Keratoconus - symptoms, diagnosis and treatment by an ophthalmologist at Focus Eye Clinic
What is keratoconus? Symptoms, diagnosis and treatments explained
What is keratoconus?
The cornea or cornea is the transparent part of the outside of the eye through which light enters. A normal cornea is shaped like a nice round soccer and is composed of collagen fibers, which give the cornea structure and strength.
Keratoconus is a progressive corneal defect at the level of these collagen fibers, in which the cornea gradually thins and changes from a convex shape to a pointed (cone) shape.
The progressive thinning of the cornea creates a bulge resulting in irregular astigmatism (oval eye) and increasing myopia (nearsightedness). Almost always (80-90%) both eyes are affected, but usually there is a difference in severity between the two eyes (bilateral asymmetric disease). Keratoconus usually develops around puberty until the age of about 45 and is more common in men than in women.
Causes of keratoconus
The actual cause of keratoconus is not known. Several factors probably play a role: hereditary (10%) and environmental.
Other possible causes may include:
Regular eye rubbing in people with an eye allergy
Physical conditions, e.g. Down syndrome, Turner, osteogenesis imperfecta, atopic eczema, connective tissue disease,....
Ophthalmic disorders
Consequence of refractive surgery
Symptoms of keratoconus
Keratoconus is difficult to diagnose because it almost always starts slowly. Possible symptoms include:
Distorted and reduced vision, similar to looking in a smile mirror
Hypersensitivity to light
Change in strength of glasses and/or lenses
Itchy eyes
Frequent rubbing of the eyes
Double vision when one eye is shielded
Personalized advice from our experts
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
Treatment of keratoconus: via Cross Linking
Initially, keratoconus can be treated with corrective lenses or (semi-)hard contact lenses, but there is a high likelihood of progressive intolerance over time. If the defect progresses, until now only corneal transplantation was possible, with a high risk of complications.
Recently, there is now a new technology that can stop the increasing thinning of the cornea, i.e. Ultraviolet Crosslink, and a method to normalize the corneal shape, i.e. intracorneal rings.
What is Ultraviolet Crosslinking?
In keratoconus, there are reduced cross-links between collagen fibers that result in decreased corneal strength.
Ultraviolet Crosslinking is a new technique. The objective of this treatment is to strengthen the collagen structure in the middle part of the cornea by forming new connections between collagen fibers. This increases the stiffness and stability of the cornea and flattens the central, weaker and thinner part of the cornea.
Myopia and astigmatism decrease. This treatment is of no use in advanced keratoconus.
Principle and benefits of Cross linking
Principle:
The cornea is instilled with a photosensitive liquid (riboflavin) that penetrates the deeper layers of the cornea. The cornea is then irradiated with ultraviolet-A light, which creates additional connections between the collagen fibers and increases the thickness of the collagen fibers. The collagen fibers become three times stronger and this process stabilizes after 6 months. As a result, the cornea becomes flatter or less steep, which can increase vision. This can stop the progression of keratoconus during the progressive phase.
Benefits:
Whereas until now this treatment took more than 1 hour (30 minutes of dripping, 30 minutes of UV), thanks to AVEDRO technology it can be reduced to a maximum of 20 minutes of dripping and 4 minutes of UV irradiation. This is mainly due to the modified product form and the higher energy of the UV source. An additional advantage is that the therapy can now be performed transepithelially, eliminating postoperative pain. Refractive anomalies (myopia, irregular astigmatism) are treated with lasers (with topography-guided Excimer laser) beforehand or afterwards with toric phake implant lenses.
Who is eligible for Cross linking
Prevention of keratoconus formation
Treatment of the progressive form of keratoconus
Treatment of ectasia (bulging) of the cornea
Instability of the cornea after radial keratotomy (scratching of the eye to correct myopia)
In chronic corneal edema (swelling) and resistant corneal ulcer (ulcer)
In recurrent keratoconus after corneal transplantation
Risks of cross linking
Potential risks with this procedure include delayed wound healing, abnormal wound healing (risk is lower with AVEDRO technology) and postoperative infections.
Treatment of keratoconus via surgery
Intracorneal rings : INTACTS
Indication for intracorneal rings:
People with corneal thickness < 325 µm, with epithelial healing problems, with herpes keratitis and in pregnancy.
What are intracorneal rings?
Intracorneal rings can be used in cases of intolerance to contact lenses and to delay a possible corneal transplant. One or two semicircular rings are placed in the outer ring of the cornea on an outpatient basis or under local anesthesia. This flattens the central, thinner part of the cornea, reducing myopia and astigmatism. The rings also support the weaker, bulging part of the cornea. This technique, which has been around for more than 15 years, has recently gained new momentum as the tunneling that previously had to be done mechanically is now performed with greater precision by a laser device (Ziemer). The irregular shape of the cornea is improved, significantly increasing the patient's quality of life. In about 10% of cases, adjustment of intracorneal rings is required.
Risks of intracorneal rings.
Possible complications include displacement of the ring or postoperative infections, but these can be easily treated if noticed early. After surgery, transient irritation, halos and photophobia may be observed.
Corneal transplantation
If the above treatments are no longer possible, a corneal transplant is considered. With further progression of keratoconus, the fitting of contact lenses no longer works and a transplant may offer a solution. Approximately 20% of keratoconus patients eventually reach this stage.
