The CLEI Center for Keratoconus
The CLEI Center of Keratoconus, founded in 2002, was the first dedicated subspecialty center for keratoconus in the nation and is world-renowned for its expertise. It led the FDA pivotal trial for the approval of corneal collagen crosslinking and continues to innovate and improve upon treatment techniques. The center also develops new specialty contact lenses for keratoconus. It offers state-of-the-art care, including diagnosis, therapy, specialty contact lenses, and advanced surgical procedures. The center’s collaborative approach ensures patients receive the best customized and comprehensive treatments to prevent disease progression and optimize vision.
Are you looking for a keratoconus specialist near you? At CLEI, we offer an exhaustive evaluation using cutting-edge technologies to create a customized treatment plan for you, including specialty contact lenses, keratoconus surgery and genetic testing. Our center is a leader in keratoconus research and innovation, with doctors who have delivered thousands of academic lectures, published hundreds of peer-reviewed manuscripts, authored numerous academic book chapters, led multiple FDA clinical trials, written several books, and hold granted patents derived from our research. Trust in our unmatched experience, skill, and expertise for the most advanced treatment options available.
Understanding Vision from Normal Corneas versus Keratoconus and Irregular Corneas
Vision Simulations with Glasses Correction
Keratoconus Treatment at CLEI
We understand that keratoconus is more than a disease, it affects everything about your life. Every waking moment is a reminder of the disease. Our goal is to improve the quality of life for those affected by keratoconus. To do this we take a comprehensive approach to your treatment which we call Keratoconus 1,2,3.
Our approach to keratoconus treatment is comprehensive.
Step 1. Stop the progression of Keratoconus: Crosslinking
Since we began treating patients with crosslinking nearly in 2008 as part of our clinical studies, crosslinking has emerged as one of the most important advancements in keratoconus treatment. Corneal collagen crosslinking (CXL) halts the progression of keratoconus to maintain your vision and level of disease. Corneal crosslinking makes the cornea stronger and more resistant to disease progression. In this procedure, riboflavin (Vitamin B2) is administered in conjunction with ultraviolet A (UVA – 365nm) light. The interaction of riboflavin and UV causes a photobiologic reaction in the corneal leading to the formation of additional molecular bonds between collagen molecules and their supporting biological sugars. This results in the stiffening of the cornea, much like placing additional cables on a bridge will help to support it. At our center, we offer standard and specialty crosslinking.
Step 2. Improve the Keratoconus Topography: Keratoconus Surgery
Keratoconus causes a corneal shape deformation, leading to poor vision. The vision can be improved by having a procedure performed to improve corneal shape. This is part of the comprehensive management of keratoconus. and improved corneal shape will allow you to have a better quality vision in glasses and soft contact lenses and improve uncorrected vision to some extent. Our Center’s doctors are experts and innovators and will select the correct treatment to optimize your cornea and vision.
Step 3: Improving Keratoconus Vision: Keratoconus Contact Lenses & Other Keratoconus Surgeries
In keratoconus maximizing vision has the greatest impact on your quality of life. This can be achieved both surgical and non-surgically.
Specialty Contact Lenses Procedure
The process of designing a customized lens to meet the needs of the keratoconus patient starts with an advanced and in-depth evaluation. This evaluation guides the process of understanding which type of specialty contact lens will meet your individual needs. A multitude of different scans, impressions, and diagnostic lenses may be used in the design process. Once a lens type has been selected, our doctors will create a custom contact lens for you. This process generally involves several revisions or modifications to ensure the lens is ideally fit, eye health is maintained and vision is the best possible.
Keratoconus Contact Lenses
Types of Specialty Contact Lenses for Keratoconus and Irregular Corneal Conditions
Genetic Testing for Keratoconus
Understanding Genetics and Keratoconus
If the last time you learned about genetics was in biology class, you’re not alone. To best understand genetic testing it’s important to revisit the basics.
There are two main categories of genetic diseases: Monogenic and Polygenic. Monogenic disease is simple, if you have the gene you have the disease. It’s a yes or no. A well-known example of this is cystic fibrosis.
Polygenic disease is more complex, no individual gene is responsible for the disease, rather, it is a collective of genes associated with a disease. If you have more genes associated with the disease, you have a higher genetic risk of the disease. These genetic factors interact with environmental factors to cause the disease. Polygenic diseases are associated with several or lots of genetic variances. Keratoconus is a polygenic disease. Other examples of polygenic diseases include hypertension and diabetes.
