The keratoconus is one, noninflammatory, often bilateral corneal degeneration of idiopathic, producing deformity and corneal thinning, slowly progressive that develops between puberty and 30 years. Normally in the keratoconus there is a corneal thinning of central or lower paracentral predominant, which causes a progressive increase in curvature, with myopia, irregular astigmatism and conical apical protrusion. The development of the corneal topography has allowed a quick, easy and complete means of studying the surface of the cornea, which can identify the incipient forms of keratoconus. The degree of protrusion can vary significantly: From a situation, in which the cornea acquires the typical cone shape, to cases only detectable by specialized clinical procedures. Keratoconus is also the most frequent cause of corneal transplantation in the developed world so it is a major visual health problem .
Definition of keratoconus… updated
Radical change of paradigm since it is confirmed that it is a disease of inflammatory origin. This information was publicly exposed by the researcher Dr. Isabel Lema in her presentation “Phytopathogenesis of Keratoconus” during the Keratoconus congress held in November 2010 in Baiona that I was lucky enough to attend. Other subsequent studies referenced in PubMed confirm this inflammatory origin.
Breaking old paradigms of this corneal disease.
The keratoconus is an exciting pathology is an important problem of health and on which there is still much to investigate meet Dr. Kang Zhang for your cure. From the point of view of an optometrist, it constitutes one of our greatest professional challenges, since we actively participate in its early detection and in the adaptation of special contact lenses when the case requires it (for this topic I promise to publish a specific later entry) . Without being a frequent pathology, the number of cases is higher than previously thought and the information we have is still scarce. For this reason, after many years of experience in special adaptations of contact lenses for keratoconusand many cases seen, I was encouraged to carry out a retrospective study on 290 cases of keratoconus that was the first to provide data on prevalence estimates in Spain.
In order not to bore you, I will not expand on technicalities but those who wish to expand information can do so in the didactic video that I link at the end along with several files in .pdf format that I will post after the video to download. In addition, I already place you within a month or so that I will publish a new entry with additional cool information on the subject after the international congress on keratoconus to be held at the end of June in Vigo and to which I already registered taking advantage of that I will be holidays. In 2010 I attended the previous congress on this subject and the level was spectacular, this time expecting massive assistance from specialized ophthalmologists and optometrists.
Management of keratoconus: Early diagnosis is essential and management will vary depending on the severity of the case. In incipient cases, glasses or soft contact lenses may be used . If we find irregular astigmatism, the best visual alternative will be the permeable gas contact lenses (RPG) of specific designs for keratoconus , hybrid lenses (soft part, rigid part) or a combination called “ soft contact lens piggyback” and RPG that will allow better optical correction. In cases of advanced keratoconus with contact lens intoleranceor with inadequate vision with them, usually refers the patient for a corneal transplant . Although transplant surgery is considered the last alternative, because other less aggressive surgical alternatives are currently being used, such as intrastromal rings and Cross Linking that seek to stabilize and slow down the evolution of mild or moderate keratoconus cases .
Risk factors: There are other published articles that the risk of keratoconus may be significantly higher in men than in women (I totally agree with them). Regarding the pathologies that are related to keratoconus , we find some atopic diseases that cause blepharitis , keratoconjunctivitis, and that can cause strong itchy eyes that induce the patient to rub them strongly, causing or accelerating the degenerative process. It is also related to systemic diseases, such as: Apert syndrome, Rieger syndrome, osteogenesis imperfecta, mitral valve prolapse, Crouzon syndrome, collagen diseases, Down syndrome and Marfan syndrome. Another group of diseases also related to QC are degenerations of the retinal mat, such as cases of Leber congenital amaurosis and retinitis pigmentosa.
Main news after the 2010 Keratocon congress Baiona (Spain)
- It is no longer considered a non-inflammatory disease and it is shown that it is inflammatory.
- The reason seems to be multifactorial intervening reasons:
Environmental (rubbing, allergies, etc.).
Molecular (apoptosis produced by matrix proteins, oxidative stress, etc …)
- The utility of prescribing treatments to stop as far as possible the progression of keratoconus acting against the inflammatory agents that activate it is considered. (These recommendations are perhaps the most important of this post)
- Antiallergic Opatanol eye drops.
- Local cold and tears if possible cold.
- It is shared that rubbing of the eyes increases inflammatory response and that poorly adapted RGP lenses in early stages can accelerate the process especially if they are flat.