Keratoconus is a genetically involved condition of the eye where the front clear window of the eye, the Cornea undergoes continued change in shape leading to distorted vision and in many cases can progress to blindness.
Keratoconus belongs actually to a spectrum of similar extreme shape disorders like Keratoconus, Keratoglobus, Pellucid Marginal Degenration (PMD). A similar pathology can also be surgically caused as a LASIK surgery complication (Lasik Ectasia).
Despite this condition being prevalent since centuries, even in present times the only treatments offered to most patients is a highly interventional corneal transplant surgery (where the distorted cornea is replaced by a cornea form a human donor eye) and the only non surgical offering is a hard (many a times uncomfortable ) contact lens.
With nearly three decades of having successfully brought many a Keratoconus patients to see 20/20 without glasses, it is my endeavor to encourage eye doctors (ophthalmologists and optometrists alike) to change their thought process from delivering usable vision with either interventional surgery or uncomfortable and expensive contact lenses to aiming for 20/20 without glasses or contact lenses.
I have been teaching this approach of mine “ Think Outside the CONE” with the desire to impart nearly 15 surgical techniques and over 40 combinations to eye surgeons and caring optometrists and opticians worldwide to free these very visually challenged population from their “Vision Imprisonment”.
With recent advances in surgery; transplants can better be done as individual layers (DALK, ALK, MLK) with less morbidity but still available at only few centers and then too with associated risk of donor graft rejection , long term healing with medications and finally still needing some sort of contact lens for usable vision.
Advances in the field of contact lenses allow optometrists to offer Scleral contact lenses, Keratoconus specialty lenses and even 3D printed contact lenses but the cost and possible long term discomfort can still be an issue. Additionally, a contact lens is not a permanent fix, it is just a crutch to get you vision leaving the underlying Keratoconus uncorrected.
INTACS, Collagen Cross Linking, Laser PRK, Corneoplqastique, Conductive Keratoplasty, Femtosecond Laser Assisted Lamellar Keratoplasty are some of the many surgical approaches which can further be used in combination or staged approach to reach 20/20
Additionally, associated conditions like cataracts with keratoconus can be addressed with Toric lens implants while corneal scars can be addressed with Laser scar peel and even patients with previous corneal transplants can be corrected with laser Corneoplastique to emmetropia by correcting Irregular astigmatism to 20/20.
Keratoconus is a great example of how eye surgeons and optometrists can collaborate in the patient’s best interest not only by providing surgical (Ophthalmologist) and Non-surgical (Optometrist) options but also by working in symbiosis ie. Scleral Contact lenses after Collagen cross linking.
These are exciting times where Keratoconus patients and caring eye doctors can seek corrective surgical outcomes or non- surgical prosthesis with pros and cons in aspiring to “Think Outside the CONE”.
This Wednesday June 14th, 2017 at 12pm EST, following numerous requests from patients, eye surgeons and optometrists worldwide, Dr. Gulani shall be live on Facebook explaining his innovative and time-trusted surgical techniques and concepts for Keratoconus patients.
Join us and hear it from Dr. Gulani in his own words.