SCRATCHING AND RUBBING THE EYES TRIGGERS KERATOCONUS

18/12/2014

Scratching and rubbing the eyes and applying strong pressure on them triggers keratoconus, a disease characterized by the thinning and steepening of cornea, the eye's transparent layer. Avoiding these actions which contribute to the early occurrence and progression of the disease is enough to prevent serious visual losses which may require a corneal transplant in the long run.

This disease is common in warm and dusty countries like Turkey.

Keratoconus is known as a disease caused by thinning and steepening of the transparent layer of the eye, the cornea, with progressive myopia and astigmatism. Onset of the disease is usually in puberty, but the patients notice the condition only in their 20's. Keratoconus progresses slowly between the ages of 20 to 40 and becomes stable after 40. Unless treated, it leads to serious visual problems which require corneal transplantation. Ophthalmologist Efekan Coşkunseven, MD, Op. of Dünyagöz Etiler shared the following information on “keratoconus”, which is characterized by the forward bulging and coning of the cornea:

“Also described as a deformity of the cornea, keratoconus has many known causes. Allergic eye conditions in which the patient rubs the eyes frequently can also pave the way for it. Unfortunately, it is more common in warm and dusty countries like Turkey, where childhood allergic conjunctivitis is common. Genetic predisposition also plays a role. If a family member has keratoconus, particular attention is necessary since genetics is important in keratoconus. Environmental factors such as eye rubbing and wearing hard contact lenses may also cause progression of the disease in patients with a genetic predisposition. Sometimes, people with no complaints, who only want to have their myopia or astigmatism corrected by laser, may be diagnosed as a result of very special tests. To avoid keratoconus, avoid rubbing or scratching your eyes and have a general eye examination every year.”

Common in Mediterranean countries

Explaining that the disease is seen in one in every 2000 people according to the literature, Dr. Efekan Coşkunseven says that this rate is much higher in warm countries like Turkey, where allergies are common, and describes the main characteristics of keratoconus:

“Keratoconus is particularly common in Mediterranean countries. In its initial stage, keratoconus has no negative effects on vision. Contrast sensitivity is disrupted first in patients with keratoconus. Complaints arise, such as seeing every color equally bright. There can be night vision problems, in particular. As keratoconus progresses, many patients notice that they can't distinguish distant objects very well while driving or can't read the subtitles while watching TV. Sometimes patients say that they have better vision and can see more clearly when they touch their upper lid, applying pressure, or pull the eyelid towards one side. This, in fact, is the case in many progressing keratoconus patients. However, this is a temporary improvement. Maintaining vision in this way is impossible.

Depending on the progression of keratoconus, patients' sight is impaired severely. This means a 95% reduction in vision and patients become unable to see one to two meters ahead. While this is not blindness as perceived by many people, it is an advanced visual impairment which is termed as legal blindness. People in this risk group should never scratch their eyes. Since the genetic aspect of the disease involves a structural change in the cornea, scratching or rubbing the eyes or applying hard pressure may trigger early onset or progression of the disease. That's why people in the risk group and patients are recommended to avoid rubbing or scratching their eyes.”

It is possible to stop keratoconus

Dr. Efekan Coşkunseven says that a method called corneal cross-linking (CCL) is used today to stop the progression of keratoconus and describes the details of this treatment:

“In order for a patient to be able to benefit from this treatment, their corneal thickness should be at least 400 microns. Therefore, we can decide about the patient's eligibility for this method after corneal thickness measurement and topographic assessment. What's critical is early diagnosis and treatment of the disease. Early diagnosis is crucial in preventing and controlling keratoconus, which may progress to a stage which requires corneal transplantation. Dünyagöz is the first center in Turkey to employ the CCL method and has used it in more than 1500 patients since 2006.”

Methods to improve vision

Coşkunseven points out that there are 4 different methods to improve the vision of a patient with keratoconus; namely, contact lenses, the ring method, topographic laser therapy and intraocular contact lenses; and continues to describe these methods:

Contact lens: This is the most common method used in the world today. However, patients can have difficulty in using them because of their hard structure. Instead, we use soft (hybrid) lenses called Clearkone which are specially designed to protect the central cornea. This method is preferred by many patients and applied successfully in our keratoconus patients.

The ring method: This is a method that we use for patients who are unable to use contact lenses. Today, this operation can be completed in 1-2 minutes at Dünyagöz, by using Intralase Femtosecond Laser to create a tunnel (8 seconds). We have experience with more than 5000 cases for the ring method and we are training doctors as well.

Topographic laser treatment: This method was also first implemented at Dünyagöz in Turkey. The treatment involves programming the laser according to the analysis of a map of the keratoconic tissue.

Intraocular contact lens: Correction of near-/far-sightedness up to -18 diopters and astigmatism up to -6 is possible with this treatment. Coşkunseven says that optimal therapy in keratoconus can be identified after a detailed examination of the patient; keratoconus can be stopped by CCL therapy; contact lens, ring, topographic laser and intraocular contact lens therapies improve vision; and therefore contact lens and CCL or the ring and CCL methods should be combined.

Make sure to consult a doctor if you have any of these symptoms:

Persistent allergy and itching in the eyes
Persistently progressive myopia and astigmatism
If you are not satisfied with your eyeglasses
Low quality of vision despite eyeglasses
Difficulty in night-time driving