Post-Surgical Ectasia
We frequently see patients who developed corneal thinning after refractive surgeries like LASIK or RK (Radial Keratotomy). This occurs if the cornea was naturally too thin or if the patient had sub-clinical keratoconus prior to surgery.
Understanding the Condition
Keratoconus is a progressive eye disease where the normally round, dome-shaped cornea thins and begins to bulge into a cone-like shape. This irregular shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision.
Who is at Risk?
Genetics: There is a strong hereditary component. If a family member has it, early screening is vital.
Age: Typically begins in the late teens or early 20s and can progress for 10-20 years.
Eye Rubbing: Chronic, vigorous eye rubbing is a major risk factor
Differential Diagnosis
Keratoconus
Central or inferior steepening of the cornea. "Cone" shape.
Pellucid Marginal Degeneration (PMD)
Thinning occurs in a band along the bottom of the cornea ("Kissing Birds" topography pattern).
The Visual Challenge
For patients with Keratoconus, standard glasses often fail. The irregular surface creates "High Order Aberrations" that glasses cannot correct.
Ghosting (Monocular Polyopia)
Seeing multiple "ghost" images of a single object, especially high-contrast text (like white subtitles on a movie).
Halos & Starbursts
Lights at night streak or have giant halos, making night driving difficult or impossible.
Fluctuating Vision
Vision that changes frequently, requiring frequent prescription updates.
Step 1: Stop the Progression
Corneal Collagen Cross-Linking (CXL)
CXL is the only treatment that stops the disease from getting worse. It uses Riboflavin (Vitamin B2) drops and UV light to strengthen the collagen fibers in the cornea, "freezing" its shape.
Dr. Fouladian's Co-Management Role:
- Evaluation: Determining if your cornea is thick enough for the procedure.
- Referral: Coordinating with top corneal surgeons for the procedure.
- Post-Op: Monitoring healing and fitting specialty lenses once the cornea stabilizes (usually 3-6 months post-op).
Ideally performed in early stages
To preserve as much vision as possible.
Step 2: Restore Vision
Visual Rehabilitation
Once progression is halted, we use advanced lenses to create a new, smooth optical surface.
Scleral Lenses
Blanchard Onefit™ & BostonSight
These large-diameter lenses vault completely over the irregular cornea and rest on the white part of the eye (sclera). The space between the lens and eye is filled with saline, which continuously hydrates the eye and masks the irregularity.
- Comfort: Does not touch the sensitive cornea.
- Vision: Often restores 20/20 vision.
- Stability: Stays centered during sports/activity.
Custom Soft Lenses
Kerasoft® & NovaKone®
For patients with mild to moderate keratoconus who cannot tolerate rigid lenses. These lenses are much thicker than standard contacts and are lathe-cut to drape over the cone shape.
- Feel: Feels like a standard soft lens.
- Technology: Customizable thickness to mask irregularity.
- Ideal for: Early stages or decentered cones.
Expert Fitting for Complex Eyes
Don't let Keratoconus limit your life. Schedule a specialty lens evaluation with Dr. Fouladian today.
TEXT FOR APPT