What Every Patient Should Know:
Published by Optom Smita Kumari Gupta, Nava Dristi Eye Hospital
Introduction
Your eyes are among the most precious gifts you have and yet, one of the most common conditions threatening young people’s vision often goes undiagnosed for years. That condition is keratoconus, a progressive eye disorder that, when caught early, can be effectively managed to preserve clear, comfortable vision for life.
At Nava Dristi Eye Hospital, Itahari, our team is committed to not only treating eye disease but to educating our community so that no patient loses precious sight due to a lack of awareness. This article explores what keratoconus is, how we detect it early, what modern non-surgical management options are available, and how one of our own patients a young man from Sunsari reclaimed his quality of life without undergoing surgery.
What Is Keratoconus?
The cornea is the clear, dome-shaped front surface of the eye that plays a critical role in focusing light onto the retina. In a healthy eye, this dome is smooth and evenly curved. In keratoconus (from the Greek keras meaning cornea, and konos meaning cone), the cornea gradually thins and begins to bulge outward into a cone-like shape.
This irregular shape distorts the way light enters the eye, causing:
- Blurred or distorted vision that is not fully corrected by ordinary glasses • Increased sensitivity to light (photophobia) and glare, especially at night • Ghost images or multiple images of a single object
- Frequent changes in spectacle prescription, particularly for astigmatism • Eye rubbing, which is both a symptom and a risk factor
Keratoconus typically begins during the teenage years or early twenties. It tends to progress for roughly 10–20 years before stabilising in most patients. In some cases, however, progression is rapid and unrelenting, making early detection not just helpful but critical.
Who Is at Risk?
Keratoconus is more common than many people realise, affecting approximately 1 in 2,000 people globally. In Nepal and South Asia, prevalence is believed to be higher, partly due to genetic factors and partly due to the widespread habit of eye rubbing often linked to allergic eye disease (vernal keratoconjunctivitis), which is itself very common in our region’s climate.
Key risk factors include:
- Family history — Having a first-degree relative with keratoconus raises your risk significantly
- Chronic eye rubbing — Perhaps the single most modifiable risk factor; vigorous rubbing accelerates corneal thinning
- Atopic conditions — Allergies, eczema, and asthma are closely associated • Down syndrome — There is a well-documented association
- Connective tissue disorders — Such as Marfan syndrome or Ehlers-Danlos syndrome
- Poorly fitted contact lens wear — Over many years
If you or a family member fits any of these profiles, a comprehensive corneal evaluation at Nava Dristi Eye Hospital is strongly recommended even if your current vision seems acceptable.
The Silent Thief of Young Vision: Why Early Detection Matters
The tragedy of keratoconus is that by the time a patient notices significant visual disturbance, the cornea has already undergone considerable structural change. Many patients spend years cycling through increasingly stronger spectacle prescriptions, frustrated that glasses never seem to fully correct their vision.
Early keratoconus has no obvious outward signs. A routine eye examination checking only your spectacle power will miss it entirely. This is why Nava Dristi Eye Hospital has invested in advanced corneal imaging technology because detecting the subtle early signs requires mapping the precise shape and thickness of the cornea in detail.
Signs That Should Prompt Corneal Screening
Please do not delay visiting us if you or your child experiences:
- Rapidly changing glasses prescription, especially increasing astigmatism • Vision that remains blurry even with the latest glasses
- Difficulty driving at night due to glare or halos
- One eye being significantly worse than the other • A history of frequent, vigorous eye rubbing
How We Detect Keratoconus at Nava Dristi Eye Hospital
- Scheimpflug Imaging
This technology provides a precise cross-sectional image of the cornea, allowing us to measure corneal thickness at every point (pachymetry). In early keratoconus, the thinnest point of the cornea begins to shift downward from centre a hallmark finding we can identify with this system.
- Aberrometry (Wavefront Analysis)
Higher-order aberrations subtle optical distortions not correctable by standard glasses increase significantly in keratoconus. Wavefront analysis helps us quantify the quality of the optical system and monitor disease progression over time.
- Slit-Lamp Biomicroscopy
Our clinicians are trained to recognise classical signs including Fleischer’s ring (an iron deposit ring at the cone base), Vogt’s striae (fine vertical stress lines in the corneal stroma), and corneal scarring in advanced cases.
