Visual Rehabilitation in Keratoconus: The Emergence of a New Era

Excerpt

Keratoconus is a progressive, non-inflammatory corneal ectatic disease characterized by corneal steepening and thinning, generating a high degree of myopia and irregular astigmatism, thereby severely impairing visual acuity [1]. Traditionally, keratoconus has been managed in first-line treatment with rigid contact lenses, which improved visual acuity in cases of moderate and advanced severity. Corneal transplantation remains an option for patients with very advanced keratoconus, who subsequently achieve mean spectacle-corrected visual acuity of 0.6–0.8 and may also need rigid contact lenses [2]. Today, we use sophisticated diagnostic tools which enable early diagnosis of keratoconus, and we are able to perform corneal cross-linking for stabilization of the corneal conus in relatively early stages of the disease. As a consequence, the need for corneal transplantation has decreased significantly [3]. However, an increasing number of patients with keratoconus are identified in a ‘grey zone’, where their contact lens-corrected vision is not great, but it is enough not to consider corneal transplantation. These patients are in need of effective visual rehabilitation, and their expectations are often relatively high. …