Private keratoconus treatment by a specialist consultant corneal surgeon at Moorfields Eye Hospital

Keratoconus Treatment At Moorfields Eye Hospital

Keratoconus is a progressive condition that leads to gradual thinning and bulging of the cornea. Doctors often explain to the patient that their eye is becoming shaped more like a rugby ball rather than a spherical football. Keratoconus occurs in around 1 in 2000 people in the UK and appears to be more common in people with asian or middle eastern ancestry (in whom frequency is 1/400). 

Keratoconus always affects both eyes, although very commonly, one eye tends to be significantly worse than the other. Most cases of keratoconus are picked up on routine screening by opticians who may notice rapid changes in your glasses prescription and increasing astigmatism. As corneal bulging increases, patients typically become more short sighted and develop more astigmatism. Vision can become difficult to correct with glasses. In some instances a spontaneous split can occur in the cornea (corneal hydrops) leading to a sudden drop in vision.

Keratoconus tends to begin during teenage  and continues to progress up to the late 30's, after which it tends to slow down and remain stable. Rapid progression seems to occur during teenage and early 20's. Unfortunately, if the condition isn't treated early on with collagen cross linking, patients are left with an abnormal shaped cornea that requires a contact lens to see well.

Keratoconus is a very variable disease and can be very mild in one person and not progress very much, whilst being severe and rapidly progressive in other cases. Keratoconus is a type of corneal ectasia and is one of a spectrum of similar diseases (pellucid marginal degeneration, keratoglobus)


Patient with Keratoglobus showing bulging forward of the cornea

Patient with Keratoglobus showing bulging forward of the cornea


Why does Keratoconus matter?

The cornea is the main optical component of the eye. The cornea helps focus images onto the retina at the back of the eye where it is perceived by the brain. As the cornea begins to bulge in keratoconus the regular optics of the cornea are distorted and hence it is difficult to focus a single clear image onto the retina. This can result in distortion, ghosting and multiple image formation. Keratoconus patients often find driving at night difficult due to multiple images, glare and haloes.

Unfortunately, as keratoconus progresses it becomes increasingly difficult for conventional spectacles to correct vision. Most keratoconus patients achieve their best vision with a rigid contact lens which works by arching over the bulging cone of cornea and artificially creating a smooth spherical surface that is optically superior.

Visual problems can include distortion and ghosting of images

Visual problems can include distortion and ghosting of images


How is keratoconus treated?

The aims of keratoconus treatment are twofold;

1. Correction of vision: Vision correction in mild cases may simply be with glasses, as severity increases your eye surgeon may suggest various types of contact lenses including rigid gas permeable lenses, hybrid soft/hard lenses or scleral lenses.

Surgical options for vision correction include intracorneal Keraring implantation, Visian ICL surgery, and toric lens surgery. In advanced cases corneal transplantation may be required.

2. Preventing progression of keratoconus: Prevention is better than cure and Collagen Cross Linking is now considered an effective treatment that halts the progression of Keratoconus. This is most beneficial when done early before the shape of the cornea is very abnormal. 

Mr Angunawela will discuss the best treatment options for you. This may involve a combination of therapies. He is also able to refer you to a contact lens expert at Moorfields Eye Hospital for specialist lens fitting.

Visit the National Keratoconus Foundation for further information