- Hey, guys. Today we're gonna talk about keratoconus.
If that's something that interests you,
I think you're gonna like it.
Stick around.
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So welcome to the EyeCare and Wellness Channel.
If you haven't been here before, I am Dr. Joel Hayden.
I will talk about all things to do with optometry:
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and many things that happen in my practice,
so I think you'll find it interesting.
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All right, let's get at it,
so today we're talking about keratoconus.
At the end, I am going to talk about
ways in which you may realize
that you have early stages of keratoconus,
but before we get to that, let's talk about what it is,
and keratoconus is a disease of the cornea,
the clear layer that rides over the iris and the pupil.
In most people, it's very regular.
It's dome-like,
but in keratoconus it literally looks like a cone,
just like the picture that I'm showing you now
compared to the one before,
and it causes people to not see well.
We can't usually correct them well
with glasses and/or contacts,
so there are many different treatments for keratoconus.
I think that's gonna be my next video on
what are the treatments?
But before we get to that,
let's talk about what the causes are,
so how do you get keratoconus?
Well, it's usually one of two ways.
One is there's a family history.
Someone in your family has had keratoconus,
and you, unfortunately, have the genetics,
the genetic trait carried on
that puts you at risk,
or potentially, of having keratoconus.
The other way that you can get keratoconus,
and I've seen this numerous times,
is some people who experience either a lot of allergies,
or for some reason they just really want to rub their eyes,
they literally rub them incessantly,
and that hard rubbing can cause distortion
in the cornea and keratoconus,
so I've had a few patients
where I've started off seeing them.
They have a mild astigmatism. I don't think much about it.
They come in a year or two later,
and their astigmatism gets worse,
and then, couple years later, their astigmatism gets worse,
and that is the telltale sign for me:
"Hey, something's going on here."
Astigmatism doesn't usually change that much,
so I'll ask them, "Do you rub your eyes a lot?"
And they usually will go, "Yeah!
"I rub my eyes a lot.
"They get really itchy,"
and they'll tell you
they take their knuckles and go right in,
and they do a lot of damage
'cause you can imagine what a knuckle would do to a cornea,
so for those people, I try to catch them as early as I can
because if I can, then I can get them to stop.
I can prescribe allergy drops
that will knock down the itching
so they don't want to rub their eyes as much,
and then hopefully, their corneas will settle back
with less astigmatism,
and hopefully decrease the keratoconus
that they're now inducing in their own eyes,
so that's usually how you get the keratoconus.
It's usually one of those two ways,
so then you're wondering,
"Well, how do you diagnose the keratoconus?"
That's not easy. It especially wasn't easy 20 years ago.
The one thing we'd notice during the eye exam
with a keratoconic patient
was that we couldn't correct them to 20/20
no matter what we did,
and it's very aggravating
trying to refract someone down to 20/20
when you can't get them that far,
and the eye itself looks pretty good.
It's hard to literally look at an eye
and tell it has keratoconus,
even though that picture that we had put up,
yeah, that one,
looks pretty obvious,
in many patients it's not that obvious,
so with the newer technologies,
we used to use something called a keratometer,
but a keratometer
only gives us about four points on the cornea.
Now we have corneal topographies
that can give us up to 15,000 points on the cornea,
and this is a normal corneal topography of a cornea,
and you'll notice
there's a lot of green and yellow in there,
and that's usually a fairly flat cornea,
so remember, the keratoconus patients
have the coning of the cornea,
and coning or steepening in the cornea
usually shows up as red on the corneal topographies,
and there we have it.
There is a patient with keratoconus,
and as you can see, that black,
that mild black circle,
that's the pupil,
so you can tell
that it's affecting the vision inside the pupil,
and that's why we usually can't correct them to 20/20,
so that's how we diagnose them.
The third way we can diagnose them
is looking at what's called an OCT,
which gives us a cross section of the cornea,
and usually we can see some thinning.
Here's an OCT of a normal
and a thinned-out, keratoconic cornea,
so that's how we diagnose them,
and then, once we diagnose them,
we have to figure out the best way to treat them,
and for some of them, it can be just,
in mild cases, regular contacts with astigmatism.
Glasses are usually the worst to try to improve vision with,
but if it's not the soft contacts,
it's usually hard contacts in mild cases,
and then, as the severity gets worse,
we look at things like scleral lenses,
which are big, hard lenses that vault over the whole cornea.
Here's a picture of an OCT
of one of my patients with keratoconus
with a vaulted scleral lens over the top,
and it's amazing
'cause many times we can correct them
right back down to 20/20,
and they can live a normal life,
and that's just it:
A lot of these patients
can't function in life.
I had a patient in not long ago. She's a banker.
She's having a really tough time holding her job.
We fit her with scleral lenses and she is ecstatic,
so not all hope is lost
if you have keratoconus.
There's a lot of good treatments out there.
Another treatment's called corneal cross-linking,
and it's a treatment
to try to stop the cornea from changing.
It's not going to fix the keratoconus.
It's not gonna fix the vision issues,
but at least if it can stop it from getting worse
then we will be much less likely
to be looking at corneal transplants down the road,
which would be an awful way
to have to fix severe keratoconus.
Potentially down the road,
you could be looking at corneal transplants,
which is not what we wanna look at,
so the corneal cross-linking,
many times will decrease that risk.
In the severest of cases,
we have to look at corneal transplants,
which is not what we wanna look at,
certainly not what the patients want.
It's a very invasive surgery,
but if we can catch the keratoconus earlier, treat it,
maybe look at the corneal cross-linking,
then we're gonna really decrease their risk
of having severe outcomes at the end.
With all that said,
I'm gonna make more videos on keratoconus,
and how to treat them, and more on the treatments,
and more on
how my patients are treated,
maybe do some really in-depth showing
of how my patients learn how to put the lenses in,
what their vision is before and after,
and really interesting stuff.
Lastly, I had talked about
how you can tell that you may have something going on.
One, do you rub your eyes?
Do you rub your eyes like crazy?
'Cause if you do, hey, you better stop.
B, there's some good allergy medications over the counter
that you could use to stop the itching.
C, if you feel like you just don't see well
with the glasses and the contacts,
like just don't see as well as you think you should
or don't think you see as well as you once did,
that's a clue that there may be something going on,
and you need to check with your optometrist
and ask them, "Can you check
"and make sure I don't have something like keratoconus?"
And of course, they're gonna shake their head
and go, "How'd you hear about keratoconus?"
But there's nothing like a well-educated patient,
so I always appreciate them,
and I think it's just a good thought process to have
if you're having issues,
but just definitely go get your eyes checked,
and I hope that was helpful.
If you have any questions for me,
please put them in the comments down below,
and I'm gonna try
to get those other videos out on keratoconus
as soon as I can,
and until then, take care.