Fouad Melamed, OD Los Angeles Eye Doctor

Kerataconous is the thinning and the subsequent development of a dome shaped cornea. The cornea is the clear lens that covers the pupil and iris of the eye. For reasons that are not fully understood this gently curved surface can become dome shaped.

The purpose of the cornea is to focus light on the retina that is located in the back of the eyeball. As the cornea becomes dome shaped, the area of focus on the retina changes. Vision then becomes blurred and images are no longer distinct.

Kerataconous is usually diagnosed during puberty until the late teenaged years. The dome will usually increase in size for about 10 years and then stop growing. Nothing can be done to stop the progression of kerataconous. Kerataconous will decrease visual acuity dramatically as the cornea becomes more misshaped.

Initially the condition may be helped by glasses or soft contact lenses. However, as the dome shape a progress, the best vision acuity is obtained when the patient is fit with rigid gas permeable (RPG) lenses. Both eyes may be affected but not always to the same degree. Severe cases of kerataconous may require surgery.

If you are diagnosed with kerataconous, it is important to go to an eye care professional that has experience with treating this condition. This is a progressive condition that will require a change from soft contacts or glasses to rigid gas permeable lenses over time. Your eye care professional will need to be ever vigilant to your changing cornea shape to make the appropriate changes.

Generally patients with kerataconous will not see optimally with glasses or soft contact lenses because of the irregular corneal shape. In most cases, RGP lenses, or rigid gas permeable contact lenses, will give the best vision. It takes a skilled practitioner to get the right fit of the RGP lens over the cone shaped cornea. You will need to expect to make a couple of trips back to your eye care professional to have the initial fit checked and the prescription fine tuned. Regular eye exams will need to become part of your routine for the rest of your life. But that really isn’t any different from anyone who doesn’t have kerataconous.

The symptoms of kerataconous can be easily dismissed at first, which is why yearly eye exams are so important. Headaches that are caused by eye strain, blurry or distorted vision, and increased sensitivity to bright lights are a few of the common symptoms. Patients can also have real issues with glare from lights.

Some patients find out they have kerataconous when they are being examined for LASIK surgery because their glasses or soft contact lens have become ineffective. Unfortunately, at this time LASIK surgery is not advised for patients that have kerataconous.

The cause of kerataconous is not known. Patients that frequently, vigorously rub their eyes are more prone to develop the condition. It has also been occasionally known to run in families, although generally someone will develop kerataconous without any family history.

Catching kerataconous early and then following up with the treatment plan is absolutely essential. If left untreated, kerataconous can cause scar tissue to form at the point of the cone. This scar tissue will have a devastating effect on visual acuity. The only reliable treatment at that point is surgical corneal transplantation.

Kerataconous is a manageable eye condition. If left untreated vision can become very poor. If treated early by an eye care professional that is experienced with kerataconous, visual acuity can be optimized. Early treatment is key is maintaining excellent vision. Your eye care professional will also keep you abreast of any new treatment options that may become available.

Fouad Melamed, O.D.

With the coming of summer it is time to stress protection from the sun’s rays. While skin cancers and their prevention receive a large amount of attention, it is also just as important to protect your eyes from the sun. This is not to minimize the need for skin protection but rather to add eye protection to your summer routines.

Our sun emits powerful ultraviolet rays along with the visible light that we see and the heat that we feel. These ultraviolet rays can cause eye damage in several forms. Certain cataracts are thought to be formed when the eye is exposed to UV light. Cataracts are a clouding of the normally clear lens that covers the pupil of the eye. This cloudiness can drastically decrease vision.

Another form of eye damage is pterygium. This is a fibrovascular proliferation or overgrowth of cells. The pterygium grows from the corner of the eye closest to the nose and then over the lens. While the cause is not certain, the main culprits seem to be sand, dust, wind and exposure to UV rays from the sun. The thought is that as the sunlight passes through the cornea it is focused on the white of the eye or the sclera closest to the nose. It is this concentrated damage that may cause the pterygium to form.

Pingueculae is another growth that forms in the whites of the eye. These are usually small yellowish growths that generally cause few problems. However, some people feel like there is something in their eye with these growths or scratchy eyes.

Macular degeneration is the leading cause of blindness in older populations. While exposure to UV rays has not been proven to be a causative factor in developing macular degeneration, there is some thought that frequent unprotected exposure to the sun can be a contributing factor.  Smoking, hypertension, obesity, family history and a sedentary lifestyle are also thought to be culprits in this devastating affliction.

Intraocular melanoma may have a link to unprotected exposure of the eyes to the sun or tanning beds. Although the connection has not been proven, there is still sufficient concern, and precautions should be taken. Skin cancers of the eye lid and around the eye do have a direct connection to sun exposure. These areas are often under protected when sun screen is applied.

How can you protect your eyes from the harmful rays of the sun? Good sunglasses are a must for starters. If you are unsure of how good your sunglasses are, take them to your eye care professional. They can let you know how effective they will be at blocking the UV rays. If you are pretty sure you bought your sunglasses based on looks rather than effectiveness, it may be time for a new pair. There are great looking sun glasses that also block 99-100% of UV rays.

In addition to blocking UV rays, (both UV-A and UV-B) the sunglasses need to block out at least 80% of visible light. If you are out in the sun frequently, you should consider wrap around lenses. These will block out the sunlight from all portions of your eye. Don’t forget to get proper sunglasses for your kids. The effect of the sun on the eye is cumulative. This means the more eye protection you have over the course of your life; the less likely you will be to develop sun related issues.

In addition to good sunglasses, a wide brimmed hat can also block a large amount of the sun from reaching your eyes. Interestingly, while you may be tempted to take your sunglasses off in the shade, you may still need to wear them to protect your eyes from reflected light. The lesson here is leave all your protective gear on until it is too dark to see with them on or you are totally out of the suns rays.

If you have any questions about any possible eye damage from the sun, make an appointment to see your eye care professional. Your eye care professional has special training to see damage at a very early stage. This is the best time to catch a problem and receive treatment if needed. Simple changes at an early stage can have big payoffs in the long run.  Don’t forget to wear your sunglasses anytime you are out in the sun regardless of the season.