Genetic tests help to guide personalized, precise, medicine. If a patient is identified with a high genetic risk for keratoconus, then our doctor will prescribe more frequent follow-up, recommend avoiding or treating environmental factors, such as treating ocular allergies and stopping eye rubbing, and may initiate earlier intervention with treatments such as crosslinking. These treatments if initiated at the earliest onset of the disease can slow the trajectory of the disease, preventing advanced disease.
Risk calculation in polygenic diseases such as keratoconus is complex. Researchers have identified 75 genes associated with keratoconus, discoveries that enabled Avellino to develop the AvaGen Genetic Eye Test, which screens for thousands of variants on those 75 genes and provides a risk assessment based on those findings.
AvaGen Genetic Eye Test is a major breakthrough in understanding a patient’s risk of keratoconus. It provides risk scores for both symptomatic and asymptomatic keratoconus patients. The results are presented as a simple score, 0 to 100, which breaks down into low, moderate, or high risk. Our doctors were involved with the original development of the test.
Both genetic and environmental factors contribute to the development of keratoconus. An example of environmental factors impacting the development of keratoconus is eye rubbing. Does this mean all people that rub their eyes will develop keratoconus? No, and this is where genetics play a role. For a person with high genetic risk, eye rubbing compounds and increases the risk for keratoconus development.
The test is simple. It is performed in-office with a cheek swab, also known as a buccal swab, which collects a small number of cells from the inner cheek.
Patients with a diagnosis of keratoconus should consider having their family members, especially their children, tested.
What is Keratoconus?
Keratoconus, one of the more obscure and less widely known eye diseases, occurs in about one out of every 725 individuals and is one of the more difficult eye diseases to diagnose. Keratoconus eye disease is caused by the weakening of the collagen tissue that makes up the cornea. The cornea begins to stretch and thin as the collagen gets weaker, resulting in a loss of the cornea’s normal dome shape.
Biologically and structurally, the cornea is made up of bands of collagen called lamellae which are “glued” together by natural biologic sugars called glycosaminoglycans or GAG’s. The cornea’s collagen and microstructure are abnormal in keratoconus, causing a weakness of the corneal, which then leads to corneal distortion and related visual problems.
It is a progressive condition which, aside from distorting the cornea’s natural optics, can also lead to scarring and other problems. The presentation and impact of keratoconus can vary widely from person to person. In its earliest stages, keratoconus often masquerades as astigmatism or nearsightedness, two of the more common eye conditions. Often, it is only after numerous unsuccessful attempts at vision correction with glasses or soft contact lenses that keratoconus is diagnosed.
Keratoconus is typified by corneal thinning and biomechanical instability. This may be caused by abnormalities in the normal collagen structure of the cornea. Collagen is the main structural component of the cornea. Collagen is a molecule that is typically very strong. For example, it makes up most of the structure of the tendons and ligaments of your muscles and bones. The cornea is made of pancakes (or lamellae) of collagen tissue in a complex array. In keratoconus, the collagen lamellar architecture may be abnormal. There may also be abnormal enzymes that degrade the collagen and reduce the collagen in the KC cornea. In addition, the cells of the cornea (keratocytes) may not be normal, contributing to the thinning and instability of the keratoconic cornea. The linkages of the collagen molecules, collagen lamellae, and corneal sugars to one another may also be weak in keratoconus. For instance, “anchoring fibrils” which normally lock the collagen pancakes to the front of the cornea, on Bowman’s layer, may be abnormal. This may allow the collagen pancakes to slide on one another and exacerbate KC progression. Because of this, it is important that the keratoconus patient does not rub his/her eyes in order to avoid mechanical shearing of the collagen pancakes. Finally, inflammation may also play a role in keratoconus. Reactive oxygen species, or oxygen free radicals, may damage the corneal cells and collagen structure, and lead to keratoconus progression. Because of this, avoiding and treating eye inflammation (for instance, eye allergies) also may be important for the patient with KC.
Detecting keratoconus eye disease can be challenging as its initial symptom is often a minor blurring of vision or gradual deterioration in vision that cannot be easily corrected. Keratoconus symptoms include:
- Blurred or distorted vision
- Increased sensitivity to light and glare
- Glare and halos around lights
- Frequent changes in eyeglass or contact lens prescriptions
- Difficulty seeing at night or in low light conditions
- Eye redness or swelling
- Eye strain or fatigue
- Headaches or migraines
What Causes Keratoconus?
The actual cause of keratoconus is unclear. It may have a genetic, inheritable component. However, in many patients there are no family members with the disease. Similarly, most children of KC patients do not have keratoconus, but they should be checked in early adolescence for signs of KC because early management can prevent the progression of the condition over time.