Keratoconus: The silent vision threat that deserves a louder voice.
When we think about vision loss, we often picture age-related conditions like cataracts or macular degeneration. But there's another, lesser-known threat that often begins in the prime of youth and, without timely intervention, can significantly impair sight: keratoconus.
What is keratoconus?
Keratoconus is a progressive eye condition in which the normally round, dome-shaped cornea gradually thins and begins to bulge outward into a cone-like shape. This distortion alters how light enters the eye and is focused on the retina, leading to blurred vision, increased sensitivity to light, ghosting, and frequent changes in prescription. While it may start subtly—with minor astigmatism or mild blurriness—keratoconus can accelerate quickly, particularly during adolescence or early adulthood.
What causes keratoconus?
The exact cause of keratoconus remains unclear, but it's generally believed to be multifactorial, with both genetic and environmental influences. Key contributing factors include:
- Genetics: Around 10–15% of people with keratoconus have a family history of the condition. Chronic eye rubbing; Common among individuals with allergies or eczema, this has been strongly associated with disease progression. Oxidative stress: Imbalance in protective enzymes in the cornea may contribute to tissue breakdown.
- Associated conditions: higher incidence among people with down syndrome, Ehlers-Danlos syndrome, asthma, and other connective tissue disorders.
Who does it affect?
Keratoconus usually develops between the ages of 10 and 25 and can progress for 10–20 years before stabilising. Although it can affect anyone, some patterns have emerged:
- Gender distribution: Studies suggest a slight male predominance, though results vary by region and population.
- Ethnicity: People of Asian, middle eastern, and African descent may have a higher risk and earlier onset.
- Geographic differences: Prevalence varies widely, with higher rates reported in hot, dry climates—possibly due to environmental or genetic factors.
Diagnosis & early signs:
Keratoconus is often missed in routine eye exams, especially in its early stages. Advanced diagnostic tools—such as corneal topography and optical coherence tomography are essential for early and accurate detection.
Common symptoms include:
Blurry or distorted vision, rapid changes in prescription, increased light sensitivity (photophobia)double vision or halos around lights, and difficulty seeing at night.
Treatment options:
From correction to prevention Glasses or soft contact lenses. Effective in the early stages, but vision correction becomes more difficult as the cornea becomes more irregular.
Rigid gas permeable (rgp) or scleral lenses. These lenses vault over the misshapen cornea, offering clearer vision by creating a smooth refractive surface.
Corneal cross-linking (cxl). A breakthrough treatment that uses UV light and riboflavin (vitamin b2) to strengthen the corneal tissue and halt progression. It’s the only treatment currently approved to stop the disease, rather than just manage symptoms.
Intracorneal ring segments (icrs). Small, arc-shaped implants inserted into the cornea to flatten its shape and improve vision in moderate cases.
Corneal transplant (keratoplasty)reserved for advanced keratoconus where scarring or thinning is severe. Full or partial-thickness transplants can restore vision, though recovery is lengthy.
Why awareness matters?
Too many individuals are diagnosed late—often after irreversible corneal damage. Raising awareness among primary care providers, optometrists, educators, and the general public is essential. Early detection through regular eye exams, especially for those with a family history or chronic allergies, can make a life-changing difference. Keratoconus may not grab headlines, but it has a profound impact on quality of life—especially for young people navigating school, work, and identity. Thankfully, today’s tools make it increasingly manageable. With a combination of awareness, access to care, and early screening, we can preserve vision, independence, and opportunity. Let’s give keratoconus the attention it deserves.