Modern Management Options: You Don’t Always Need Surgery
One of the most important messages we want our patients and community to understand is this: the majority of keratoconus patients especially those detected early can be managed very effectively without surgery. Modern non-surgical and minimally interventional options have transformed the outlook for this condition.
- Rigid Contact Lenses — Optical Rehabilitation
For patients with keratoconus, specialised contact lens fitting is the primary tool for achieving good vision. Rigid lenses vault over the irregular corneal surface, replacing it with a smooth, regular refracting surface. At Nava Dristi Eye Hospital, our contact lens clinic offers:
- Rigid Gas Permeable (RGP) Lenses: The traditional workhorse of keratoconus management. These durable lenses provide excellent optical correction and are highly cost-effective.
- Scleral Lenses: Large-diameter rigid lenses that rest on the white of the eye, completely vaulting the cornea. The space is filled with sterile saline, creating an entirely smooth optical surface. Particularly valuable for advanced keratoconus or patients with associated dry eye.
- Spectacles — A Role in Early and Mild Disease
In very early or mild keratoconus, glasses can still provide functional vision and remain a valid first-line option. However, as the condition progresses, glasses become increasingly unable to correct the higher-order aberrations introduced by the irregular corneal surface. Spectacles are rarely sufficient as a long-term sole management in progressive disease.
- Management of Comorbidities
Because eye rubbing and allergic eye disease are so closely linked to keratoconus progression, managing these is an integral part of our treatment plan:
- Allergy management: Prescription antihistamine and mast cell stabiliser eye drops to control itching and reduce the urge to rub
- Patient and family education: Every patient and family receive counselling on the harmful effects of eye rubbing and how to break the habit
- Lubricating eye drops: Preservative-free artificial tears to manage ocular surface discomfort
- Monitoring and Follow-Up
Keratoconus is a dynamic condition. Regular corneal examination is essential to monitor disease stability and guide timely decisions. At Nava Dristi Eye Hospital, we schedule follow-up appointments according to each patient’s disease stage and progression risk, using our imaging data to make objective, personalised decisions.
CASE STUDY
Rekindling Clear Vision Without Surgery
The following is a real case from Nava Dristi Eye Hospital, Itahari. The patient’s name has been changed to protect privacy, with full consent obtained for publication.
Patient Background
Rajan Thapa*, 19 years old, from Inaruwa, Sunsari District, presented to Nava Dristi Eye Hospital in early 2023 after struggling with blurred vision for nearly two years. He had visited local optical shops twice in the preceding 18 months and received progressively stronger glasses each time — but his vision never felt right. He described seeing “multiple ghost images” when looking at lights at night and complained of significant glare while studying under artificial light.
Rajan was preparing for his +2 board examinations and was deeply anxious that his deteriorating eyesight would affect his academic performance. He was also an avid cricket player but had begun avoiding matches due to difficulty judging the ball. His family history revealed that his older sister had been diagnosed with keratoconus at a hospital in Biratnagar the previous year.
Clinical Findings at Presentation On examination at Nava Dristi Eye Hospital:
- Best corrected visual acuity (BCVA): Right eye 6/18, Left eye 6/9 (with spectacles)
- Refraction: Significant irregular myopic astigmatism in both eyes, right eye considerably worse
- Slit-lamp examination: Fleischer’s ring visible in the right eye; Vogt’s striae detected under high magnification
- Corneal imaging and keratometry: Classic inferior steepening confirmed in both eyes. Maximum keratometry (Kmax): 52.3D right eye, 46.8D left eye. Thinnest corneal thickness: 438 μm right, 487 μm left
- Keratoconus Grade: Right eye — Grade II (Moderate); Left eye — Grade I (Early/Mild) on Amsler-Krumeich classification
Serial review of Rajan’s previous spectacle prescriptions confirmed that both eyes had shown significant astigmatic progression over the preceding 18 months, establishing documented disease progression.
