Genetics, allergies, Southern Asians and Downs Syndrome are linked to the population affected by Keratoconus, which is a degenerative disease process of the cornea of the eye. A collagen malfunction induces changes in the structure of the cornea from curved to conical resulting in visual impairment. A connection in those afflicted with this disorder has been possibly attributed to allergic disease affecting the eyes that cause some to develop secondary “eye rubbing” resulting in a contributing factor in cornea deterioration in genetically predisposed patients. Treatments for keratoconus can restore 20/20 vision.
Early symptoms may exhibit minor blurring of vision often associated with refractive eye defects. Early diagnosis is often in adolescence. This disorder is often bilateral, but can exhibit asymmetrically. Acuity can deteriorate rapidly at all distances. Photophobia, eye-strain and itching without pain may present. Night vision may be significantly impaired. A classic, definitive clue is the perception of “ghost” images, with image movement noted relative to heartbeat. Patients may be aware of streaking and flaring distortion at light sources.
Definitive diagnosis is accomplished through slit-lamp examination of the cornea. The test with highest accuracy is corneal topography that allows mapping of the curve of the cornea. Topography will identify keratoconus, which should not be treated with laser surgery. Advanced disease is determined by degree of thinning at the point of the cone through a painless examine called pachymetry.
Patients with keratoconus have a good prognosis. Very mild cases may be corrected through glasses or soft contact lenses. Most patients, however, will require rigid contact lenses for the best visual correction. Patients with more advanced disease will benefit optimally from gas-permeable contact lenses, which will maintain their ability to legally drive and read normal print.
Surgery may be necessary in treatments for keratoconus that have progressed. Corneal ring segments restore reshaped corneas for effective use of contact lenses. Experimental corneal cross-linking reduces flexibility of the cornea to stabilize the disorder, allowing follow up with safe correction through laser surgery. More rarely, corneal transplantation may be required.
Corneal transplantation is reserved for those patients with the most severe presentations of deterioration. Results are generally good. Recovery can be lengthy, however, and patients usually need contact lenses. Rejection risk is much lower than other organ transplants.
In the case of young adults that do not have a perfect vision improvement with glasses needs to be evaluated by a specialist in corneal refractory diseases. There is evidence that unaddressed allergic disease with eye involvement can precipitate the exacerbation of this disease and recommend all patients abstain from rubbing their eyes, although the general consensus is that the disease is not preventable.
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