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- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 19, 2024
At Blue Fin Vision® Eye Clinic in London, we understand that the decision to undergo laser eye surgery is a significant one. While procedures like LASIK, LASEK, PRK, and SMILE have transformed the lives of millions by reducing or eliminating the need for glasses or contact lenses, it’s crucial to be aware of potential complications. One such rare but serious complication is corneal ectasia. In this comprehensive guide, we’ll explore what corneal ectasia is, its causes, symptoms, and the latest treatment options available.
Understanding Corneal Ectasia
Corneal ectasia is a condition characterised by the progressive thinning and bulging of the cornea, the clear front surface of the eye. When this occurs after laser eye surgery, it’s often referred to as post-LASIK ectasia, although it can happen following other refractive procedures as well. This condition is similar to keratoconus, a naturally occurring corneal disorder, but the underlying mechanisms may differ slightly.
The cornea plays a crucial role in focusing light onto the retina at the back of the eye. When its shape becomes distorted due to ectasia, vision becomes blurred and distorted, often resulting in a significant decrease in visual acuity that cannot be fully corrected with glasses.
Causes of Post-Laser Eye Surgery Ectasia
Corneal ectasia following laser eye surgery is primarily believed to be caused by the weakening of the corneal structure during the procedure. Here are some key factors that may contribute to its development:
Excessive tissue removal: During laser eye surgery, a thin layer of corneal tissue is removed to reshape the eye and correct vision. If too much tissue is removed, the remaining cornea may be too thin to maintain its proper shape against the eye’s internal pressure.
Pre-existing corneal weakness: Some patients may have undiagnosed early keratoconus or other corneal abnormalities that make them more susceptible to ectasia after surgery.
Residual stromal bed thickness: If the remaining corneal thickness (residual stromal bed) after surgery is too thin, typically less than 250-300 microns, the risk of ectasia increases significantly.
High myopia corrections: Patients requiring correction for high levels of short-sightedness may be at increased risk due to the greater amount of tissue removal needed.
Young age: Younger patients, particularly those under 25, may have a higher risk of developing ectasia.
It’s important to note that with advancements in screening techniques and more conservative treatment approaches, the incidence of post-laser eye surgery ectasia has decreased significantly in recent years.
Symptoms of Corneal Ectasia
The onset of symptoms can vary widely, ranging from a few weeks to several years after the initial laser eye surgery. Common signs and symptoms include:
Progressive vision changes: Patients often experience a gradual increase in myopia (short-sightedness) and astigmatism.
Blurred and distorted vision: As the cornea’s shape becomes more irregular, vision becomes increasingly distorted.
Difficulty with night vision: Many patients report increased glare and halos around lights, especially when driving at night.
Frequent changes in prescription: The need for frequent updates to glasses or contact lens prescriptions may indicate progressive ectasia.
Eye strain and headaches: The effort to focus through a distorted cornea can lead to eye fatigue and headaches.
Loss of best-corrected visual acuity: In advanced cases, even glasses or soft contact lenses may not fully correct vision.
At Blue Fin Vision® Eye Clinic, we emphasise the importance of regular post-operative check-ups to monitor for any signs of ectasia, allowing for early detection and intervention if necessary.
Diagnosis of Corneal Ectasia
Diagnosing corneal ectasia after laser eye surgery requires a comprehensive eye examination and advanced imaging techniques. At our London clinic, we utilise state-of-the-art technology to accurately assess corneal health and detect early signs of ectasia.
Corneal topography: This non-invasive imaging technique maps the surface curvature of the cornea, revealing any irregularities or asymmetric steepening characteristic of ectasia.
Corneal tomography: More advanced than topography, tomography provides a three-dimensional map of the entire cornea, including its posterior surface, which can show early signs of ectasia before they’re visible on the front surface.
Optical coherence tomography (OCT): This high-resolution imaging technique allows us to measure corneal thickness precisely and evaluate the cornea’s internal structure.
Wavefront analysis: This technology measures how light travels through the eye, helping to identify higher-order aberrations that may indicate corneal irregularities.
Visual acuity and refraction tests: Regular assessment of vision and refractive error can track any progressive changes indicative of ectasia.
Early diagnosis is crucial for managing corneal ectasia effectively and preserving vision. Our experienced ophthalmologists at Blue Fin Vision® Eye Clinic are skilled in interpreting these complex diagnostic tests to provide accurate and timely diagnoses.
Treatment Options for Corneal Ectasia
While the development of corneal ectasia after laser eye surgery can be distressing, it’s important to know that several treatment options are available. The choice of treatment depends on the severity of the condition and how quickly it’s progressing. At Blue Fin Vision® Eye Clinic in London, we offer a range of advanced treatments to manage corneal ectasia effectively.
Corneal Collagen Cross-linking (CXL)
Corneal collagen cross-linking has revolutionised the treatment of corneal ectasia. This procedure aims to strengthen the cornea and halt the progression of ectasia. Here’s how it works:
The process: The eye is first treated with riboflavin (vitamin B2) drops. Then, it’s exposed to controlled ultraviolet (UV) light. This combination causes new bonds to form between collagen fibres in the cornea, increasing its strength and stability.
