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Medical Forum / General / Vision / September 2005Keratoconus
All, I have been diagnosed some 16 yrs ago with KC. I weard RGP lenses which whilst comfortable are not giving me clarity of vision. My opthalmologist has attempted to use a much smaller rigid lens that has been designed to closely fit my very steep corneas. Whilst the vision is now better.. still some more play around required, the fit is not at all as comfortable. She is now suggesting another way forward which I read about on this group some 10 years ago. This is to piggyback lenses. I'm sure which way round the lenses go and which one has the correction and which not. Perhaps someone could explain. Further, is there any reason why having LASIK treatment and the wearing a non-correctional lens would not work? Thanks in advance Rajeev Rajeev, The issue of LASIK for keratoconus patients is being hotly debated within the ophthalmic community. One group point out that significant correction in refractive error can be achieved (although they mostly recommend PRK or a similar surface ablation technique). The other group say that doing anything that thins a keratoconus cornea is just plain foolish. A refractive surgery technique that not only can provide better vision quality AND slow or stop the progression of keratoconus is Intacs. You may want to read http://www.usaeyes.org/faq/subjects/keratoconus.htm Glenn Hagele Executive Director USAEyes.org "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org http://www.ComplicatedEyes.org I am not a doctor. > Rajeev, > [quoted text clipped - 8 lines] > quality AND slow or stop the progression of keratoconus is Intacs. You > may want to read http://www.usaeyes.org/faq/subjects/keratoconus.htm Glenn, Thanks. Well I do have much scarring on my corneas which I also understand have 'drooped'. Is PRK a refractive surgery technique? Rajeev PRK is virtually identical to LASIK with the difference being where in the cornea the laser removes corneal tissue. With PRK the tissue is removed from the surface of the cornea, whereas with LASIK the tissue is removed from underneath a flap of cornea. PRK is removal on the top, LASIK is removal in the middle. Since the LASIK flap provides almost no structural support, PRK is almost universally preferred when corneal structural compromise is a concern. Glenn Hagele Executive Director USAEyes.org "Consider and Choose With Confidence" Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org http://www.ComplicatedEyes.org I am not a doctor. PRK, because it removes tissue, also weakens the structural integrity of the cornea. This is especially true for higher amounts of myopia, as would be expected to occur along with the excessive corneal steepening of keratoconus. Proof of this is that post-PRK corneas show reduced IOP as do post-LASIK corneas. If I had keratoconus, I wouldn't go near an excimer laser. DrG Dear Rajeev, Instead of trying smaller lenses which are less comfortable, I might suggest trying larger lenses, such as cornea-scleral or scleral lenses which are quite comfortable. These lenses range in size from 13.4mm up to 25mm in diameter. I have personally used cornea-scleral lenses for keratoconus patients with good results. Insofar as I am aware, LASIK is absolutely contraindicated for keratoconus, and always has been, because it weakens an already weak cornea. I have seen studies using INTACS with some success, though. However, INTACS do not subtract corneal tissue, but reinforce it by using implantable ring segments. DrG > Dear Rajeev, > [quoted text clipped - 9 lines] > However, INTACS do not subtract corneal tissue, but reinforce it by > using implantable ring segments. DrG Thanks for your reply. I read with much interest information on Intacs. I will be asking my specialist to do some research on this. I have found 3 clinics in London that offer the surgery. How long has this tecnhnique been around? Rajeev Rajeev, you may find this link of interest: http://intacsforkeratoconus.com/main/ >From what I have been told, Intacs were first invented by an Oklahoma optometrist specifically for the treatment of keratoconus -- a brilliant idea. Then, sometime around 1998 or so, the marketing people sought approval for Intacs as a treatment of nearsightedness as an alternative to PRK and LASIK -- a not so brilliant idea. DrG |
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