Welcome to question of the day #264

Eyetools question of the day #264

One of my patients has early keratoconus in both eyes and I have fitted him with rigid gas permeable contact lenses that provide him with a visual acuity of 6/5 in each eye. I review him every six months looking for progression of the keratoconus. Is there anything else I can do?

Keratoconus is a progressive corneal disease. It can be successfully managed with rigid gas permeable contact lenses but the underlying condition is likely to get worse. The cornea will become thinner and bulge forward with time.

Depending on local availability it would be in your patient’s best interest if you asked an ophthalmologist with corneal expertise for an opinion on whether your patient is suitable for corneal cross-linking treatment.

In corneal cross-linking, a specifically formulated vitamin B2 and ultraviolet (UV) light is used to add (cross-link) new bonds between the collagen fibres in the cornea. The newly formed cross-links act like support beams to help the cornea stay stable. Vitamin B2 helps the cornea absorb the UV light.

Corneal cross-linking is the only treatment that can stop progressive keratoconus from getting worse, and it may help avoid a corneal transplant. The procedure doesn’t reverse cornea changes that have already happened — it just keeps them from getting worse.

Recently I have been asked for an expert opinion on two cases where a patient with keratoconus was managed for many years with contact lenses without a review from an ophthalmologist and by the time the patient was referred for an opinion, as the keratoconus had progressed, it was too late to treat with corneal cross-linking.

My practice is to refer a patient with early keratoconus to an ophthalmologist to be considered for cross-linking and then to review them. Many of those who have been treated with corneal cross-linking still need to use rigid gas permeable contact lenses for the best possible visual acuity.