A new treatment for keratoconus has been flagged off by Mumbai-based Dr Vinay Agarwal of Clear Vision Eye Centre. The procedure known, as Corneal Collagen Cross linking with Riboflavin (C3-R) was first performed by Agarwal, a corneal surgeon specializing in keratoconus management.
Keratoconus results in the cornea becoming weak. It may gradually bulge outward. Most often, this bulging is seen in the lower half of the cornea. It may first present itself as astigmatism.
"However, not all astigmatism is due to keratoconus. In mild or early stages of Keratoconus (forme fruste keratoconus), eyeglasses may correct the astigmatic vision," says Dr Agarwal.
C3-R has been proven to make the weak corneal structure stronger. This method works by enhancing the collagen cross linking. These are the natural anchors within the cornea. These anchors prevent the cornea from bulging out and becoming steep and irregular- a consequence of advanced keratoconus.
Dr Agarwal has successfully performed corneal cross linking on a number of patients from across the country and abroad. "Corneal Cross Linking is the first real treatment for my keratoconus patients. The achievement of stabilisation is a dramatic event in the life of these patients with a disease that is otherwise progressive and affects both eyes", he says.
The 30-minute non-invasive C3-R treatment can be carried out in the doctor's office itself. During the treatment, custom-made riboflavin eye drops are applied to the cornea. It is then activated by ultraviolet light. This amazingly simple process has been depicted in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In documented European studies, such treatments have been proven safe and effective in patients.
The abnormal curvature of the cornea due to keratoconus changes the cornea's refractive error resulting in moderate to severe blurriness of vision. "As keratoconus advances, rigid gas-permeable (RGP) contact lenses maybe the only non-surgical way to achieve clear vision," says Dr Agarwal. If the disease continues to advance, scarring of the central cornea may occur.
Almost half of keratoconus patients do not have to make more lifestyle changes other than wearing corrective lenses. The cornea stabilizes after a few years without ever causing severe vision problems. For others, the only resolution to keratoconus has been penetrating keratoplasty (PKP). This has a long healing period and an unpredictable refractive error. Even after corneal transplant PKP, keratoconus can present itself in the new donor cornea.