Keratoconus Treatment Singapore

In a healthy eye, the cornea maintains a regular, rounded shape that focuses light accurately onto the retina. In keratoconus, the corneal tissue weakens over time, causing it to thin and protrude forward.

This irregular shape disrupts how light is focused, producing blurred, distorted, or doubled vision.

The condition typically presents during the teenage years or early adulthood and can affect one or both eyes. Where both eyes are involved, the degree of change often differs between them.

As the cornea continues to change shape, astigmatism (irregular curvature of the eye’s focusing surface) tends to increase, and glasses or standard soft contact lenses may no longer provide adequate correction.

Studies have suggested that an imbalance of enzymes in the cornea exposes the eye to oxidative damage from free radicals. In turn, this damage can lead to the weakening and bulging of the corneal tissue, resulting in keratoconus.

Other factors that could predispose one to keratoconus are:

• Overexposure to the sun’s ultraviolet (UV) rays
• Excessive eye rubbing
• Chronic eye irritation
• Genetics

Keratoconus does not remain stable in all cases. In some patients, the cornea continues to change over months or years, progressively affecting vision quality and making correction more difficult.

An eye specialist is able to monitor the rate of change through serial corneal mapping, identify when treatment is needed to slow progression, and guide decisions about vision correction options suited to the current severity of the condition.

Routine glasses prescription updates alone do not address the underlying corneal changes. Instead, specialist assessment allows for corneal collagen cross-linking treatment of keratoconus to be considered at an appropriate stage, before significant structural changes occur.

Symptoms vary depending on the severity and stage of the condition. Early keratoconus may be subtle, and some patients are unaware of the changes until identified during a routine eye examination.

Common signs and symptoms include:

• Distorted or blurred vision: Objects may appear wavy, smeared, or duplicated, particularly at certain distances.
• Frequent prescription changes: A need to update glasses or contact lens prescriptions repeatedly over a short period.
• Ghosting or multiple images: Seeing a shadow or secondary image alongside the main object.
• Increased sensitivity to light and glare: Particularly noticeable at night or in bright environments.
• Difficulty with night vision: Halos or streaking around lights, especially when driving after dark.
• Contact lens discomfort: Lenses may fit poorly or feel unstable as the corneal shape changes.

Diagnosis involves a combination of vision testing and corneal imaging. Several measurements are taken to assess the shape, thickness, and curvature of the cornea and determine the severity of the condition.

The diagnostic process typically includes:

Together, these assessments help determine the stage of keratoconus and whether the condition is progressing. They also guide decisions about which treatment options are appropriate for your eyes.

For most patients with keratoconus, vision correction with contact lenses and cross-linking to stabilise the cornea are sufficient. However, surgery is considered when these approaches are no longer adequate.

Situations where surgery may be appropriate include:

• Poor vision with contact lenses: When lens-corrected vision no longer meets functional needs.
• Contact lens intolerance: When the irregular corneal surface makes lens wear uncomfortable or impractical.
• Significant corneal scarring: When opacity or scarring reduces vision quality beyond what lenses can address.
• Advanced thinning: When the cornea has become too thin or irregular for other interventions to be effective.

In these situations, a corneal transplant may be considered for treatment. The appropriate surgical approach depends on the depth and extent of corneal involvement.

Keratoconus requires long-term monitoring, as the condition can continue to evolve over time, even after treatment. A single appointment or intervention is rarely sufficient.

For patients who have had cross-linking, follow-up typically includes corneal mapping at intervals over the first one to two years to confirm that the cornea has stabilised. Contact lens fitting may need to be adjusted as the corneal shape settles.

For patients managed with contact lenses alone, regular reviews allow the clinical team to track changes in corneal curvature and vision and update the lens prescription or type as needed. As dry eye is a common concurrent condition, it may also be monitored during follow-up, and dry eye treatment may be considered as an option.

Where surgery has been performed, recovery depends on the procedure. Patients are advised on specific timelines and restrictions at the time of their consultation.

A keratoconus assessment at LSC Eye Clinic follows a structured process. Knowing the stages in advance can make the visit feel more straightforward.

Your first visit typically includes the following stages, from initial history-taking through to discussion of treatment options:

1. History and Registration: A record of your symptoms, current vision correction, and relevant medical or family history.
2. Eye Tests: Vision testing, corneal mapping, corneal thickness measurement, and a slit-lamp examination of the cornea.
3. Review of Findings: A discussion of your results and the treatment options suited to your case.
4. Next Steps: A possible follow-up appointment to review results or plan treatment.

Patients are encouraged to ask questions about their diagnosis, the likely progression of the condition, and the management options available.