Visit Family Vision Care Optometry at either the Los Angeles Office (213) 749-3461 or Valencia Office (661) 775-1860.

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A primary focus of our practice in both offices is the care of the keratoconus patient. Our strong focus and success in managing keratoconus has led to patient referral from other doctors throughout Southern California. Feel free to contact us if you require information beyond what you find here or in the Keratoconus Links offered at the bottom of this page.

Keratoconus is a disorder that causes progressive thinning and distortion of the cornea - the clear dome at the front of the eye. The cornea normally has a rounded shape, but in keratoconus the thinned area bulges forward to produce a cone like protrusion. This results in progressive distortion and reduced vision. Many keratoconus patients experience blurred distance vision, glare, light sensitivity, disturbed night vision, headaches and reading problems, Keratoconus may affect only one eye but more commonly occurs in both eyes. It affects people of all races and both sexes. Most patients develop keratoconus in their late teens to early twenties although it can begin at any age. Pellucid marginal degeneration (PMD) is a corneal thinning disorder related to keratoconus that primarily affects the inferior cornea.

Establishing the Diagnosis

Patients who develop keratoconus often experience reduced vision as a first symptom. Nearsightedness and astigmatism (irregular curvature of the eye) are often the first signs of the disorder. Frequent prescription changes are another common sign of keratoconus. Before computerized corneal topography became available, it was sometimes difficult to establish a diagnosis of keratoconus, especially if the practitioner was not familiar with the symptoms in the early stages of the disease. The classic signs of keratoconus include: Fleischer's ring (an iron colored ring surrounding the cone), Vogt's striae (stress lines caused by corneal thinning) and apical scarring (scarring at the apex of the cone).

Corneal topography has facilitated the diagnosis of keratoconus, helping establish the diagnosis earlier, follow progression more accurately and differentiate keratoconus from other conditions.

No one knows for certain what causes keratoconus. We do know that keratoconus runs in families and that many patients who have keratoconus report vigorous eye rubbing. Many patients with keratoconus also have allergies, but the link to allergic disease also remains unclear. Two theories for keratoconus have been proposed:

• Keratoconus corneas are more easily damaged by minor trauma such as eye rubbing.
• Keratoconus corneas lack the ability to self-repair routine damage easily repaired by normal corneas.

Although contact lenses have been suggested as a possible cause of keratoconus, this has not been proven and remains questionable. We advise patients with keratoconus to avoid eye rubbing as much as possible. Cold compresses applied to the eyes are helpful. Newer anti-allergy medications such as Patanol or Zaditor are also useful in managing itch and eye rubbing.

Treatment Options

We are great believers in conservative treatment. In the mildest form of keratoconus, eyeglasses or soft contact lenses often provide adequate vision. As the disorder progresses and the cornea becomes increasingly distorted, specially designed soft lenses, hybrid rigid-soft (Softperm) lenses or the recently introduced Epicon lens will often work well.

In more advanced keratoconus, rigid gas permeable contact lenses are usually the best choice for visual rehabilitation. There are numerous contact lens designs used to treat keratoconus and pellucid marginal degeneration. The Rose-K is an example of an exceptional and flexible lens design originally introduced by New Zealand Optometrist, Dr. Paul Rose. However, the key to a successful contact lens fitting isn't as much the lens as it is the skill and experience of the contact lens fitter. Fitting contact lenses on a keratoconic cornea is delicate and time-consuming. You can expect frequent return visits to fine-tune the fit and prescription. In some cases the process can take many months. For many patients it is also a continuing process which begins all over again as the condition progresses.

Fitting patients with PMD can be challenging. In the early stages, the central cornea is regular although highly astigmatic. Custom soft toric contact lenses will often provide adequate performance and safety. As the condition advances, specialized rigid lenses provide viable options.

Improperly fitted contact lenses can cause extensive damage to the cornea and can ultimately lead to a corneal transplant.

If your cornea can't tolerate a rigid contact lens, or contact lenses no longer provide acceptable vision, the next step is surgery; a cornea transplant, also called a penetrating keratoplasty. We work closely with several leading corneal surgeons if the need arises. However, even after a transplant, you most likely will need eyeglasses or contact lenses for clear vision.