Keratoconus Q and A

Q: RGP lenses (rigid gas permeable contacts) will stop keratoconus from getting worse. Is this true?

A: No, this is not true. RGP lenses temporarily flatten the non-structural epithelium of the cornea. Keratoconus continues to progress, and contacts must be updated to keep up with the progressing disease. Keratoconus is a progressive disease, there must be some medical intervention to stop it, such as CXL corneal crosslinking.

Q: OK I have heard about CXL or corneal collagen crosslinking. Will this improve my vision as well as stop the KC from getting worse?

A: The aim of corneal crosslinking (also called corneal collagen cross-linking or CXL) is to stabilise the cornea and stop any future progression of keratoconus. The treatment strengthens the weakened collagen (structural protein) fibres in the cornea.

CXL is not expected to improve vision, and in the majority of cases, patients with moderate to severe keratoconus will require additional treatments, such as wearing contact lenses, Intacs, conductive keratoplasty (CK), or phakic IOL surgery, in order to achieve vision correction. 

Q: Will I go blind from keratoconus?

A: No. Keratoconus does not lead to complete black blindness. However Keratoconus can impair vision to a level where one will experience difficulty leading a normal life, unless you wear contact lenses.

Corneal hydrops (extensive scarring) as well as contact lens intolerance can occur as the disease progresses. This can lead to severe vision impairment and can eventually lead to the need for a corneal transplant or graft.

Q: If I have any keratoconus treatment, will I need to wear contacts or glasses afterwards?

A: With very mild keratoconus, it is possible that you may not need glasses or contact lenses after having certain treatment. In the majority of cases, however, patients do need  from some type of vision correction. This can include glasses, contacts, or additional vision correction procedures such as lens replacement or cataract operations.

Everyone is different and KC is unique to each person.

Q: I have been diagnosed with the beginning stage of keratoconus and was fitted with rigid gas permeable lenses . However, I could not tolerate wearing them. What are any other options I could consider?

A: Keratoconus is an eye condition where the clear front surface of the eye, the cornea, gets thin and bulges outward into a cone shape. 

As the cornea thins and bulges, it becomes distorted and even droopy, creating blurred vision that is not very correctable with glasses. Certain types of contact lenses can vault over the irregularly shaped cornea to help focus light properly. Rigid gas permeable lenses (also called RGP or GP lenses) usually can be prescribed successfully.

There are a number of gas permeable lens designs that can be tried before turning to other options. Before you give up on GP lenses, ask your practitioner if he or she can prescribe specially made rigid lenses such as the Rose K design for keratoconus. Also, large-diameter scleral contact lenses made of GP material might work better than standard RGP lenses.

If GP lenses will not work, hybrid contact lenses might be an option. These lenses have a GP central zone, surrounded by a skirt of soft lens material for added comfort, and special designs are available for keratoconus.

Soft lenses also are made for people with keratoconus, but they are not rigid enough to help keep the cornea from bulging over time. On the other hand, often they can offer better vision than glasses.

Q: Should people with keratoconus be driving a car?

A: As long as they meet the legal driving requirements, and are safe, yes!

Q: Does early diagnosis make any difference in keratoconus progression? 

A: Yes. Early diagnosis means vision may be only minimally affected. In those cases, corneal crosslinking should be considered to stabilise and prevent future vision loss. This is really important for younger children and teenagers.

Q: I have keratoconus, and currently I wear hard rigid gas permeable (RGP) lenses. I’m very sensitive to sunlight. What sunglasses should I use? 

A: People with keratoconus should always wear good quality sunglasses, because they protect the corneas from the harmful ultraviolet light of the sun, which has been shown to increase free radicals (cellular byproducts) that can accelerate keratoconus progression.

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