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Keratoconus Baltimore, Maryland

Keratoconus Baltimore, Maryland

Dr. Azman is a top eye doctor in Baltimore that provides a vast array of vision options for complicated corneal diseases, like keratoconus, to his Baltimore, Maryland patients. In the areas below, Dr. Azman, a prominent keratoconus specialist in the greater Baltimore, Maryland area, reviews and outlines keratoconus as well as the latest and most effective treatment options.

Keratoconus/ Post-LASIK Ectasia

The cornea is the transparent tissue that covers the anterior surface of the eye and is in charge of focusing inbound light rays onto the retina. A typical cornea can focus incoming light rays onto the retina either naturally (by the cornea itself) or with rehabilitative eyewear. The cornea is made up primarily of collagen and water and is prone to a number of diseases that can hinder its capacity to focus light rays onto the retina.

Astigmatism is a typical corneal condition. In “normal” astigmatism, the cornea is formed like a football instead of a basketball. People with “regular” astigmatism call for glasses or get in touch with lenses.

Keratoconus is a disorder that leads to thinning of the cornea, generating a “cone-like” form and also producing an irregular surface. In patients with keratoconus, the light rays focused onto the retina are misshaped. This causes blurred vision and also “irregular” astigmatism, which can not be fixed with glasses or get in touch with lenses.

This disorder has an occurrence of about 1 in 2,000 people in the basic populace. It normally impacts both eyes, with one eye being much more afflicted than the various other. Keratoconus impacts males and also ladies in equal regularity, and also there is no ethnic or racial partiality. It generally very first appears in the age of puberty as well as advances until the very early 30s, although the rate of development is difficult to forecast. Some people have a light form of the condition (forme fruste), which may go unseen for several years.

Post-LASIK Ectasia
In 1998, it was documented that specific patients that had actually gone through the LASIK treatment had actually established a keratoconus-like disorder called “post-LASIK ectasia.” Post-LASIK Ectasia is often described as keratoconus in somebody who has previously undertaken the LASIK treatment. The occurrence of post-LASIK ectasia is thought to be about 1 in 1,000 patients. It is assumed that the LASIK procedure– given that it includes the elimination of corneal cells with the laser– results in a long-term weakening of the cornea, which then brings about post-LASIK ectasia.

Post-LASIK Ectasia can occur not only after LASIK however likewise after PRK (photorefractive keratectomy). People who have post-LASIK ectasia experience a decrease in best dealt with visual acuity numerous months or years after they have undertaken their LASIK or PRK procedure. Post-LASIK Ectasia is diagnosed with corneal topography and the Pentacam device, which reveals a steepening of the cornea, comparable to what is seen in keratoconus.

A number of threat factors for post-LASIK ectasia have actually been reported in the ophthalmic literature, such as thin corneas, high nearsightedness, high preoperative keratometry readings, preoperative irregular astigmatism and also young age. A threat aspect scoring system has been developed and released in a peer examined medical journal (Randelman, B.J. et al. Ophthalmology 2008 Vol. 115) to appoint a rating for creating post-LASIK ectasia after LASIK. Variables include preoperative corneal topography pattern, recurring corneal stromal bed density, age, preoperative corneal thickness as well as preoperative spherical matching (which is the prescription gauged by the physician prior to the LASIK treatment). This racking-up system identified 92 percent of individuals who were at threat for creating post-LASIK ectasia.

However, other research studies have discovered that a great deal of patients who had the same risk factors did not establish post-LASIK ectasia (Binder, P.S. Journal of Cataract and also Refractive Surgery 2007 33( 9) 1530-1538). Why specific individuals develop post-LASIK ectasia after LASIK is not fully comprehended. It more than likely includes biomechanical factors related to the cornea.

What Causes Keratoconus?
While hereditary aspects contribute in keratoconus, only 13-15 percent of people with keratoconus have a family history of the condition. Genetics treatment, which is not yet offered, might ultimately be the only therapy that can possibly cure this illness. There are a variety of hereditary conditions associated with keratoconus, that include a background of allergic reactions and atopy, Down syndrome, Ehlers-Danlos syndrome as well as Leber’s hereditary amaurosis.

Numerous theories have tried to explain the reason for keratoconus, yet none have actually been proven. Eye rubbing is one such theory. Patients with keratoconus often report that they often scrub their eyes. Given that patients with keratoconus have a greater occurrence of allergies and also atopy, eye rubbing might be a response to the allergic reaction, which in turn might bring about the development of keratoconus. Keratoconus patients are strongly recommended not to massage their eyes, considering that this might affect the development of the condition. In patients that have undergone LASIK, eye rubbing may be a source of post-LASIK ectasia, so patients must be instructed to stay clear of strenuous eye massaging after LASIK. Allergic symptoms of the eyes such as irritation, redness and also tearing need to be treated with topical anti-allergy drug.

A deficiency in collagen cross-linking is another prospective cause of keratoconus. Cross-linking of collagen is necessary for the biomechanical stability of the cornea, and also complimentary radicals are believed to interfere with cross-linking in keratoconus patients. Corneal cross-linking making use of riboflavin, as well as ultraviolet light, has been made use of to halt and also reverse the development of keratoconus in a number of research studies. Dr. Azman was among the first eye doctors in Maryland to become involved in crosslinking as a treatment for keratoconus and only works with surgeons who only use an FDA approved cross-linking device.

Diagnosis of Keratoconus
Patients who suffer from keratoconus often visit an eye care specialist, unaware of any problem other than blurry vision. Often, the patients’ eyeglass prescription will change but without any improvement in visual acuity. Often specialty contact lenses are needed to fully correct vision in patients with keratoconus.

During a routine eye exam, the physician may detect subtle signs of keratoconus at the slit lamp, but the best way to diagnose the condition is with a topographical map of the cornea (corneal topography), which reveals an irregular shape in patients who have the condition. In addition, a device known as the Pentacam uses a camera to take 50 cross-sectional views of the cornea. The Pentacam maps show irregularity both on the front surface and the back surface of the cornea. They also provide a thickness map of the cornea, which shows areas of thinning in eyes affected by keratoconus.

Keratoconus Treatments

FDA Approved Corneal Collagen Cross-linking

CXL, an advanced keratoconus and post-LASIK ectasia treatment, involves ultraviolet light in combination with topically applied riboflavin (vitamin B) eye drops to increase the crosslinking of the collagen fibers, which in turn strengthens the cornea.

Read more about corneal cross-linking.

Specialty Contact Lenses

In the early stages of keratoconus, patients are often able to see clearly with spectacles or soft contact lenses. As the condition worsens, and the shape of the cornea becomes more irregular, rigid gas permeable (RGP) lenses, scleral lenses, and other specialty lenses are often necessary to provide clear vision. Scleral lenses eliminate the irregularity of the cornea and allow the incoming light rays to focus clearly onto the retina to provide the best vision.

Another type of contact lens for keratoconus is the piggyback lens, in which a soft contact lens is fit first on the eye and an RGP lens piggyback on top of the soft lens. This is sometimes used when the patient can not tolerate an RGP lens by itself. Hybrid lenses, which consist of an RGP center and a soft skirt, can also be used.
Scleral lenses have now become the standard of care for people with keratoconus. They are specially designed to vault over the entire corneal surface and rest on the sclera. The lens replaces the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by keratoconus and other corneal irregularities.

Dr. Azman designs and prescribes all of the specialty contact lenses for keratoconus.