Keratoconus – stopping the progression of the disease

Although keratoconus is a serious and progressive eye disease, there are several effective methods to slow or stop its progression. Corneal crosslinking is considered the most effective method of stabilizing the cornea. Special contact lenses, intrastromal corneal rings and avoiding eye rubbing are also important measures to control the disease. Regular ophthalmologic check-ups are crucial to monitor the condition of the cornea and implement appropriate treatment strategies.

1. corneal crosslinking (CXL)

Corneal crosslinking is currently the only treatment method that has been proven to stop the progression of keratoconus. Riboflavin (vitamin B2) is applied to the cornea and then irradiated with UV light. This process strengthens the collagen fibers in the cornea and increases their stability. Studies have shown that CXL can effectively slow down or stop the progression of keratoconus.

2. fitting of special contact lenses

Special contact lenses can help to improve vision and distribute the pressure on the cornea more evenly. There are different types of contact lenses for keratoconus, including

• RGP lenses (Rigid Gas Permeable): These rigid, gas permeable lenses provide better vision correction and stability.
• Hybrid lenses: These combine a firm, gas-permeable central area with a soft outer zone to increase wearing comfort.
• Scleral lenses: These large lenses sit on the sclera (the white part of the eye) and bridge the irregular cornea, improving comfort and quality of vision.

3. intrastromal corneal rings (intacs)

In this method, small, semi-circular rings are implanted into the cornea to change its shape and stabilize it. These rings can help to improve vision and slow down the progression of keratoconus.

4. avoidance of eye rubbing

Frequent eye rubbing can worsen the condition of the cornea and accelerate the progression of keratoconus. Patients should take care not to rub their eyes and treat allergic reactions that can lead to eye itching.

5. regular ophthalmologic check-ups

Regular visits to the ophthalmologist are crucial to monitor the progression of keratoconus and, if necessary, to take countermeasures at an early stage. Modern diagnostic techniques such as corneal topography enable precise monitoring of the shape and thickness of the cornea.

How crosslinking (CXL) works:

• Preparation: The eye is anesthetized and the patient lies under a UV light device.
• Riboflavin drops: Riboflavin (vitamin B2) is dripped onto the cornea.
• Infiltration: The riboflavin seeps into the cornea and accumulates.
• Irradiation: The cornea is irradiated with UV-A light, which activates riboflavin.
• Cross-linking: The activation of riboflavin cross-links and strengthens collagen fibers in the cornea.
• Conclusion: After irradiation, the treatment is completed and the eye is covered with a protective lens.

Differences between epi-on and epi-off crosslinking

There are two main methods of crosslinking: epi-on and epi-off.

• Epi-off Crosslinking:
  • The epithelium (the top layer of the cornea) is removed before riboflavin is applied.
  • Removing the epithelium enables faster and deeper penetration of the riboflavin into the cornea.
  • This method has proven to be very effective, but carries a higher risk of pain and complications during the healing phase.
• Epi-on Crosslinking:
  • With this method, the epithelium remains intact and the riboflavin is applied through the epithelium.
  • Epi-on is less painful and the healing time is shorter because the top layer of the cornea remains intact.
  • However, the effectiveness may be lower as the riboflavin may not penetrate as deeply into the cornea as with the Epi-off method.