Effectiveness: CXL has shown remarkable success in stopping the progression of ectasia in most patients. In some cases, it can even lead to slight improvements in corneal shape and vision.
Types of CXL: There are two main approaches – epithelium-off (standard) and epithelium-on (transepithelial). The choice depends on the individual case and the surgeon’s preference.
At Blue Fin Vision® Eye Clinic, we offer the latest CXL techniques, ensuring the best possible outcomes for our patients.
Contact Lenses
For many patients with corneal ectasia, specially designed contact lenses can provide excellent vision correction:
Rigid gas permeable (RGP) lenses: These hard lenses maintain their shape on the eye, creating a smooth surface over the irregular cornea.
Scleral lenses: These large-diameter lenses vault over the cornea, providing comfort and excellent vision for many patients with severe ectasia.
Hybrid lenses: Combining a rigid centre with a soft skirt, these lenses offer the visual benefits of RGP lenses with improved comfort.
Our experienced optometrists work closely with patients to find the most suitable and comfortable lens option.
Topography-Guided PRK Combined with CXL
In some cases, a combination of treatments can provide optimal results:
The procedure: This involves performing a limited photorefractive keratectomy (PRK) to reshape the cornea’s surface, followed immediately by CXL to stabilise the cornea.
Benefits: This combined approach can both improve vision and halt ectasia progression in carefully selected patients.
Candidacy: Not all patients with ectasia are suitable for this treatment. A thorough evaluation is necessary to determine eligibility.
Intrastromal Corneal Ring Segments
For some patients, the insertion of tiny, clear plastic segments into the cornea can help reshape its surface:
How it works: The segments are placed in the periphery of the cornea, flattening the central cornea and potentially improving vision.
Reversibility: Unlike some other treatments, this procedure is reversible if needed.
Combination therapy: Often, this treatment is combined with CXL for optimal results.
Corneal Transplantation
In advanced cases where other treatments are ineffective, a corneal transplant may be necessary:
Types: Depending on the extent of the ectasia, either a full-thickness (penetrating keratoplasty) or partial-thickness (deep anterior lamellar keratoplasty) transplant may be performed.
Last resort: This is typically considered only when other treatments have failed to provide adequate vision or comfort.
At Blue Fin Vision® Eye Clinic, we exhaust all other options before considering transplantation, given the risks and long recovery period associated with this surgery.
Prevention and Risk Reduction
While it’s not always possible to prevent corneal ectasia after laser eye surgery, there are steps that can significantly reduce the risk:
Thorough pre-operative screening: At Blue Fin Vision® Eye Clinic, we conduct extensive pre-operative evaluations, including corneal topography and tomography, to identify patients who may be at higher risk for ectasia.
Conservative treatment approach: We err on the side of caution, sometimes recommending against laser eye surgery for patients with borderline corneal thickness or suspicious topography patterns.
Newer surgical techniques: Procedures like SMILE (Small Incision Lenticule Extraction) may carry a lower risk of ectasia due to the preservation of the stronger anterior corneal layers.
Regular follow-up: We emphasise the importance of attending all scheduled post-operative appointments to monitor corneal health and detect any early signs of ectasia.
Living with Corneal Ectasia
A diagnosis of corneal ectasia after laser eye surgery can be challenging, but with proper management, most patients can maintain good vision and quality of life. Here are some tips for those living with this condition:
Stay informed: Keep up to date with the latest treatments and management strategies. Our team at Blue Fin Vision® Eye Clinic is always available to discuss new developments in ectasia treatment.
Adhere to treatment plans: Whether it’s wearing specialised contact lenses or following post-CXL care instructions, adherence to your treatment plan is crucial for the best outcomes.
Regular check-ups: Attend all scheduled appointments to monitor the progression of your condition and adjust treatment as necessary.
Protect your eyes: Wear sunglasses to protect against UV light, and avoid rubbing your eyes, which can exacerbate corneal weakening.
Seek support: Connect with others who have experienced similar challenges. Support groups can provide valuable emotional support and practical advice.
Conclusion
Corneal ectasia after laser eye surgery, while rare, is a serious condition that requires expert management. At Blue Fin Vision® Eye Clinic in London, we are committed to providing the highest standard of care for patients facing this challenge. From state-of-the-art diagnostics to the latest treatment options, including corneal collagen cross-linking and advanced contact lens fittings, we offer comprehensive care tailored to each patient’s unique needs.
If you’ve undergone laser eye surgery and are experiencing changes in your vision, don’t hesitate to seek professional advice. Early detection and intervention are key to managing corneal ectasia effectively. Our team of experienced ophthalmologists and optometrists are here to provide expert care and support throughout your journey to better vision.
Remember, while corneal ectasia is a significant complication, advances in treatment mean that most patients can achieve good visual outcomes with appropriate management. At Blue Fin Vision® Eye Clinic, we’re dedicated to helping you maintain the best possible eye health and vision, no matter what challenges you may face.
For more information or to schedule a consultation, please contact Blue Fin Vision® Eye Clinic. Your vision is our priority, and we’re here to provide the expert care you deserve.
