornea. Intacs help the cornea to flatten into a more spherical shape. This device only takes minutes to implant during an outpatient procedure, and can easily be removed or adjusted as needed. The vast majority of patients have achieved adequate driving vision with Intacs®, and more than half achieve 20/20 vision or better. Despite these advantages, Intacs® cannot eliminate the need for an eventual corneal transplant if keratoconus continues to progress.
Corneal crosslinking is designed to prevent the advancement of keratoconus, and avoid the need for corneal transplants. Crosslinking involves the removal of the surface epithelial cells of the cornea, and the application of riboflavin drops. The patient then looks into a UVA light for several minutes. This process strengthens the collagen strands that make up the cornea, helping it return to its proper shape. To aid in recovery, a soft contact lens is placed and worn over the cornea for five days as a bandage. After the lens is removed, antibiotic and anti-inflammatory drops are administered for two weeks.
Patients with more severe cases of keratoconus may need a corneal transplant (keratoplasty). Corneal transplant surgery has the highest success rate of any transplant surgery. The success rate of corneal transplantation in keratoconus patients is very good – in fact, the vast majority of patients achieve 20/40 vision.
Treating keratoconus begins by first assessing the extent of the disease and resulting vision impairment. Based on this data, Dr. Holzman will recommend the least aggressive treatment option possible for meeting your needs.
During this procedure, one or more of the five corneal layers will be removed with an instrument called a trephine. Next, donor tissue is used to replace the removed tissue. Finally, the doctor will suture the donor tissue in place. The recovery period will depend on the patient’s personal healing tendencies and the extent of the procedure. Typically, recovery takes about four to six weeks. Keratoconus rarely recurs in corneal transplant patients.
Topography-guided Conductive Keratoplasty
Not to be confused with keratoplasty, conductive keratoplasty (CK) is a noninvasive procedure that uses radiofrequency energy to change the shape of the cornea. Topography-guided therapies are a type of customization that focuses on an individual patient’s cornea alone (versus Wavefront-guided treatments that look at all the elements of the eye). Topography-guided CK can be effective for keratoconus and may help patients avoid or delay keratoplasty.
Combining Treatments for Greater Benefits
Recent research has shown that combining Intacs and cross-linking for progressive keratoconus can provide even greater benefits. Intacs alone are a great treatment solution, but when used in conjunction with C3-R, the corneal shape is further improved. The combination of the two treatments can halt progressive keratoconus so patients can experience long-lasting vision correction.
Intacs and C3-R are the preferred treatment methods over corneal transplants. Even when combined, the procedures are quick and improve vision within a day or two. On the other hand, recovery from corneal transplantation may take several months to a year to restore vision.
Choosing the Right Ophthalmologist
Patients themselves can ensure the success of their own keratoconus treatment by trusting their care to the right ophthalmologist. Dr. Holzman has performed more than 90,000 vision correction procedures for satisfied patients, including pilots and professional athletes. He is considered a leader in his field, and his practice was one of the few in the nation to be approved to perform corneal cross-linking leading up to its Food and Drug Administration approval in 2016. Under Dr. Holzman's care, you can expect a safe treatment recommendation based on your health history, the current state of your vision, and your personal goals.
Contact Us Today to Learn More
Although keratoconus is a chronic condition, it can be managed with the help of an experienced ophthalmologist. With Dr. Holzman' recommended course of treatment, you can experience clear, dependable vision. Reach out to our practice today to schedule a consultation at one of our five conveniently located offices