Answering Questions about Keratoconus
Learn how to respond to some of the most common
questions asked by new keratoconus patients.
By Long D. Tran, OD, and Timothy B. Edrington, OD, MS,
(KC) is a condition that typically affects otherwise healthy people beginning in
their second or third decade of life. This is usually the start of some of the
patients' most active and productive years.
Most, if not all, patients have some level of
anxiety the moment you first diagnose them with KC. These patients typically
have numerous questions and concerns about how the condition may affect their
work, their family and their life. However, because of apprehension or lack of
opportunity, these fretful questions often go unasked. New keratoconic patients
may often find themselves worried about the health of their eyes and uncertain
about the future of their sight.
and Support Web Sites
NATIONAL KERATOCONUS FOUNDATION (WWW.NKCF.ORG)
on keratoconus, contact lenses and research
brochures on keratoconus and corneal transplants
(Available in Spanish)
� Links to other
keratoconus related sites
� A non-profit
PARTICIPATE, E-MAIL INFO@NKCF.ORG)
worldwide, online forum
include patients who have keratoconus, optometrists,
contact lens fitters
� A part of the
ALL ABOUT VISION (WWW.ALLABOUTVISION.COM)
information on keratoconus
Over the years, we've encountered
several recurring questions that KC patients and their families tend to ask. By
addressing these questions beforehand, you can be more effective in educating KC
patients and easing their concerns.
Following are some of the
most frequently asked questions we've heard from keratoconus patients and how we
"Will I go
blind?" You need to reassure newly diagnosed patients that KC won't
cause blindness, although their vision is likely to progressively worsen.
However, with the use of GP contact lenses, most KC patients can maintain good
functional vision and a normal lifestyle.
We also mention that
although KC tends to progress through a patient's 20s and 30s, its progression
usually stabilizes during the patient's early 40s. In the event that vision
becomes unsatisfactory through their GP lenses or if they can no longer tolerate
contact lens wear because of discomfort, a corneal transplant may be necessary.
"Can I get LASIK?"
This is usually the second question that we encounter unless a laser center
referred the patient. With frequent advertisements for LASIK, some patients are
under the impression that laser surgery is a solution for all vision problems.
You need to make sure patients understand that KC is a corneal thinning
condition and that LASIK is a corneal thinning procedure. Surgically making a
thin cornea thinner will probably only speed up the progression of KC and worsen
the condition. You should also stress to these patients that even if they may
find a surgeon who is willing to perform the procedure, LASIK is highly
contraindicated for patients who have KC or who are KC suspects.
One surgical option
that is available for mild-to-moderate KC patients is Intacs (Additions
Technology, Inc.). You should discuss Intacs with your patients to see if it's
the best option for their present and future vision needs.
"Will my kids
have keratoconus, too?" With the World Wide Web so readily available,
some of your patients will already know much about KC before even setting foot
in your office. Some of the materials that they encounter suggest a genetic
etiology for KC. Patients may question whether or not they should have children,
and those who already have children may wonder if their kids will develop it,
You should inform
these patient that although KC has a genetic predisposition, the literature
reports that less than 25 percent of KC patients have a family member who has
clinical KC. Some precautionary measures that parents can take are to warn their
children against aggressive eye rubbing and to ensure that they receive regular
eye examinations. You should encourage these patients to have as many children
as they desire.
"Why can't I
wear soft lenses?"
This is typically the question that patients immediately ask when we tell them
that they need to wear GP lenses to optimize their vision. We try to explain to
our patients that while those who have early KC may attain adequate vision
through soft lenses, most attain their best vision through GP lenses. Soft
lenses are generally not able to adequately correct the irregularities of KC
corneas and instead tend to contour to the hills and the valleys of the cornea.
You can use the example of plastic wrap to help illustrate how a soft lens takes
the shape of what's underneath, while GP lenses are able to mask many of the
irregularities of the keratoconic cornea. Because a GP lens doesn't bend or fold
like a soft lens, its front surface can act as the new optical surface for the
eye. As a patient's condition worsens, the parameters of the GP lens need to
change accordingly. You need to help patients understand that frequent follow-up
care is necessary for you to identify these changes, as well as to monitor the
health of the cornea.
"Will I need a
Patients who surfed the Web before coming to your office will often ask this
question. You need to reassure patients that only about 10 percent to 20 percent
of KC patients ever require a corneal transplant procedure. Generally, KC
patients are referred for a penetrating keratoplasty (PK) if they meet one of
1. Unacceptable vision
through the best-fitting GP lens.
2. Inability to
comfortably wear lenses.
successfully wear GP lenses and can maintain surprisingly good vision, even with
moderate corneal scarring.
Helping Patients Cope
You become more than a contact
lens prescriber when you diagnose KC. You become an advisor and a supporter.
Because of the lifestyle changes that KC demands, patients may easily become
overwhelmed. You should explain the general characteristics and etiology of the
condition to KC patients to dispel myths that patients may have obtained from
You can also recommend other
sources that will help them learn about and manage their condition. Resources
such as The National Keratoconus Foundation (www.nkcf.org) provide information
on KC. Patients and their families may also find online support groups helpful.
Table 1 lists some of these resources. By properly educating KC patients about
their condition, you can help them better cope.
Tran is an assistant professor at the Southern California College of Optometry.
E-mail him at firstname.lastname@example.org.
Edrington is a professor at the Southern California College of Optometry. E-mail
him at email@example.com.
Contact Lens Spectrum, Issue: August 2006