Keratoconus Laser Eye Surgery Is Possible

How advanced treatments like corneal cross linking are revolutionising keratoconus laser eye surgery

If you’ve been diagnosed with keratoconus, you know the frustration of living with blurry, distorted vision. Blurry vision is a primary indicator of keratoconus progression, often worsening as the disease advances, and may not be fully corrected by glasses or standard contact lenses. Keratoconus is a degenerative disease that affects the shape of the cornea, causing it to thin and bulge outward, resulting in visual distortion and irregular astigmatism.

For years, the primary focus of treatment has been on halting the progression of this corneal condition. But what if we told you there’s a growing body of evidence suggesting we can not only stabilize your vision but also significantly improve it?

For too long, the conversation around vision correction for keratoconus has been limited. Many patients are told that traditional LASIK surgery is not an option due to the fragile nature of their corneas and the risk of further weakening, making it generally unsuitable for keratoconus patients. This can be disheartening, leaving many to rely on contact lens options for functional vision.

Soft contact lenses may be used in the early stages or mild cases, while rigid contact lenses are often necessary for more advanced keratoconus to correct irregular astigmatism and provide good to excellent vision. However, some patients may not be able to tolerate contact lenses, requiring alternative solutions.

However, exciting advancements in ophthalmology are changing this narrative. A recent study published in the American Journal of Ophthalmology – “Efficacy of Customized Photorefractive Keratectomy With Cross-Linking Versus Cross-Linking Alone in Progressive Keratoconus: A Systematic Review and Meta-Analysist)” – sheds light on a powerful combination therapy that is yielding remarkable results.

This comprehensive review highlights that customized, or topography-guided (c-PTK or t-PTK), laser treatments combined with collagen cross-linking (CXL) not only have a long history of efficacy and safety but also significantly improve vision in patients with keratoconus. A comprehensive eye exam is essential for accurate diagnosis and to determine the best keratoconus treatment options for each individual.

Advanced diagnostic tools, such as corneal topography, are used to detect corneal irregularities and map the front surface of the cornea, particularly in the early stages when symptoms may be subtle.

What does this mean for you?

Essentially, this approach takes personalized care to a whole new level. While cross-linking alone is highly effective in strengthening the cornea and preventing further bulging, the addition of a customized laser treatment (often a form of PRK, rather than traditional LASIK, specifically adapted for keratoconus patients) allows ophthalmologists to meticulously reshape the irregular corneal surface.

The excimer laser is used for laser resurfacing to smooth the corneal surface, while the femtosecond laser enables precise corneal procedures. This is akin to fine-tuning the eye’s optics, leading to:

Enhanced Vision:

Patients are experiencing not just stabilization but a measurable improvement in their visual acuity and overall quality of vision. Imagine seeing the world with greater clarity, sharper vision, and less distortion!

Improved Quality of Life:

Better vision translates directly to a better quality of life, making everyday tasks easier and more enjoyable.

A Proven Track Record:

The article emphasizes the “long history of efficacy and safety” of these combined treatments, offering reassurance to those considering their options.

Broader Treatment Spectrum:

Keratoconus treatment options now include corneal implants, corneal transplantation, deep anterior lamellar keratoplasty, and cross-linking and laser procedures, providing a range of interventions tailored to the severity and individual needs.

Tailored Patient Selection:

Suitable patients for advanced laser procedures are identified through individual assessment, including corneal topography and refractive error, to ensure optimal outcomes.

Visual Goals:

The aim of these treatments is to achieve good vision, excellent vision, and sharper vision, with refractive correction that reduces dependence on glasses or contact lenses.

Implantable Lenses:

In some cases, implantable lenses are positioned in front of the natural lens to provide additional refractive correction for those who are not candidates for other procedures.

Cross-Linking Mechanism:

During corneal cross-linking, UV light is used to activate riboflavin, strengthening the corneal collagen fibers and halting disease progression.

This represents a significant step forward in the management of keratoconus. It means that for many, the goal isn’t just to halt progression but to actively restore and enhance vision. If you or someone you know is living with keratoconus, it’s crucial to have a comprehensive discussion with your ophthalmologist about all available treatment options, including these advanced combined therapies.

Don’t let the limitations of past treatments define your future vision. The landscape of keratoconus care is evolving, offering new hope for clearer sight.

The Role of Collagen in Keratoconus Treatment

Collagen is the essential building block that gives the cornea its strength and stability. In a healthy, normally round cornea, layers of collagen fibres are tightly organized, helping the cornea maintain its shape and provide clear vision.

However, keratoconus involves a gradual weakening of these collagen fibres, causing the cornea to thin and bulge outward into a cone-like shape. This irregular shape leads to distorted vision, blurred vision, and increased sensitivity to light—hallmarks of this progressive eye disorder.

One of the most significant advances in keratoconus treatment is corneal cross-linking (CXL). This non-invasive treatment uses riboflavin drops and ultraviolet light to create new cross-links between collagen fibres in the cornea.

By strengthening the corneal structure, CXL helps prevent further deterioration and slows or halts the progression of keratoconus. For patients with mild keratoconus or progressive keratoconus, corneal cross-linking CXL can be a highly effective way to stabilize the affected cornea and preserve vision.

Corneal collagen cross-linking not only helps maintain corneal strength but can also reduce the need for glasses or contact lenses, especially when combined with other advanced treatments, such as laser refractive surgery procedures. In some cases, patients experience improved visual acuity and a noticeable reduction in symptoms, allowing for a better quality of life and more satisfactory vision.

For those with severe keratoconus or advanced disease, where the cornea has become too thin or irregular for cross-linking alone, corneal transplant surgery may be necessary. This procedure involves replacing the affected cornea with healthy donor corneal tissue, restoring a more regular, round cornea, and offering the potential for clear vision once again.

Ultimately, understanding the role of collagen in keratoconus treatment empowers patients to make informed decisions about their care and treatment. Whether through corneal cross-linking, laser refractive cxl, or corneal transplant surgery, working closely with your eye doctor to develop a personalized treatment plan is key. The goal is always to improve vision, prevent further progression of keratoconus, and help you enjoy a higher quality of life.