Panic is not an unusual reaction to a new diagnosis of keratoconus. Fear of corneal transplant or even blindness is on everyone’s mind. But the good news is that this disease can be very successfully managed.
Read on for the most important things your teenager should know about this eye condition.
1. Put yourself in experienced hands
Keratoconus is relatively uncommon, with about 1 in 2000 Australians affected.
This means that most optometrists only come across a couple of patients a year with the disease. With this limited exposure, it is impossible to gain the experience necessary to manage the complexities of this disease.
One of the most important steps in successful management of the disease is choosing the best possible practitioner – an optometrist experienced in prescribing all forms of vision correction for keratoconus including glasses and customised contact lenses.
An expert surgeon is also a must. Your experienced optometrist may work closely with a number of corneal surgeons. It is essential to consult with the surgeon about a procedure called collagen cross linking (C3R) if your teenager’s keratoconus is progressing.
C3R stops the disease in its tracks in most cases. It doesn’t reverse the damage or provide clearer vision, but it does prevent or slow the progression of the disease.
2. Eye rubbing must be eliminated!
Eye rubbing is one of the big risk factors for keratoconus developing and progressing. Successful management depends upon providing relief from itchy eyes that cry out to be rubbed.
Your keratoconus expert may prescribe eye drops (steroids or antihistamines) to stop the itch. It is really important to avoid preservatives in all eye drops as well as contact lens solutions and artificial tears.
Here are some tips:
- Avoid all-in-one contact lens cleaning solutions, which tend to be heavily preserved. Talk to your optometrist about a peroxide system such as AOSEPT.
- Use preservative free artificial tears (the ones that come in unit dose vials or a preservative-free formula)
- If you need prescribed drops, such as steroids, talk to your optometrist about getting preservative-free versions made up in a compounding pharmacy.
- If your eyes are still itchy, try a cool pack. A gel eye-mask from the freezer can provide soothing relief from itchy eyes.
3. You will not go blind from keratoconus if managed properly from the start
This is the scariest thing for most patients to contemplate. But, managed properly from the start, this disease does not usually lead to corneal transplant (never mind blindness).
The most important things are:
- Choose an experienced keratoconus practitioner who is an expert in fitting contact lenses.
- An optometrist who dedicates their practice to keratoconus is the person most likely to keep you out of needing a corneal graft.
- Poorly fitting contact lenses are a fast track to needing a corneal graft.
- Corneal graft is a last resort option, for when you have failed in contact lenses even when fitted by an expert. It is never an easy option and does not restore your vision to how it was before you developed keratoconus.
- You may still need to wear hard contact lenses after your corneal graft.
- An initial corneal graft lasts for an average of 15 years before it needs to be replaced. A second graft lasts on average half that time.
4. Cleanliness is key
An eye infection is one of the most serious things that can go wrong with wearing contact lenses.
Infection can lead not only to the inability to wear your contact lenses for some time, but also can cause permanent scarring.
Infections are caused by bacteria and other pathogens entering the eye at a vulnerable spot, such as an abrasion.
The trick is to avoid both the bugs and the trauma (see 5, below) and then infections simply can’t happen.
Some important things to note:
- Contact lenses must be kept scrupulously clean.
- If your contact lens falls on the ground, or you have to stay out overnight without your contact lens solutions and case, NEVER store the lens in water.
- Worse still is licking it – the mouth harbours billions of bacteria!
- Better to wrap it in a clean tissue until you get home to fully sterilise it.
5. There is no such thing as good pain when it comes to contact lenses
Lenses must be comfortable. Uncomfortable lenses often mean a poor fit and this can lead to abrasions (which can allow infections to occur).
Poorly-fitting lenses can also lead to rubbing of the centre of the cornea (which can lead to permanent and debilitating scarring and it one of the reasons you may ultimately end up with a corneal transplant).
If your contact lenses are not comfortable, see your keratoconus expert. If they can’t get them to fit your comfortably, it’s time to seek a second opinion. Look for a highly experienced practitioner who sees these patients every day, and not just a couple of times per year.
