Corneal transplantation for keratoconus most often results in the need to still wear a contact lens following surgery in order to obtain maximum vision. The majority of patients who have had corneal transplantation for keratoconus would have been able to be successfully fit in contact lenses prior to surgery if they were treated by an experienced expert in contact lens fitting in keratoconus. Should we be aggressive in suggesting corneal transplantation for patients with keratoconus? To the lay patient with keratoconus the thought of having a surgery that “cures” the disease seems very attractive, however we need to look closely at the typical outcomes of corneal transplantation surgery in keratoconus. A recent online publication in I-Site, an international electronic newsletter on topics relating to corneal health and vision published by world renowned cornea and contact lens authority, Dr. Eef van der Worp, reviewed the literature on outcomes from corneal transplantation surgery. Although advancements in surgical techniques have significantlyincreased success rates for corneal transplantation and for sure some of the highest success rates for corneal transplantation are found when used to treat keratoconus vs. other corneal diseases – suboptimal vision outcomes are often the reality after surgery. In fact, most keratoconic eyes that have undergone corneal transplantation still require contact lenses for optimal vision and virtually all (with few exceptions) require some form of vision correction device (glasses or contact lenses) following surgery. Thus the expectation to see clearly without glasses or contact lenses after transplantation surgery for keratoconus is not realistic.
More importantly, many patients are referred for corneal transplantation surgery too early. Studies have show that 69% of eyes that were referred for corneal transplantation could have been fit with contact lenses of one form or another. The problem is that many keratoconic patients are not appropriately referred to experienced experts in the specialty contact lens management of the disease prior to suggesting surgery.
The take home message is clear here: if you have keratoconus you should be evaluated by a doctor who has extensive experience and expertise in the contact lens management of the disease. Currently corneal transplantation surgery should only be considered if all contact lens options have been explored and exhausted. Finally, if corneal transplantation is going to be performed, the patient should have realistic expectations that they likely will still need to wear a contact lens (hopefully with greater success than prior to the surgery) in order to obtain the optimal vision possible.
For more information on contact lens and surgical options for keratoconus please visit: www.nsvc.com and go to our eye disease section on keratoconus.