Factsheets Treatments and Interventions for Keratoconus 3

Treatments and Interventions 3

This is the third in a series of three factsheets. This factsheet will include information about:

• The treatments and interventions for Keratoconus that you will usually receive at hospital.
• Two treatments that are relatively new in the UK, and few people with learning disabilities have had access to them.

  The newer treatments are called:

  • Intacs
  • Corneal Collagen Cross Linking (CCCL)
• Some people will have an eye operation called a corneal graft, which is complicated for most people.
• Many people with learning disabilities have had successful corneal grafts when receiving good advice and support.
• Some people will not benefit from glasses, contact lenses, eye operations or other treatments but can still get other help to make the best use of their remaining vision.

The following two treatments (Intacs and CCCL) are currently being trialled in the NHS after achieving some success correcting Kerataconus in the USA. However, as these are still in trial stage, they only may be available in limited areas of this country.

Intacs

• Intacs are specially designed inserts, made of medical plastic, which are surgically placed under the surface of the cornea. 
• Intacs help reshape the cornea to its natural dome-like shape, leading to clearer vision.
• This is still a surgical procedure, and individuals will still need help in regards to anaesthetic, preventing eye rubbing after treatment, consent etc.
• If someone’s keratoconus progresses they may still need a corneal graft.

This is currently a procedure common in the USA, but at present only carried out in limited parts of the UK.  Look Up is currently unaware of this procedure being offered to any individuals with a learning disability.

Corneal Collagen Cross-linking

This is again a new treatment that strengthens the corneal structure in people with keratoconus, and can help prevent keratoconus getting worse.

• Eye drops are applied to the cornea which is then activated by a special ultra-violet light.
• Be aware that the individual usually needs to remain awake and very still for about 45 minutes, whilst this procedure is carried out.
• Eyes may be sore for a number of days after this treatment.

Again, however, Look Up is currently unaware of this procedure currently being offered to any individuals with a learning disability in the UK. 

Corneal grafts

In its more advanced stages the corneal curve becomes too steep for a contact lens to be fitted satisfactorily.  A corneal graft to improve their vision may be considered for a small percentage of people.

• Only when contact lenses cannot safely be worn should other forms of management for keratoconus be considered.
• A graft is only undertaken as a last resort.  It entails the removal of the distorted corneal tissue and replacement by a disc of healthy cornea from a donor.  Aftercare may be life long and requires careful consideration and planning.
• Corneal grafts for keratoconus have a high success rate; additional treatment continues to be necessary.  The regime is complex and can include:
  •  Frequent eye drops and other medication, such as immunosuppressant drugs to reduce the possibility of the graft being rejected.
  • Medication that may  have side effects that need careful monitoring.  There will be many hospital visits.
  • Return visits up to two years later to have stitches removed from cornea, and may require further anaesthetic.
  • the necessity for people to still need to wear glasses or contact lenses after a successful graft.

Help with poor vision

Even if an individual cannot benefit from corrective lenses, surgery and other medical treatments they can still receive help to make best use of their remaining sight. These include:

• Low Vision Services
• Rehabilitation Workers for the visually impaired people

These services can offer advice and support regarding:

• Lighting
• Contrast
• Size

to help people make the best use of their vision.

June 2009  

For further information on this topic please read:

Keratoconus

Treatments and Interventions for Keratoconus Part 2

Related Information:

Adapting Accommodation for People with Learning Disabilities

Consent to Medical Treatments

Eye Poking and Touching in People with Learning Disabilities

Eye Poking and Touching - Strategies for Supporting People

Eye Surgery for People with Learning Disabilities

Low Vision Services for People with Learning Disabilities

The Need for an Eye Examination

Supporting People to use their Sight Effectively

Taking Action on Eye Problems