Keratoconus and cataracts , symptoms and types
What is Keratoconus, How it looks and what are the symptoms? Also, find out Keratoconus’s types and stages , Learn more with ILAJAK Medical.
Summary
What is Keratoconus?
Keratoconus is when the cornea becomes thin and gradually bulges outward into a cone shape. Changing the shape of the cornea makes light rays out of focus, and as a result, your vision is blurry and distorted. This may make daily tasks such as reading or driving more difficult. Many keratoconus patients don't realize they have the disease.
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Keratoconus diagnosis criteria
In addition to a full medical history and eye examination, an eye care specialist may perform the following tests for the diagnosis of keratoconus:
- Corneal topography: This is the most accurate way to diagnose early keratoconus and follow its progression. A computerized image creates a map of the curve of the cornea.
Essentially, corneal topography measures the elevation of the cornea similar to geographic topography that shows hills and valleys on a map. Topography is color-coded with cooler colors (blues) being flatter and hotter colors (orange and reds) showing steepening from Keratoconus.
- Slit-lamp exam: This examination of the cornea can help detect abnormalities in the outer and middle layers of the cornea.
- Pachymetry: This test is used to measure the thinnest areas of the cornea
- A study has shown that the combination of aberrometry with the determination of the activity of the lacrimal fluid lysozyme makes it possible to diagnose keratoconus in the initial stages of its manifestation.
Corneal thickness keratoconus
The average corneal thickness is about 555μm (or a little over half a millimeter). Thinning at the bulging cone can lead to a corneal breakdown, scarring, loss of vision, and additional complications that may lead to a Penetrating Keratoplasty (corneal transplant). Therefore, corneal thinning is often measured for monitoring the progression and staging of the disease.
- Mild Keratoconus = Lowest corneal thickness of ≥ 500μm
- Moderate Keratoconus = Lowest corneal thickness of 300μm – 500μm
- Advanced Keratoconus = Lowest corneal thickness of ≤ 300μm
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Keratoconus age of onset
Keratoconus generally begins at puberty and progresses into the mid-30s. There is no way to predict how quickly the disease will progress, or if it will progress at all. Keratoconus typically affects both eyes, with one being more severely affected than the other. A recent study confirms that keratoconus may continue to progress beyond age 30. Older patients with keratoconus should be monitored for progression, particularly for possible corneal collagen cross-linking or astigmatic correction in cataract surgery.
Keratoconus symptoms
The first symptom is a slight blurring of vision or progressively poor vision that is not easily corrected. Other symptoms of keratoconus include:
- Glare and halos around lights
- Difficulty seeing at night
- Eye irritation or headaches associated with eye pain
- Increased sensitivity to bright light
- Sudden worsening or blurring of vision
Types of keratoconus
There are 4 main types of Keratoconus:
- Forme Fruste,
- Nipple Cone
- Oval Cone
- Globus Cone
Grading the types of keratoconus is largely based on where the area of bulging (or cone) is located on corneal topography.
- And there's also a type called Posterior keratoconus, and it’s a distinct disorder despite its similar name, is a rare abnormality, usually congenital, which causes a non-progressive thinning of the inner surface of the cornea, while the curvature of the anterior surface remains normal. Usually, only a single eye is affected.
Keratoconus bilateral
Keratoconus is a usually bilateral, usually asymmetrical, non-inflammatory corneal ectasia that is progressive into early middle age. This ectasia causes corneal steepening with irregular asymmetrical astigmatism most typically seen in the inferotemporal paracentral zone.Keratoconus bilateral ICD 10
ICD-10-CM code that can be used to indicate a diagnosis for Keratoconus reimbursement purposes.The ICD-10 codes for keratoconus are as follow:
H18.611–Keratoconus, stable, right eyeH18.612–Keratoconus, stable, left eye
H18.613–Keratoconus, stable, bilateral
Stages of keratoconus
Early keratoconus
Forme Fruste keratoconus has only very slight corneal distortion; it has little or no effect on the quality of vision and exhibits minimal or no progression. Spectacles are usually successful in correcting myopia and astigmatism and give adequate vision.
Moderate Keratoconus
Corneal distortion increases and corneal changes typical of keratoconus can be observed. As the visual quality with spectacles decreases, rigid gas permeable contact lenses become the option for better quality vision.
Advanced Keratoconus
Substantial corneal distortion with moderate keratoconus corneal changes, slight to moderate corneal scarring present.
Severe Keratoconus
Dramatic corneal distortion, substantial corneal scarring, and thinning.
To grade Keratoconus by curvature, corneal topography is used to measure the absolute steepest part of the cornea at the height of the cone.
- Mild Keratoconus = steepest corneal curvature of ≤ 48.00D
- Moderate Keratoconus = steepest corneal curvature of 48.00D to 53.00D
- Advanced Keratoconus = steepest corneal curvature of ≥ 53.00D
Keratoconus causes
The exact cause is still known. Some cases may be partly due to genes. Some health conditions are linked to this disorder and may help to cause it. This include:
- Down syndrome
- Ehler-Danlos syndrome
- Eye injury (especially from too much eye rubbing or contact lens use)
- Leber congenital amaurosis
- Osteogenesis imperfecta
- Retinitis pigmentosa
- Retinopathy of prematurity
- Vernal keratoconjunctivitis
- Sleep apnea
Keratoconus after LASIK
The incidence of corneal Keratoconus following refractive surgery (Lasik) is estimated to affect approximately 160,000 patients in the United States, qualifying it as an orphan disease.
Keratoconus in children
A child may be born with a predisposition to developing keratoconus. Because keratoconus makes the cornea thin and delicate, children with the condition should avoid rubbing their eyes. Allergy medicines and avoiding triggers are important preventive strategies for children whose allergies make their eyes itchy.
Tips for Keratoconus treatments
Besides wearing eyeglasses or contact lenses to improve your vision, the following are specific tips for keratoconus-afflicted adolescents or young adults to preserve eyesight.
- Avoid direct sunlight or the glare of a mobile phone screen into the eyes.
- Wash your hands before touching your eyes to lessen eye infection risk.
- Wear corrective eyeglasses or contact lenses as prescribed.
- Avoid rubbing your eyes.
- Give all the medical information related to your medical history to the doctor.
- Ask the doctor about the stage and severity of the disease.
- You should ask what contact lenses that fit the stage of your Keratoconus.
- Ask how many collagen fibers cross-linking are in your cornea.
- Check periodically to monitor Keratoconus progress
Common questions about keratoconus
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Resources:
precisionfamilyeyecare hopkinsmedicine pubmed keratoconus Cedars-sinai
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