By Richard Cohen - Boca Raton Keratoconus Specialist

Keratoconus is a cornea disease causing progressive and painless cornea thinning and steepening with gradual loss of vision. It is usually bilateral, and males and females are equally affected. It can manifest itself as early as the teens and can progress through the 5th decade.

SYMPTOMS -

Early symptoms include poor vision and inability to see well with glasses or soft contact lenses. As symptoms progress, patients may need to change to a hard or gas-permeable contact lens to achieve their best vision.

TREATMENT

Early on, patients can achieve good vision with glasses or contact lenses. As the cornea begins to steepen, it may become necessary to convert to gas permeable contact lenses. As the cornea continues to change, further treatment may be needed.

Scleral Contact lenses, such as the Acculens, can be tried when the cornea becomes too steep to wear gas permeable hard contact lenses.

INTACS

INTACS are plastic rings placed in the middle of the cornea to flatten the cone of the cornea and improve vision. The INTACS procedure is a 15 minute, in-office surgery which is usually covered by health insurance. During the procedure, the patient’s cornea is anesthetized with eye drops. The Intralase femtosecond laser is used to create two circumferential grooves mid- cornea at a depth of 400 microns. After the grooves are created, the INTACS rings are placed.

For those patients who do not have insurance, the costs may range from $5000 to $7500 per eye. The INTACS rings can remain in the patient’s eye indefinitely and are not felt by the patients. They can also be removed if needed. Please contact your eye care professional for further information.

COLLAGEN CROSS LINKING (CXL) is a new procedure available outside the United States as it is not FDA approved. CXL is a procedure to manage cornea ectasia (weakening). This procedure is an in-office, 30 minute treatment to restore biomechanical stability to the cornea and prevent further progression. The cornea is soaked with Riboflavin (vitamin B2) and then exposed to ultraviolet A (UVA) light. The riboflavin absorbs the UVA and this reaction causes covalent bonds to form within and between the collagen molecules (crosslinks). These crosslinks stiffen and strengthen the cornea thus diminishing the tendency for thinning, weakening and progression of the keratoconus.

The most current and effective therapies combine INTACS with collagen cross linking to treat keratoconus.

PARTIAL THICKNESS CORNEA TRANSPLANT (Lamellar keratoplasty) involves removal of the top 50-75% of the patient’s cornea and replacing it with the appropriate sized donor cornea to either thicken a very thin cornea or remove a scar. This procedure is done at a surgery center and carries a risk of rejection and infection. The costs of this procedure will include the cost of the cornea ($2500), surgeon’s fee ($3000), surgery center fee ($1000-1500) and the anesthesiologist fee ($500).

FULL THICKNESS CORNEA TRANSPLANT (Penetrating Keratoplasty) is the more common type of cornea transplant performed. This is usually used as a “last resort” in those patients, whose cornea is so thin, bulging so much or so scarred that no other treatment will work. This surgery is also performed in an outpatient surgery center. Usually 16-24 sutures are placed in the cornea and the patient will use steroid eye drops to prevent rejection. The costs are similar to a Partial Thickness Cornea Transplant.

If you are seeking a second opinion on a keratoconus eye disease case please feel free to contact us directly. Dr. Richard Cohen is a Boca Raton Keratoconus specialist that is fellowship trained in matters related to the cornea. If you live in South Florida and would like a second opinion on keratoconus please feel free to contact Dr. Richard Cohen.

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