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Keratoconus

Berks Eye Physicians & Surgeons, Ltd.

Keratoconus

Keratoconus is a progressive eye disease in which degenerative changes occur in the clear
front surface of the eye (cornea), causing it to bulge outward in an irregular, cone-like shape, causing distorted
vision that cannot be corrected with glasses or soft contact lenses. It can occur in one or both eyes. Keratoconus
is relatively rare. Most studies indicate it occurs in less than 0.6 percent of the U.S. population. Onset of the
disease usually occurs in people in their teens or early twenties.

What causes keratoconus?


Research suggests the weakening of the corneal tissue that leads to keratoconus may be due
to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidation from
compounds called free radicals, which causes it to weaken and bulge forward. Risk factors for oxidative damage and
weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one
member of the same family. Keratoconus also is associated with overexposure to ultraviolet rays from the sun,
excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

Signs and symptoms of keratoconus


Keratoconus usually appears in a person’s late teens or early twenties, and its onset can
be slow and gradual or relatively rapid. As the cornea becomes more irregular in shape, it causes a progressive
increase in nearsightedness and irregular astigmatism, creating problems with distorted and blurred vision. Other
symptoms include glare and light sensitivity and frequent eyeglass prescription changes.

Keratoconus treatment


In very early and mild keratoconus, vision with eyeglasses or soft contact lenses may
remain acceptable. But as the disease progresses and the cornea thins and becomes increasingly more irregular in
shape, glasses or soft contacts no longer provide adequate vision correction. Treatments for moderate and advanced
keratoconus include:

Gas permeable contact lenses: Because they are
rigid, gas permeable (GP) contacts replace the irregular shape of the central cornea of a keratoconic eye with a
smooth, uniform refracting surface for better vision correction. In some cases, large-diameter GP lenses called
scleral contact lenses may be used to vault over the entire corneal surface to correct vision problems caused by
keratoconus.

“Piggybacking” contact lenses: Because fitting a gas
permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus,
some eye care practitioners advocate fitting the eye with a soft contact lens, and then fitting a GP contact lens
over the soft lens. With this “piggybacking” technique, the underlying soft lens acts as a cushion between the GP
lens and the corneal surface for greater comfort.

Hybrid contact lenses: Hybrid contact lenses are
premium contacts that have a GP optical center, surrounded by a “skirt” of soft lens material. These lenses are
designed to provide the optical clarity of a gas permeable contact lens, combined with wearing comfort comparable to
soft contact lenses. Special hybrid lens designs are available for the correction of keratoconus.

Intacs: These tiny plastic inserts are surgically
placed just under the eye’s surface in the periphery of the cornea, and help re-shape the cornea for clearer vision.
Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or
eyeglasses.

CXL: Corneal collagen cross-linking (CXL) is a
relatively new procedure that strengthens bonds between connective tissue (collagen) fibers within the cornea to
halt the progression of keratoconus. The surface layer of the cornea (epithelium) is gently removed and the
underlying corneal tissue is treated with eye drops of riboflavin (vitamin B2) and then exposed to ultraviolet light
for several minutes. Within a few days of the brief in-office treatment, the epithelial layer grows back. Early
results of CXL research show the procedure can successfully stop the progression of keratoconus, and some patients
experience reversal of the condition and vision improvement.

Corneal transplant: In advanced cases of keratoconus
that cannot be successfully treated by other means, the last remedy is a cornea transplant, also called a
penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still
need glasses or contact lenses for clear vision.

Article ©2011 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use
is strictly prohibited.

Let Us Solder Your Eyeglasses

Berks Eye Physicians & Surgeons, Ltd.

Berks Eye is unique in more ways than one – we are one of the few places that offer frame soldering right in our office. Bring in your frames and we will evaluate their condition. We have our very own laboratory with state-of-the-art equipment and lab technicians with over 20 years experience. Here, we can assure you of the highest quality workmanship in eyewear. If you have any questions at all, please feel free to call our office!

Some Facts About Pink Eye

Berks Eye Physicians & Surgeons, Ltd.

“Pink eye”, or conjunctivitis, is condition that has likely impacted us all at one point or another but still holds a level of mystery for many. What are its causes and treatments? First, let’s understand what is meant by the words “pink eye”. In case you haven’t yet experienced it, when you have pink eye, your eye becomes pink or red because it’s irritated or inflamed. We all have a thin membrane that covers the inside of our eyelids and the whites of our eyes – it’s called the conjunctiva. When it becomes inflamed or irritated, we have a case of conjunctivitis.

There are a lot of non-infectious agents that can be irritating and cause our eye to get pink. If we’re allergic to pollen or pet dander, that can give us a type of pink eye. Sometimes the chlorine in pools will do the same. We can also pick up a bacterial or viral infection that results in pink eye and is infectious, easily spreading person to person.

Viral conjunctivitis is by far the most common, especially in adults. This form of pink eye is highly contagious, can accompany a flu or upper respiratory infection, and has typical symptoms of tearing and discomfort. It usually infects one eye first and then spreads to the other. There are no standard treatments for viral pink eye other than letting the virus take its course. Artificial tears may help your eyes feel more comfortable but do nothing to speed the recovery.

Bacterial conjunctivitis is typically seen in children, although the exact rates of incidence are difficult measure. This form of pink eye involves a lot of mucous-like discharge and is also contagious. This is the only form of pink eye that will respond to antibiotic drop treatment, thus shortening the course of infection. However, even if left untreated, the condition will resolve on its own in about a week.

Allergic conjunctivitis is easier to diagnose as people are generally aware of environmental allergies they may have, be it seasonal, animals, or otherwise. Because the offending cause is in the air, this form will affect both eyes simultaneously. Itching, tearing, swelling of the lids are typical symptoms of allergic pink eye. Treatment is based on the severity of the eyes’ reaction. Avoidance of the affecting agent is the easiest treatment but in a time where that is not practical there a number of very effective allergy eye drops available to reduce or eliminate the symptoms involved.

There are of course exceptions to any rule but the best way to tell which cause is the culprit is to have your eye care specialist inspect your eyes. Also, other serious eye conditions can mimic conjunctivitis, so anyone who complains of severe pain, changes in eyesight, swelling around the eyes, or sensitivity to light should be examined. If the pink eye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor. If your child has pink eye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your eye care specialist. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.

Pink eye has very real social and economic impacts as well. While there are no universal guidelines regarding school exclusion for conjunctivitis, many schools will not allow children to return to school until they have been on antibiotics for some period of time, most typically 24 hours, or their infection has cleared. The American Academy of Pediatrics states that children with viral or bacterial conjunctivitis should be allowed to remain in school once any indicated therapy is started unless limiting contact with other children is not possible. Therefore, young children, whose play behavior inherently requires touching and sharing toys, should be excluded from school per this recommendation. For parents, the advantage of initiating antibiotic drops is that the child may then return to school; however, the danger here is that, if it is a viral illness, the antibiotics are not actually doing any good and it can continue to spread.

To simplify: if you’re an adult, it’s probably viral and there is no specific treatment; if you’re a child it is also likely viral but can also be due to a bacteria in some cases with the difference typically lying in the primary symptom (tearing=viral and mucous discharge=bacterial); and if your eyes itch more than anything it is likely allergic. One of the best methods of disease prevention (and not just pink eye) is to keep your hands clean and to limit touching your nose, eyes, or mouth. Also, remember not to share any items that have been near an infected person’s eye, such as pillowcases, towels, or makeup. Regardless of the cause of pink eye, knowing what to do and what to expect can lessen the impact of this condition. And if you are yet to experience it, those days are numbered.

J. Mark Snyder, O.D.

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