From the Guidelines
Bilateral keratoconus should be treated with corneal cross-linking (CXL) as early as possible to halt progression and improve vision, as evidenced by a recent study published in 2024 1. This approach is supported by the latest research, which demonstrates the efficacy of CXL in stabilizing the cornea, inducing flattening, and potentially improving corneal optics and vision. Key findings from the study include:
- A decrease in the topography-derived maximum keratometry value by 1.6 ± 4.2 D from baseline to 1 year in the treatment group
- Improved CDVA compared with the sham control eyes
- Long-term studies confirming that standard Dresden CXL stops the deterioration and progression of keratoconus
- Meta-analysis showing more improvement in uncorrected vision than in corrected distance vision and a late reduction in keratometry values
When managing bilateral keratoconus, it is essential to consider the following:
- Treatment typically begins with prescription eyeglasses for mild cases, progressing to rigid gas permeable contact lenses as the condition advances
- CXL is recommended early to halt progression, involving riboflavin drops and UV light to strengthen corneal tissue
- Advanced cases may require corneal transplantation (penetrating keratoplasty or deep anterior lamellar keratoplasty)
- Patients should avoid eye rubbing, which can worsen the condition, and maintain regular follow-ups with an ophthalmologist every 6-12 months to monitor progression
- Genetic factors play a role in development, with approximately 10% of patients having a family history
- Early intervention is crucial to preserve vision and prevent severe visual impairment, as keratoconus can significantly impact quality of life if left untreated, as reported in the study 1.
From the Research
Definition and Treatment of Bilateral Keratoconus
- Bilateral keratoconus is a progressive eye disease that affects both eyes, causing thinning and conical shaping of the cornea.
- Treatment options for bilateral keratoconus include rigid gas-permeable (RGP) contact lenses, which have been shown to improve visual acuity and stereoacuity in patients with the condition 2.
Contact Lens Options for Bilateral Keratoconus
- Various contact lens options are available for the treatment of bilateral keratoconus, including RGP lenses, soft and soft toric lenses, piggy back contact lenses (PBCL), hybrid lenses, and scleral lenses 3, 4.
- The selection of a contact lens depends on the type and severity of keratoconus, as well as the patient's individual needs and preferences.
Comparison of Contact Lens Types for Bilateral Keratoconus
- A study comparing hybrid contact lenses and RGP contact lenses in patients with moderate and advanced keratoconus found that both types of lenses improved vision, with no significant difference between the two groups 5.
- Another study found that RGP contact lenses improved binocular resolution and stereoacuity in patients with bilateral keratoconus, whereas only stereoacuity improved in patients with unilateral keratoconus 2.
Clinical Guidelines for Managing Bilateral Keratoconus with Contact Lenses
- Clinical guidelines for the management of keratoconus patients with gas permeable contact lenses have been developed based on expert consensus and available evidence 6.
- These guidelines provide a strategy for the successful fitting of RGP contact lenses in patients with keratoconus, including how to calculate parameters of the first diagnostic lens and criteria for assessing good fit.