Following on from our recent look at short sightedness, this week we are investigating the condition...
more..Keratoconus Eye Surgery
Cross-Linking, C3R, INTACS eye treatments from the UK's leading surgeons
What is keratonconus?
The cornea is the clear window on the front of the eye and provides the majority of the focusing power of the eye. Keratoconus is a common bilateral corneal condition, occurring in more than 1 in 2000 people. It is characterized by progressive corneal thinning and stretching which gradually progresses in both eyes resulting in the corneas adopting an irregular cone shape. As a result, the eye develops astigmatism and the vision may become severely blurred. Keratoconus is not visible to the naked eye but apparent upon scans and examination.
What is Cross linking?
Corneal cross linking is a new advanced technique that halts the progression of the disease by treating the underlying cause of the corneal weakness and distortion. This is a unique treatment as until now treatments only improved vision where possible.
The principal of cross-linking is photopolymerisation. Riboflavin is administered to a de-epithelialised cornea which is activated by UVA light. The light-induced production of oxygen radicals leads to the development of strong chemical bonds between collagen fibrils, thereby stiffening and strengthening the cornea.
Can the UVA light used damage my eyes?
No – the wavelength of light used in the procedure is absorbed effectively enough to protect the deeper layers of the eye thus posing no risk
What is to be expected after surgery?
A contact lens is placed on the treated eye for 4 days following surgery. Once this is removed you should expect some dryness and distorted vision as the cornea settles. It takes approximately 1 month to stabilize after which you can be fitted for contact lenses or glasses.
Can I wear my contact lenses or glasses after surgery?
After surgery it will take a month or so for the corneas to settle and during this time your prescription will be fluctuating. Once it has settled you can be refitted for contact lenses and/or glasses.
What are Intacs?
INTACS are a treatment option for mild to moderate keratoconus that is quick and effective. The procedure takes 30 minutes and involves placing small, micro-thin, clear inserts, inside the cornea. The ring inserts are designed to reshape the cornea, flattening it to improve the shape of the cone, thus reducing the optical defect caused by keratoconus. They are safe, reversible and do not affect the central visual axis of the cornea.
Can my body reject the intacs?
No as they are made of a biocompatible material. They are also removable and exchangeable so different rings can be used as the correction required changes.
What does the surgery involve?
The eye is numbed using anesthetic eye drops and nothing is felt during the procedure. A tiny 1mm incision is made so the corneal layers can be separated to form a tunnel where the intacs are inserted one at a time. The incision is closed with a single stitch.
Keratoconus is a bilateral, progressive and non-inflammatory disease of the cornea, affecting approximately 1 in 2000 of patients. It is characterised by paraxial stromal thinning, which causes the normally round-shaped cornea to become progressively stretched, resulting in the development of a conelike bulge. This bulge changes the corneal refractive error producing irregular astigmatism and myopia and, thus, visual distortion.
Keratoconus is the most common of the corneal dystrophies. Although there is no definite known cause, keratoconus does have strong links to conditions such as asthma, hayfever and eczema, as well as systemic ailments (such as Down’s syndrome and connective tissue disorders). Other linking factors include trauma, eye rubbing and certain ocular diseases.
Previously, patients that had keratoconus treatments were fitted with rigid gas permeable contact lenses (RGPs). However, if the disease progressed and they became intolerant to them, corneal grafting was the only option available to restore functional sight.
There is now an alternative for these patients; corneal collagen cross-linking (C3R) which aims to strengthen the thinning cornea and halt progression of the disease. This treatment can be combined with INTACS (stromal inserts) to further flatten the corneal curvature. In certain cases, this may be followed up with surgery for implantable contact lenses (ICLs), should the refractive error remain high or complex.
The types of treatment that will be offered to keratoconus sufferers depend on disease progression; treatment plans are completely individual and personalised.
The Keratoconus treatments available at Advanced VisionCare are:
Corneal Collagen Cross-linking (C3R)
The procedure of cross-linking was first noted by dermatologists who found that generating collagen cross-linking strengthened sagging skin. This was then developed from 1993 by ophthalmologists at the University of Dresden in Germany.
Corneal cross-linking was first carried out in 1998 and since then much research has been undertaken. Recent studies from ophthalmic departments all over the world have proven that crosslinking of corneal collagen reduces the progression of keratoconus and improves visual acuity, with minimal toxicity.
Collagen cross-linking treatment is not a cure for keratoconus. Rather, it aims to slow or even halt the progression of the condition. After the treatment patients should expect to continue wearing spectacles or contact lenses (although a change in the prescription may be required). However, it is hoped that the treatment will prevent further deterioration in vision and the need for corneal transplantation.
