Pathogenesis, presentation, and treatment of keratoconus within the United States
Huntington, Brian Thomas
MetadataShow full item record
Keratoconus is a non-inflammatory thinning of the cornea that can lead to an irregular conical shaped protrusion generally of the lower mid-peripheral nasal or temporal hemisphere of the cornea. This degenerative disorder has no known individual cause, nor does it have a known cure. Causes have been theorized to be multifactorial ranging from genetic disorders to environmental stimuli. Overall roughly 1 in 2,000 people suffer from the disorder. The treatment for keratoconus has generally focused on a broad range of different types of contact lenses, with the patients whose corneas degrade to dangerously thin limits or where visual acuity can no longer be corrected, become candidates for corneal transplant surgery. It is today the third most common cause for corneal transplant. This study focused on detailing the various treatment options keratoconus patients have, as well as what advances these treatments have each made in recent years. These treatments generally focus on maximizing visual acuity while attempting to retain the corneal protrusion. The other goal of these treatments is to push off the necessity for corneal transplant due to the risks of graft rejection, the risks of surgery, and the overall decrease in quality of life an implant can have on a patient’s life. The studies showed that treatment has come a long way, though there still remains to be a treatment that can appropriately halt the progression of keratoconus. This brings the paper to examine the role and potential impact corneal collage cross linking could have on keratoconus patients in the U.S. Corneal Collagen Cross Linking is a procedure where through riboflavin (vitamin B2) and UV-A light, collagen cross links can be induced within the corneal stroma. By linking the collagen polymers, it is theorized that this could permanently halt the progression of keratoconus. This treatment has been approved in Europe since 2006 and in Canada since 2008, but only entered into clinical trials within the U.S. in 2008. By performing an extensive literature review, it was concluded that corneal cross linking is a safe and effective method of treatment for keratoconus. Enough literature has been published by the international community over the past 15 years that the U.S. could have begun and concluded FDA clinical trials sooner. The treatment has the potential to halt the progression of keratoconus before it has any debilitating effects, though as of now is not available to most Americans. With the FDA likely to approve the procedure within the next year, keratoconus patients will have a new treatment option that will very likely substantially improve their quality of life.
Thesis (M.A.)--Boston University