Keratoconus: it is time to shake off old habits!

A little more than a decade ago, the therapy of keratoconus was a waiting game: the typically young patient would over the years progress from needing spectacles to contact lenses. Many, a decade or two after diagnosis and progression of their disease, would then face a desperate need for keratoplasty to restore the diminishing vision. After all, spectacles, contact glasses or intracorneal rings do help to improve vision, but do not stop the progression of keratoconus. And keratoplasty, as most of us are aware, is not without its ensuing problems: it neither solves visual challenges in each and every patient, nor do its advantages last a lifetime. Keratoplasty, while quite successful in its various forms, remains an imperfect and often time-limited solution even with access to ample resources. The published data suggest that the magnitude of the problem of keratoconus is significant in various geographical areas. According to a population-based study from Iran, the prevalence of keratoconus in the population group of 40 to 64 years was found to be 0.72 % and 0.79 % in men and women respectively (Hashemi H et al, 2013). In a hospital-based study from Nepal, 7 % of all patients requiring keratoplasty had keratoconus (Bajracharya L et al, 2013). The threat to vision imparted by the diagnosis of keratoconus in a young population group is a heavy burden weighing down upon the quality of life and career planning of these patients. But there is good news: during the past 15 years the advent of corneal collagen cross-linking (CXL) to stop the disease progression has considerably brightened the outlook. In the original Dresden Protocol developed by Theo Seiler in 1998, the central corneal epithelium is removed and the corneal stroma is then saturated with yellow riboflavin. This is followed by UV light exposure as per protocol. The required basic equipment (an older low-fluence model UV source) can easily be purchased at about the price of a slit lamp. This simple procedure does not normally require an operating theatre, and the equipment can easily be taken to outlying areas. The required consumables too can be reasonably affordable even in developing countries. The one thing that a low-fluence CXL definitely takes is time: low-fluence protocols require eye drops to be instilled every two minutes for a total of 60 minutes. But this step of the procedure can be delegated to trained ancillary staff. Yes, there are newer …