Can Cataract Surgery Help Keratoconus?

The eye is an incredibly complex organ with literally millions of working parts. As impressive as this may be, this complexity also opens the door to a number of complications, including eye diseases such as keratoconus. This ectatic eye disease, though uncommon, can pose significant issues, including affecting a patient’s suitability for Laser Eye Surgery. But could Cataract Surgery help? Or if not, does having keratoconus make one unsuitable for the procedure? Let’s find out.

What is Keratoconus?

Before we get into the ins and outs of Cataract Surgery and its effects on keratoconus, let’s explain a little more about this eye disease. Keratoconus is characterised by progressive thinning and irregularities in the cornea and breaks in the Bowman’s layer. These irregularities cause the cornea to become distorted into a conical shape.

Essentially, keratoconus causes a severe form of astigmatism. As the shape of the cornea changes, so too does the way light is refracted into the eye and onto the retina. As a result, keratoconus is associated with blurry and distorted vision that can make daily tasks such as reading and driving more difficult. It can also cause distorted vision, increased sensitivity to light, and redness/swelling.

The cause of keratoconus is not fully understood, but it may be linked to genetics (it is estimated that around 1 in 10 people with keratoconus also have a parent with the condition). Keratoconus may also be associated with eye allergies, excessive eye rubbing, and connective tissue disorders.

Can Cataract Surgery Help Keratoconus?

Cataracts are cloudy obstructions that form in the lens of the eye as proteins begin to break down. Cataracts gradually get worse over time and can eventually cause significant impairment to vision and even blindness if left untreated. The formation of cataracts is considered a natural part of the eye’s ageing process with an estimated 71% of those aged over 85 years old affected.

Patients with keratoconus are at an increased risk of developing cataracts. Furthermore, while most cases of cataracts are age-related, patients with keratoconus are at a higher risk of developing them at an earlier age.

Cataract Surgery involves creating a small incision in the surface of the eye, through which the cataract-affected lens can be removed. A new artificial lens, known as an intraocular lens (IOL), is then put in its place.

Treating Cataracts in Patients with Keratoconus

The treatment of cataracts in patients with keratoconus poses some challenges that are not present in the average treatment. Additional considerations will likely be needed when treating a patient with keratoconus.

For example, as keratoconus causes the cornea to become steep and thin, the surgeon may need to make an incision in the sclera as opposed to the cornea. A small stitch may also be required to close the wound.

Calculating the required lens power for correction can also be more difficult. Lens power calculations are based on average eyes, so traditional formulas will not be accurate for patients with keratoconus. The high astigmatism caused by keratoconus can provide unpredictable corneal measurements, making it more difficult to accurately determine the lens power needed. It can also be more challenging to choose the right type of intraocular lens.

Despite these challenges, patients with keratoconus are generally still suitable for Cataract Surgery. It is generally recommended that Cataract Surgery is performed before other treatments for keratoconus, such as cross-linking treatment.

While there is no evidence that Cataract Surgery improves keratoconus, the vast majority of patients with keratoconus (around 98%) report improved vision after Cataract Surgery.

If you’re concerned about cataract treatment due to keratoconus or would simply like to learn more about Cataract Surgery at London Vision Clinic, get in touch with one of our friendly clinic coordinators. Alternatively, Book a Consultation to start your journey to clear, cataract-free vision today!