Refractive approaches to visual rehabilitation in patients with keratoconus

Abstract

Purpose of review As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus. Recent findings Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity. Summary Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.

Keratoconus: An updated review

“…Refractive surgery. Various refractive surgery interventions have been used for keratoconus management, with phakic lens implantation and photorefractive keratectomy (PRK), being the two most widely studied [372,373]. These techniques are contraindicated in progressive keratoconus and are performed when the condition stabilises.…”

Corneal “re-shaping” by lenticule implantation in keratoconus: The role of tissue addition

“…On the other hand, tissue-subtractive techniques such as PRK-based apical corneal remodeling combined with CXL, is to be limited only to non-progressive cones, in mild-stage diseases, with sufficient pachymetry. These options showed significant reduction of refractive error and improvement of visual acuity, but the refractive photoblation should be limited only to partially improve the refraction, in order to avoid excessive corneal weakening, and additional studies are warranted to assess the effectiveness and safety of this surgery (Kim and Mian 2020).…”

Blinding associations of keratoconus

“…Essentially being a corneal stromal disease, visual rehabilitation is possible in a majority of the patients. [ 2 ] Severe visual impairment is seen in patients where posterior segment pathology coexists.…”