Have you been diagnosed with keratoconus and wondering if LASIK is an option for you? Keratoconus is a progressive eye condition that causes thinning and bulging of the cornea, leading to vision problems like nearsightedness, irregular astigmatism, glare, and halos. LASIK is a popular laser eye surgery that corrects vision by reshaping the cornea. But is it safe for someone with keratoconus?
In this comprehensive guide, we’ll explain what keratoconus is, why LASIK is not recommended for keratoconus patients, and better treatment options available. You’ll learn about specialty contact lenses, corneal crosslinking to halt progression, and new laser treatments that may improve vision quality. We’ll also provide tips on finding the right keratoconus specialist.
Let’s start by understanding more about keratoconus and how it impacts your vision.
What is Keratoconus?
Keratoconus is a non-inflammatory eye condition in which the cornea progressively thins and bulges outward, causing a cone-like protrusion. This irregular cone shape prevents light from focusing properly on the retina, resulting in distorted and blurred vision.
The condition typically begins in the teenage years and progresses over the next two decades. Keratoconus often affects both eyes, but may be worse in one eye. As it advances, the cornea becomes increasingly thinner and more unstable.
Some of the common symptoms of keratoconus include:
- Irregular astigmatism, leading to blurred and distorted vision
- Nearsightedness that keeps getting worse
- Sensitivity to light and glare
- Halos or starbursts around lights
- Frequent changes in eyeglass prescription
While the exact cause is unknown, keratoconus seems to be linked to genetics and excessive eye rubbing. Oxidative stress from free radicals may also damage corneal cells, causing thinning. Using rigid contact lenses at a young age is another associated risk factor.
If you notice vision getting progressively worse, it’s important to get evaluated by an ophthalmologist. They can run diagnostic tests to check for keratoconus.
During a comprehensive eye exam, your ophthalmologist has several tools to detect keratoconus:
- Corneal topography uses a machine to map the curvature of the cornea. It can identify the irregular cone shape associated with keratoconus.
- Slit lamp exam allows the doctor to closely inspect the cornea for thinning and protrusion.
- Corneal pachymetry measures the thickness of the cornea using ultrasound. A thinner corneal measurement can indicate keratoconus.
- Keratometry evaluates the corneal curvature. Steepening of the cornea is common with keratoconus.
Based on a combination of exam findings and your reported symptoms, your doctor can determine if you have keratoconus. Detecting it early allows closer monitoring and treatment to prevent rapid progression.
Why LASIK is Not Recommended for Keratoconus
So if you’ve been diagnosed with keratoconus, should you consider LASIK surgery? Unfortunately, the answer is no. Here’s why:
LASIK (laser-assisted in situ keratomileusis) uses a precise laser to reshape the cornea and improve vision. But in order to reshape the cornea, a thin flap is created and tissue is removed using the laser.
This permanent removal of corneal tissue poses significant risks in someone with keratoconus. Since the cornea is already thin and weak, taking away more tissue can further destabilize it and speed up progression of keratoconus.
There is also a risk of inducing a condition called corneal ectasia after LASIK in susceptible individuals. This leads to forward bulging of the cornea and vision loss from irregular astigmatism.
For these reasons, LASIK is considered unsafe and contraindicated in patients with keratoconus or any other corneal instability. Most LASIK surgeons will not operate on patients with a keratoconus diagnosis.
While disappointing, avoiding LASIK helps protect your cornea from further damage. Luckily, there are several specialized treatment options that can improve vision in keratoconus.
Better Options for Keratoconus
If you have keratoconus, don’t lose hope. Several effective treatments are available to support your changing vision needs:
Specialty Contact Lenses
For mild to moderate keratoconus, custom soft contact lenses can help improve vision temporarily. These specialty lenses are designed specifically for your unique cone-shaped cornea.
However, as keratoconus progresses, your cornea may become too steep or irregularly shaped for soft contacts to work well. This is when your ophthalmologist may fit you for rigid gas permeable (RGP) lenses.
RGP contacts vault over the irregular cornea, creating a smooth optical surface. With an expert fitting, most people with keratoconus can achieve good vision with RGP lenses. But they take some getting used to.
Newer specialty contact lenses like Rose K and Kerasoft also show promise for improving comfort and vision in keratoconus.
Corneal Collagen Crosslinking
To stop keratoconus from getting worse, corneal collagen crosslinking (CXL) may be recommended. This procedure uses vitamin B2 drops and UV light to strengthen corneal tissue and halt progression of keratoconus.
Over 95% of patients who undergo CXL experience stabilization of their cornea. In some cases, CXL even improves vision slightly and reduces astigmatism.
The procedure takes about an hour and involves removal of the corneal epithelium. Your ophthalmologist will provide medication to manage discomfort as the epithelium grows back over a few days.
Along with specialty contact lenses, CXL provides a way to gain control over changes caused by keratoconus.
Refractive Crosslinking (CXL-Plus)
Some ophthalmologists now offer refractive crosslinking, also called CXL-plus. This combines corneal collagen crosslinking with PRK laser vision correction in one procedure.
The crosslinking element stops keratoconus progression, while the PRK laser treatment reshapes the cornea and improves irregular astigmatism. This can enhance vision clarity and quality.
Refractive crosslinking does not eliminate the need for glasses or contact lenses. But many patients experience a reduction in halos and glare at night after CXL-plus. This makes it easier to function in low light.
CXL-plus is only performed on patients whose keratoconus has been stabilized by CXL. Not everyone is a candidate, so be sure to consult an expert keratoconus specialist.
The Role of Corneal Transplant
If you have advanced keratoconus that continues to worsen despite specialty contact lenses and CXL treatment, a corneal transplant may be required. This surgery replaces damaged corneal tissue with healthy donor tissue.
There are a few options for corneal transplants in keratoconus:
- Deep anterior lamellar keratoplasty (DALK) selectively replaces diseased corneal stroma but leaves your healthy endothelium intact. This offers faster recovery compared to a full corneal transplant.
- Penetrating keratoplasty (PKP) transplants the full thickness cornea and has been the gold standard for advanced keratoconus.
- Descemet stripping endothelial keratoplasty (DSEK) replaces only the diseased endothelium layer if that’s the source of corneal dysfunction.
Though a big decision, a corneal transplant can restore vision when all other options have been exhausted. Your ophthalmologist will discuss if and when it may be appropriate.
Finding the Right Specialist
Getting diagnosed with keratoconus can be scary. But finding an experienced keratoconus specialist is key to safeguarding your vision. Here’s what to look for:
- They specialize in cornea conditions and are knowledgeable about latest treatments.
- They take time to explain keratoconus and your options in a compassionate way.
- They have access to advanced diagnostics like corneal topography and pachymetry.
- They ask questions about your lifestyle, eye rubbing habits, contact lens use, and vision goals.
- They don’t push LASIK and explain why it’s not recommended for you.
Look for ophthalmologists or optometrists who are specially trained in keratoconus management. Ask other patients for recommendations too. Navigating keratoconus takes a team effort between you and your doctor.
Being diagnosed with keratoconus can make you feel hopeless about your vision. However, today’s specialty contact lenses, corneal crosslinking, and new laser treatments allow most keratoconus patients to achieve functional vision. While LASIK is not safe for unstable corneas, alternatives like CXL-plus may still reduce glare and halos. Catching keratoconus early and finding an expert you trust offers the best path to maintaining your vision long-term.