One of my patients who has early keratoconus has asked me if there is any treatment. What should I tell her?

Keratoconus is a progressive corneal disorder that can in its early stages be treated using rigid case permeable contact lenses. These can be uncomfortable and sometimes difficult to insert and/or remove. Also, rigid gas permeable contact lenses have only little effect on slowing progression.

Another form of treatment is corneal cross-linking. This involves the application of riboflavin (vitamin B2) solution to the eye that is activated by illumination with UV-A light for approximately 30 minutes. The riboflavin causes new bonds to form across adjacent collagen strands in the stromal layer of the cornea (cross-links), which recovers and preserves some of the cornea’s mechanical strength. The corneal epithelial layer is generally removed to increase penetration of the riboflavin into the stroma.

The added strength to the stromal layer helps prevent further progression of the keratoconus in around 90% of cases. In around 45% of cases cross-linking leads to improved vision with spectacles or contact lenses.

This patient deserves referral to an ophthalmologist specialising in corneal conditions for further investigation and to be considered for corneal cross-linking.