These enable our surgeons to diagnose with precision and offer the
best treatment options, particularly for most modern surgeries for
cataract [phacoemulsification], the retina and vitreous, LASIK,
glaucoma, squint, keratoplasty, cornea, and oculoplasty.
Modern technology ~ yet a humane touch!
"Patient Satisfaction" always comes first at Shroff Eye
Hospital. With this aim in mind, Shroff Eye Hospital is equipped with
the finest talent of doctors and staff and with the latest diagnostic
and surgical instrumentation.
Observing internationally accepted protocols and standards of
medical hygiene and patient comfort, the five story Shroff Eye
Hospital is proud to be considered at par with the best eye hospital
in the world.
Superiority is visible in every aspect of the hospital. The Operation
Theatre Complex is built to stringent international design standards.
The HEPA filtered air-conditioning system and laminar air flow
maintains an absolutely sterile surgical environment.
NEW
KERATOCONUS (cone shaped cornea)
What is keratoconus?
Keratoconus is a common bilateral corneal condition, occurring in more
than 1 in 1000 people. The condition typically starts in adolescence
and early adulthood.
Keratoconus is a disease with an uncertain cause, and its progression
following diagnosis is unpredictable. If afflicting both eyes, the
deterioration in vision can affect the patient's ability to drive a
car or read normal print. Further progression of the disease may lead
to a need for surgery.
Despite its uncertainties, keratoconus can be successfully managed
with a variety of clinical and surgical techniques, and often with
little or no impairment to the patient's quality of life.
SYMPTOMS
At early stages, the symptoms of keratoconus may be no different from
just having the need for spectacle correction. As the disease
progresses, the vision deteriorates. Visual acuity becomes impaired at
all distances, and night vision is sometimes quite poor. Some
individuals have vision in one eye that is markedly worse than that in
the other eye. Some develop photophobia (sensitivity to bright light),
eye strain from squinting in order to read, or itching in the eye.
There is usually little or no sensation of pain. Keratoconus can cause
substantial distortion of vision, with multiple images, streaking and
sensitivity to light.
DIAGNOSIS
This is usually done by an ophthalmologist with a detailed eye
examination. Diagnosing early keratoconus can be tricky, since mild
disease often does not show any identifiable signs on slit-lamp
examination; however, recent and a more definitive diagnosis can be
obtained using corneal topography, in which an automated instrument
projects an illuminated pattern onto the cornea and determines its
shape from analysis of a digital image. The topographical map reveals
distortions or scarring in the cornea, with keratoconus revealed by a
characteristic steepness of curvature which is usually below or around
the centre of the cornea. The topography record of the degree and
extent of the deformation is used for assessing its rate of
progression. Unilateral cases tend to be uncommon. Sometimes it’s a
mild condition in the better eye, below the limit of clinical
detection. It is common for keratoconus to be diagnosed first in one
eye and not until later in the other.
At our hospital, we use a very sensitive Topography instrument called
the ‘Topolyser’ from Wavelight Inc.
PROGRESS
However good the vision may be with the use of contact lenses, vision
may be difficult to maintain at times as the condition progresses and
contact lens tolerance varies. Contact lenses are used as temporary
measures of treatment, but do not, unfortunately, slow down the rate
of progression of the cone. In about 10% to 20% of keratoconus
patients the cornea may become extremely steep, thin and irregular or
the vision cannot be improved sufficiently with contact lenses. The
cornea may then need to be replaced surgically with a corneal
transplant or graft. Visual recovery after a transplant takes a long
time - sometimes as long as a year to 18 months - to settle down and
there is a strong possibility that the eye will still need to be
fitted with a contact lens afterwards in order to see properly.
Surgery is therefore not a shortcut to perfect vision and nor is it a
way of avoiding contact lens wear.
There is also a risk of the transplant rejecting afterwards, although
a majority of corneal transplants done for keratoconus are successful.
TREATMENT
Treatment of mild keratoconus is geared towards eliminating or
reducing the myopia and astigmatism.
Temporary:
Permanent:
New modality of treatment:
- Corneal Collagen Crosslinking with Riboflavin (C3-R®*)
Contact lenses
Initial management is tried with rigid contact lenses
by our contact lens specialist. In very early stages of keratoconus,
spectacles can suffice to correct minor astigmatism. As the condition
progresses, spectacles may no longer provide the patient with a
satisfactory degree of visual acuity, and most doctors will move to
managing the condition with contact lenses.
Rigid gas permeable contact lenses for keratoconus improve vision by
means of tear fluid filling the gap between the irregular corneal
surface and the smooth regular inner surface of the contact lens,
thereby creating the effect of a smoother cornea.
Many specialized types of contact lenses have been developed for
keratoconus, and our contact lens expert helps you with the best fit.
The irregular cone needs expertise to produce a contact lens with
optimal contact, stability and steepness. Some trial-and-error fitting
might be necessary.
