Dr. Orwa Nasser MD MPH - Removing glasses in cases of keratoconus

Removing glasses in cases of keratoconus

Many patients with keratoconus are interested in removing glasses with a laser. In most cases, they receive a negative answer that it is not possible to perform the laser and stay with glasses for the rest of their lives. Apparently, recently, with the use of advanced techniques and lenses, glasses can be removed for patients with keratoconus.
 

What is keratoconus?
Keratoconus is a condition in which the cornea loses its natural shape, as it begins to bulge until it becomes a cone shape (conus). Over time, the cornea begins to thin, irregular astigmatism (angles, astigmatism or cylindricality) develops and constant changes in the numbers of glasses occur. If this condition is left untreated, it can end up with loss of vision and blindness.
 

Why is laser removal of glasses not suitable for patients with keratoconus?
In the laser procedure for removing glasses, a special and precise laser with a specific wavelength is used. This laser weakens the connections between the corneal fibers and thus the corneal surface can actually be reshaped and the numbers can be corrected. It is possible to perform a laser procedure for removing glasses up to certain numbers (usually no more than minus 10) and also up to certain angles (cylinders) (usually up to 4-6 cylinders). The laser is suitable for regular cylinders but not irregular cylinders.

In keratoconus there is irregular astigmatism (angles or cylinders) which is usually accompanied by high spectacle numbers. Therefore, the laser will not be suitable for correcting the cylinders and also for correcting the numbers in keratoconus. The laser in patients with keratoconus, who already have weak corneal fibers, will further weaken the cornea and can cause further thinning and worsening of the keratoconus. Therefore, any patient with keratoconus is not recommended to undergo a laser procedure for removing glasses.
 

How do patients with keratoconus get rid of glasses?
For patients with keratoconus, laser is not an option as mentioned. However, glasses can still be eliminated with new surgical techniques and advanced intraocular lenses. There are two options:

- ICL or ARTISAN lens implantation: This surgery is an excellent option for getting rid of glasses for patients who are not suitable for laser eye surgery due to severe visual impairment or other reasons. This surgery is mainly suitable for young people, usually under the age of 40. In this surgery, a small, thin silicone lens, like a contact lens, is implanted in the eye behind or in front of the iris (the colored part of the iris). This surgery can correct high numbers and severe aberrations (cylinder) with excellent results without any damage to the cornea. The treatment and recovery period is short and the success rate is high.

- Lens replacement surgery: This surgery is recommended for patients who are not suitable for lens implantation surgery, or for older patients over the age of 40. This surgery is also an excellent option for getting rid of glasses for patients who are not suitable for laser eye surgery due to severe visual impairment or other reasons. In this procedure, the natural lens of the eye is replaced with a silicone intraocular lens as in cataract surgery. In such surgery, different types of lenses can be implanted to correct high numbers and severe astigmatism (cylinder). The treatment and recovery period is short and the success rate is high.