LASIK Laser Eye Surgery Articles from
Pasadena Vision Specialist Dr. James Kao

Keratoconus
James J. Kao, DO, PC

Keratoconus refers to the abnormal thinning of one’s corneas. Typically it is associated with increasing myopia and astigmatism and the loss of one’s best corrected vision. In the early stages, one may not have signs or symptoms other than the gradual and significant changes in eyeglass prescription combined with diminished corrected vision. Keratoconus typically begins during one’s late teens or twenties; and progresses during one’s thirties. In later stages, a more rapid loss of best corrected vision and increasing astigmatism are telltale signs. Both eyes are typically affected but usually asymmetrically.

This is a condition that is common in certain ethnicities. It is believed to have a genetic or hereditary component. Patients with keratoconus often have thin corneas (clear portion over the colored portion of our eyes) and a concurrent a history of eye rubbing. It is believed that eye rubbing, if done with regularity and force, has the potential to further thin the corneas and to change the prescription of one’s glasses.
Previously, treatment for keratoconus was limited to corneal transplants or the lifelong usage of rigid gas permeable contact lenses. Corneal transplants have the risk of graft rejection and the need for long-term use of medications. Rigid contact lenses are uncomfortable and have risks for infection or corneal scarring. Laser vision correction surgery such as Lasik is not an option for individuals with keratoconus. As keratoconus corneas are thinner and weaker than normal, laser treatment (removing tissue) would only further weaken an already thin and weak cornea.

The most current and advanced treatment for keratoconus is INTACs (intracorneal ring segments) surgery. This treatment involves the insertion of inert ring segments that bolster or strengthen the corneas thereby preventing further changes. By having the INTACs surgery, patients lower the chance of needing a corneal transplant. Secondarily, the segments reduce the amount of myopia which does provide some visual improvement for some patients. The goal is to maintain or possibly improve functional vision.

INTACs surgery is performed as an outpatient procedure with topical anesthesia. In the first step, the IntraLase laser is utilized to create perfectly controlled symmetrical channels at a predetermined corneal depth. This is followed by the insertion of the INTAC ring segments. A suture may or may not be needed at the end of the procedure. Medication drops are prescribed and utilized up to 4-6 weeks postoperatively. The patient may be fitted for soft contact lenses or utilize glasses. Patients return to functional activities within a matter of days. Full healing and stabilization of vision takes up to 6 months for full recovery. Patients are reminded of the importance of refraining from eye rubbing.

Our offices provide evaluations at various convenient locations. We would be glad to answer any questions or concerns that patients may have. INTACs surgery for keratoconus may possibly be covered by your medical insurance and our offices may assist in the verification of coverage

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