INTACS
INTACS is a Keratoconus treatments option for mild to moderate keratoconus and it is quick and effective. It can be done alone or in combination with cross linking. The procedure takes 30 minutes and involves placing small, micro-thin and clear inserts inside the cornea. The ring inserts are designed to reshape the cornea, flattening it to improve the shape of the cone, thus reducing the optical defect caused by keratoconus. They are safe, reversible and do not affect the central visual axis of the cornea.
The material used is PMMA (poly methyl methacrylate), a biocompatible plastic which has been safely and commonly used in contact lenses and routine cataract surgery for many years. There is no risk of rejection as this material is completely tolerated by the eye.
The aim of the treatment is to alter the corneal surface in such a way that correction with contact lenses or glasses is not only easier but also more effective.
The main advantage of the use of INTACS is they are removable and exchangeable; therefore different rings can be used as the required correction changes. Cosmetically, once in place the INTACS are no more visible than a contact lens.
Cross-Linking and INTACS Procedure
The treatment consists of a one time application of riboflavin eye drops to the eye. The riboflavin is activated by UVA light (for 30 minutes) and this enhances the bonds between collagen fibrils thereby stiffening and strengthening the cornea.
This is an extremely safe procedure as the wavelength used in the procedure is absorbed effectively enough to protect deeper layers of the eye.
Following treatment a contact lens is inserted for 4-5 days for the epithelium to heal. Only one eye is treated at a time due to the intense nature of the treatment and the variation in healing time.
Advantages of cross-linking
- 1. It is safe and simple
- 2. It only needs to be carried out once and induces a permanent change
- 3. There are no incisions and therefore no stitches which insure a quick recovery
- 4. Contact lenses can still be used after treatment to correct any residual prescription
The procedure is carried out under local anaesthetic drops. A surgeon will then use the topography maps taken during the patient’s consultation to determine where the incisions need to be made. The incision is only 1mm and allows the surgeon to separate the corneal layers to form a tunnel in which the INTAC is to be inserted. INTACS are inserted one at a time and the incision can then be sealed with a single stitch.
INTACS Implantable Contact Lenses (ICL) In some cases, implantable contact lenses (STAAR ICL) can be successfully used after cross-linking or INTACS to give good vision and eliminate the need for distance glasses. Some patients may require a combination of all three treatments to stop the progression of keratoconus and for visual rehabilitation. However, this decision can only be made once the patient has had a thorough and personalized assessmentCross-Linking and INTACS Testimonial
Ibrahim Khan’s AVC Testimonial
Name:Ibrahim Khan
Posted by admin | 9th September 2010| in AVC Procedures, Eye Care, Implantable Contact Lenses, Testimonials, Treatments
Treatment received at AVC: Hyperopic Implantable Contact Lens
Why you decided to have treatment:
I had been wearing glasses since childhood. For the last ten years, I was thinking about it. As Laser was not suitable, I had been waiting for the right procedure.
How was the AVC experience?Excellent. The care provided was very good from the very start. I was impressed with the thorough consultations. The procedure itself was painless and very quick.
How has your life changed post-treatment?It has changed everything. I can do a lot more sports. I can enjoy my life a lot better. I’m feeling very happy. Implantable Contact Lenses is an option which is safe and reversible. I highly recommend it. It will change your life.
Paul Ravenscroft’s AVC Testimonial
Posted by admin | 24th June 2010 | in AVC Procedures, Implantable Contact Lenses, Treatments
Name: Paul Ravenscroft
Treatment received at AVC: Implantable Contact Lenses
Why you decided to have treatment
I visited another eye clinic in Leeds offering Laser treatment. On the two occasions I visited, I was given conflicting information. I resigned myself to the fact that I would have to wear glasses and contact lenses forever. Then a friend in the Ophthalmic industry suggested me to try AVC.
How was the AVC experience?AVC advised me that Laser eye surgery was not possible due to me having Keratoconus. The alternative option was Implantable Contact Lenses. The procedure is painless and the care that you receive from the staff at AVC is out of this world.
How has your life changed post-treatment?The results are astounding! After 24 hours my sight was 20:20. I would recommend AVC to everyone.
Emma Riddell’s AVC Testimonial
Posted by admin |24th June 2010 | in AVC Procedures, Implantable Contact Lenses, Testimonials, Treatments
Treatment received at AVC: Implantable Contact Lenses
Why you decided to have treatmentI had worn glasses for 25+ years. I knew that Laser surgery was not an option as I was very short-sighted.
How was the AVC experience?I am thrilled with the results.
How has your life changed post-treatment?In order to view the content, you must install the Adobe Flash Player. Please click here to get started.
