Keratoconus Treatment

My options for treatment were limited.  I can either choose to wear the Rigid Gas Permeable contact lens to correct my vision, or I can do the Corneal Cross-linking (A new treatment).  The rest of the treatment options can be found below.

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and soft contacts no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses. If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment. Their rigid lens material enables GP lenses to vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface to improve vision.

Normal eye vs. eye with small amount of keratoconus. The keratoconic cornea bulges slightly, for a more cone-shaped surface. (Artist's re-creation of keratometry images.)

But RGP contact lenses can be less comfortable to wear than soft contacts.

Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.

"Piggybacking" contact lenses. Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for a person with keratoconus, some eye care practitioners advocate "piggybacking" two different types of contact lenses on the same eye.

For keratoconus, this method involves placing a soft contact lens, such as one made of silicone hydrogel, over the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Your eye care practitioner will monitor closely the fitting of "piggyback" contact lenses to make sure enough oxygen reaches the surface of your eye, which can be a problem when two lenses are worn on the same eye. However, most modern contacts — both GP and soft — typically have adequate oxygen permeability for a safe "piggyback" fit.

ClearKone hybrid contact lenses. (SynergEyes Inc., Carlsbad, Calif.) These hybrid contact lenses combine a highly oxygen-permeable rigid center with a soft peripheral "skirt." The ClearKone version was designed specifically for keratoconus and vaults above the eye's cone shape for increased comfort.

The manufacturer says hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses.

ClearKone hybrid lenses are available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.

Scleral and semi-scleral lenses. Larger diameters found in these gas permeable (GP) lenses enable edges to rest on the eye's white sclera. Scleral lenses cover a larger portion of the sclera, whereas semi-scleral lenses cover a smaller area.

Because the center vaults over the irregularly shaped cornea, this lens doesn't apply pressure to the eye's cone-shaped surface and feels more comfortable. These types of lenses also are more stable than conventional contact lenses, which move with each blink because they cover the cornea only partially.

One example of a scleral lens is the Boston Scleral Lens Prosthetic Device (BSLPD). This cone-shaped device resembles a large contact lens and works partly by maintaining a "pool" of fluid on the eye's surface through which light rays pass and are bent to achieve proper focus.

The BSLPD also fills in a highly irregular eye surface with fluid to help achieve proper focus.
To qualify for the BSLPD, you must have a severe, unusual or otherwise untreatable condition.
In cases of financial need, the non-profit Boston Foundation for Sight providing the lens will help subsidize or pay outright the $7,600 needed for lenses and fittings for both eyes. The price of a lens and fitting for one eye is $5,000.

The BSLPD also has demonstrated effectiveness as a treatment for severe dry eye.

Intacs. (Addition Technology, Des Plaines, Ill.) Intacs, or corneal inserts, received FDA approval for treating keratoconus in August 2004. These tiny plastic inserts are placed just under the eye's surface in the periphery of the cornea and help re-shape the cornea for clearer vision.

Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes.
Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress.

Corneal cross-linking. This non-invasive procedure strengthens corneal tissue to halt bulging of the eye's surface in keratoconus. In the United States, FDA clinical trials for corneal collagen cross-linking (CXL) began in early 2008.

With CXL, the outer portion of the cornea (epithelium) is removed to allow application of riboflavin, a type of B vitamin, which then is activated with UV light. Another investigational method of strengthening the cornea, known as transepithelial corneal cross-linking, is performed with the corneal surface left intact.

Early results showing benefits of this method have been promising. In 2008, University of Siena researchers in Italy reported positive outcomes in all 44 eyes that were followed for three years after treatment with CXL.*

Other researchers have concluded that this simple treatment might reduce significantly the need for corneal transplants among keratoconus patients. Corneal cross-linking also is being investigated as a way to treat or prevent keratoconus-like complications following LASIK or other vision correction surgery.

Research involving a combination of corneal cross-linking with Intacs implants (see above) also has demonstrated early promising results for treating keratoconus.

Topography-guided conductive keratoplasty. While more study is needed, early results of a small study involving topography-guided conductive keratoplasty (CK) show this procedure might help smooth irregularities in the corneal surface.

This treatment uses energy from radio waves, applied through tiny probes, to reshape the eye's surface. A topographic "map" created through imaging of the eye's surface helps create individualized treatment plans.

In October 2010, the American Journal of Ophthalmology reported that 15 of 21 keratoconic eyes treated with topography-guided CK achieved more normal corneal symmetry.

Corneal transplant. Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision.
The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a transplant, you most likely will need glasses or contact lenses for clear vision

Read more: http://www.allaboutvision.com/conditions/keratoconus.htm#ixzz1EtE3I8bB