Traditionally, contact lenses for keratoconus have been the 'hard' or
rigid gas-permeable variety, although manufacturers have also produced
specialized 'soft' or hydrophilic contact lenses. A soft contact lens
has a tendency to conform to the conical shape of the cornea, thus
diminishing its effect. These do not however prove effective for every
patient.
Some patients also find good vision correction and comfort with a
"piggyback" contact lens combination, in which gas permeable rigid
contact lenses are worn over soft contact lenses, providing clarity of
vision and comfort.
Precaution with contact lenses: There is a small risk of infection
when wearing contact lenses and the risk becomes much greater if the
contact lenses are not kept clean, so it is important to strictly
follow the hygiene instructions given when the contact lenses are
fitted.
A NEW PERMANENT NON SURGICAL TREATMENT: CORNEAL COLLAGEN CROSSLINKING
WITH RIBOFLAVIN (C3-R®*)
So far there has been not one successful way to stop the
progression of keratoconus.
With current methods using rigid contact lens or intra corneal ring
segments, only the refractive error (spectacle numbers) can be
corrected, but it has very little effect on the progression of
keratoconus. It is estimated that eventually 21% of the keratoconus
patients require surgical intervention to restore corneal anatomy and
eyesight. A new non surgical, non invasive treatment, based on
collagen cross linking with Ultraviolet A (UVA, 365nm) and riboflavin
(Vitamin B 2), a photosensitizing agent is now available. This changes
the intrinsic biomechanical properties of the cornea, increasing its
strength by almost 300%. This increase in corneal strength has shown
to arrest the progression of keratoconus in numerous studies all over
the world.
What is collagen cross-linking?
A new treatment for keratoconus which has shown great success is
Corneal Collagen Crosslinking with Riboflavin (C3-R®*),
a one-time application of riboflavin eye drops to the eye. The
riboflavin, when activated by approximately 30 minutes illumination
with UV-A light, augments the collagen cross-links within the stroma
and so recovers some of the cornea's mechanical strength.
C3-R®*,
developed at the Technische Universität Dresden, Germany has been
shown to slow or arrest the progression of keratoconus, and in some
cases even reverse it, particularly when applied in combination with
intracorneal ring segments.
How is the treatment done?
The treatment is performed in our operation theatre under
complete sterile conditions. Usually, only one eye is treated in one
sitting. The treatment is performed under topical anesthesia (using
anesthetic eye drops). The surface of the eye (cornea) is treated with
application of Riboflavin eye drops for 30 minutes. The eye is then
exposed to UVA light for 30 minutes. Hence, the treatment takes about
an hour per eye. After the treatment, antibiotic eye drops are
applied; a bandage contact lens may be applied, which will be removed
by our doctor during the follow up visit. Protective eye wear, such as
sunglasses (also given by us) is to be worn for a few days until
complete healing takes place.
Who can benefit from this treatment?
Collagen cross-linking treatment is not a cure for
keratoconus, rather, it aims to slow or even halt the progression of
the condition. This is important to understand. Patients may need to
continue to wear spectacles or contact lenses (although a change in
the prescription may be required) following the cross-linking
treatment but it is hoped that it could limit further deterioration in
the patient's vision and reduce the case for keratoplasty.The main aim
of this treatment is to arrest progression of keratoconus, and thereby
prevent further deterioration in vision and the need for corneal
transplantation.
What are the risks and consequences involved?
Very few potential risks associated with this treatment have been
reported so far. The Ultraviolet light dose used is designed to
prevent damage to the cells that line the back of the cornea or the
other structures within the eye.
No lens opacities (cataracts) have been attributed to this treatment
in European trials.
The treatment involves the outer layer (epithelium) of the cornea.
There is therefore discomfort and a short-term haze.
Other lesser but more common risks include:
- Inability to wear contact lenses for several weeks after the
treatment
- Changes in corneal shape necessitates fitting of a contact lens
or a occasional change in spectacle correction.
As is the case with any treatment, there may also be long-term
risks that have not yet been identified.
The increased corneal rigidity induced may wear off over time and
further periodic treatments may be required.
How does Cross Linking arrest keratoconus?
Until recently, there was no method to change the integrity
and strength of the
cornea itself for keratoconus patients. The non-invasive treatment
C3-R®*
(corneal collagen cross-linking riboflavin) treatment has been proven
to strengthen the weak corneal structure in keratoconus. This method
works by increasing collagen cross-linking, which are the natural
"anchors" within the cornea. These anchors are responsible for
preventing the cornea from bulging out and becoming steep and
irregular (which is the cause of keratoconus).
Issued in public interest by
ShroffEyeHospital, Mumbai, India
India’s first LASIK Centre to
launch the 400 Hz Wavelight laser
India’s first EyeHospital to be
awarded the JCI- Joint Commission International certification (USA),
the Gold standard of Healthcare Internationally. |