Management Plan at Nava Dristi Eye Hospital
Step 1 — Allergy Management and Eye Rubbing Counselling
Rajan reported a long history of itchy eyes, particularly in dusty or outdoor environments consistent with vernal keratoconjunctivitis, a common allergic eye condition in young males in our region. He admitted to rubbing his eyes vigorously multiple times per day for relief. He was started on topical antihistamine and mast cell stabiliser eye drops and given detailed counselling along with his parents on the critical importance of stopping eye rubbing completely. Cold compress application was demonstrated as a safe alternative for itch relief.
Step 2 — Regular Monitoring
Rajan was enrolled in a structured follow-up schedule with regular corneal examinations every 3 months for the first year, then 6-monthly if stable. At his 12-month review, his corneal findings showed no progression in either eye a clear indication that the combination of allergy management and cessation of eye rubbing had achieved its goal.
Outcome
Fourteen months after his initial presentation, Rajan sat his board examinations and passed with strong marks. He had returned to playing cricket regularly, his vision well-supported with his updated spectacles. The anxiety and frustration that had clouded his first visit had been replaced with relief and optimism.
“For two years I kept getting new glasses and my eyes kept getting worse. I didn’t know what was wrong. Now I understand what keratoconus is, I understand why my sister also has it, and I know what to do to protect my eyes. I wish I had come here sooner.”
— Rajan Thapa*, patient, Nava Dristi Eye Hospital, Itahari
When Is Surgery Considered?
While this article focuses on non-surgical management which is appropriate for the vast majority of patients it is important to be transparent about when surgical options may be discussed:
- Intrastromal Corneal Ring Segments (ICRS/Intacs) may be considered in moderate keratoconus where contact lens tolerance is poor and vision cannot be adequately rehabilitated optically
- Deep Anterior Lamellar Keratoplasty (DALK) or Penetrating Keratoplasty (PKP) corneal transplant surgery is reserved for very advanced cases where the cornea has significantly scarred or where contact lenses cannot maintain functional vision
The goal of early detection and appropriate management is precisely to prevent patients from ever needing transplant surgery. At Nava Dristi Eye Hospital, our philosophy is always to exhaust the most conservative effective options first.
Frequently Asked Questions
Q: Can keratoconus affect children?
Yes. While it most commonly presents in teenagers and young adults, keratoconus has been diagnosed in children as young as 8–10 years old, particularly in the presence of allergic eye disease and eye rubbing. Children with a family history should be screened regularly.
Q: Is keratoconus hereditary?
It has a genetic component approximately 10–15% of patients have a first-degree relative with the condition. However, many cases appear sporadic. If you have keratoconus, we encourage your siblings and children to undergo corneal screening.
Q: Will I go blind from keratoconus?
Keratoconus does not cause blindness in the traditional sense. However, it can cause severe visual impairment if left unmanaged. With modern early detection and treatment, the vast majority of patients maintain good functional vision throughout their lives.
Q: Can I play sports with keratoconus?
Yes, with appropriate correction. Many patients return to active sports after their vision is rehabilitated. We advise protective eyewear in contact sports and strongly emphasise never rubbing the eyes.
Q: How often should I have my cornea checked?
For patients with known keratoconus, we recommend corneal examinations every 3–6 months depending on stability. For patients at risk (family history, allergies, frequent eye rubbing), annual corneal screening is advisable.
Our Commitment at Nava Dristi Eye Hospital, Itahari
Nava Dristi Eye Hospital was established with a mission to bring world-class eye care to the people of Province No. 1 and the Terai region without requiring patients to travel to Kathmandu or abroad. Our keratoconus service brings together:
- Advanced corneal imaging and examination technology for early and precise diagnosis
- Specialised contact lens clinic offering RGP and scleral lens fitting
- Experienced ophthalmologists and optometrists trained in keratoconus diagnosis and management
- Patient education and counselling in Nepali and local languages
We believe every young person in Sunsari, Morang, Jhapa, and across the Koshi region deserves access to the early detection that can protect their vision for life.
Book a Comprehensive Corneal Evaluation Today
If you or someone you love has been told their glasses prescription keeps changing, or they struggle with blurry or distorted vision that glasses don’t fully correct do not wait.
Nava Dristi Eye Hospital Itahari, Sunsari, Province No. 1, Nepal
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