Corneal transplantation is a surgical procedure in which damaged or diseased corneal tissue is replaced with healthy tissue from a donor. There are several techniques, depending on the nature and location of the damage to the cornea:
Penetrating keratoplasty (PK):
This is a complete corneal transplant in which all layers of the cornea are replaced. It is used in cases of extensive damage to the entire cornea.
DMEK (Descemet Membrane Endothelial Keratoplasty):
This is a transplantation of only the inner layer (endothelium) of the cornea and the Descemet membrane. It is often used in conditions such as Fuchs' endothelial dystrophy.
DSAEK (Descemet Stripping Automated Endothelial Keratoplasty):
This involves replacing a slightly thicker layer than DMEK, including part of the stroma. It is suitable for similar conditions to DMEK, but the technique may be simpler in execution.
Each form of corneal transplantation has its own specific advantages and is tailored to the individual needs of the patient. Thanks to these advanced techniques, many people can improve their vision and experience a better quality of life.
Meet our experienced ophthalmologists
Focus Eye Clinic is led by two renowned physicians, each with approximately 20 years of experience in innovative eye care. Together, they bring more than 35 years of expertise, which was built and passed on by two previous generations of Focus Eye Clinic owners. This rich history makes us leaders in the world of ophthalmology.
Our doctors combine precision, safety and the latest technologies to help you achieve a glasses-free future. Meet the driving forces behind our clinic and your glasses-free future.
Dr. Bart PION - Specialist in refractive surgery
Dr. Bart Pion received his degree in Medicine magna cum laude from the Free University of Brussels in 2002. He specialized in cataract, vitreoretinal and refractive surgery, with a strong focus on precision and innovation.
His continuous development is supported by regular participation in renowned training courses and international congresses, where he always embraces the latest techniques and innovations.
Dr. Nashwan Al-Sabai - Expert in eye laser treatments
Dr. Nashwan Al-Sabai received his degree in Medicine from the Free University of Brussels in 2006. His passion for ophthalmology led him to further specialization, culminating in the prestigious title of Fellow of the European Board of Ophthalmology (FEBO). With a strong focus on innovation and continuous development, he is a respected expert in cataract and corneal surgery.
35 years of expertise and confidence in eye care
The latest eye laser technology, unique in Belgium
Swiss precision from Ziemer Z8 Femto laser for hyper personalized treatments.
A team of experienced ophthalmologists for optimal care
With more than 2,000 surgeries per year and 35 years of experience, we have the expertise needed to give your eyes the best care.
High patient satisfaction through personalized approach
We do our utmost every day for our patients. Togetherness, caring and excellence. These are our values for which I stand.
A comfortable and pleasant setting for your treatment
Warm and personalized welcome in stylish surroundings.
Always the best eye care for your eye condition
High-tech equipment for optimal eye care
Investing in the latest technology for the best results
At Focus Eye Clinic, we combine expertise and innovation with state-of-the-art equipment in ophthalmology aimed at treating a variety of eye conditions. With technologies such as the Ziemer Z8 Femtolaser and WaveLight® EX500 excimer laser, we perform refractive treatments (including Femto-LASIK, PRK and SMILE) with unparalleled precision.
For cataract surgery, we use advanced systems such as the Zeiss CALLISTO, IOLMaster 700 and Alcon Centurion Vision System, resulting in highly accurate implant measurements and predictable results. In addition, we use the Heidelberg Spectralis HRA-OCT, Pentacam® HR and Nidek OPD-Scan III to comprehensively diagnose a variety of eye conditions.
In the treatment of dry eyes, we deploy LipiScan and LipiFlow, among others, for lasting relief of symptoms. Thanks to this innovative equipment, Focus Eye Clinic offers safe, efficient and personalized eye care of the highest quality - fully tailored to your individual needs.
Personal approach and customized care
At Focus Eye Clinic, your care is paramount. Our team of nurses, optometrists and assistants work together with one goal: improving your vision. From your first moment of contact to your final checkup, we will guide you with a personalized and caring approach.
A multidisciplinary team for your treatment:
Our experienced multidisciplinary team offers a wide range of ophthalmic treatments. After an initial diagnosis, we refer you to the doctor who best suits your specific needs, ensuring you receive the highest quality of care.
Your personal point of contact:
Throughout the entire procedure, a permanent assistant is available to you. She knows your file inside out and ensures that all your questions are answered quickly and clearly. If necessary, she will put you in direct contact with the right doctor.
Fast and efficient follow-up
We strive to offer you an appointment within two weeks and plan with you the most convenient time. This efficient system ensures a smooth and personalized experience, allowing you to concentrate fully on your treatment.
A luxurious and comfortable setting at Focus Eye Clinic
At Focus Eye Clinic, we believe that medical treatment should be not only effective, but also comfortable and soothing. Therefore, we have designed our clinic with an eye for luxury and comfort, so that you feel completely at ease from the very first moment.
Our modern and stylish spaces exude calm and confidence, and are designed to provide you with a relaxing experience. From the warm welcome at reception to the comfortable waiting areas and state-of-the-art treatment rooms, every detail has been carefully chosen with your well-being in mind.
At Focus Eye Clinic, we combine advanced technology with luxurious surroundings, so you can enjoy the highest quality care in a setting that exudes peace and confidence. Your health and comfort are our priority, and you will notice that with every visit.
