Cause of Keratoconus - We Now Know It
Brian S. Boxer Wachler, MD

Keratoconus (also known as Pellucid) is a progressive non-inflammatory disorder that causes a characteristic thinning and cone-like steepening of the cornea. This steepening results in distortion of vision, increased sensitivity to glare and light and an associated reduction in visual acuity.

These keratoconus symptoms usually appear in the late teens and early twenties. Keratoconus may progress for 10-20 years and then can slow or even stabilize. Each eye can be affected differently. This can result in a dramatic decrease in the ability to see clearly even with corrective lenses. (Note: as keratoconus and pellucid are the same disease process, any reference to "keratoconus" on this site also applies to "pellucid" as well.)

The cause of the weakening is due to an imbalance of enzymes within the cornea itself that leads to high levels of damaging "reactive species" chemicals. Different types of reactive species include superoxides, hydrogen peroxide, and nitric oxide. These substances essentially are free radicals that cause oxidative damage to the cornea.

Reactive species (free radicals) accumulate		The reactive species cause weakness		The weakness causes the cornea to herniate which leads to keratoconus

Research suggests that patients with keratoconus cannot clear away the normal amount of reactive species that are normally produced. The reason for poor clearance is that the good enzymes (Catalase and Superoxide dismutase) are not functioning properly which leads to the toxic accumulation of the reactive species and eventual damage in the cornea from the buildup of reactive species.

There are some genetic reasons explaining why the good enzymes do not function properly. Non-genetic sources can also increase the reactive species. Such sources include ultraviolet light sun exposure, eye rubbing, poorly fit contact lenses, and chronic eye irritation. All these cause an increase in reactive species (free radicals).

For these reasons, we recommend that all patients with keratoconus protect their eyes by wearing 100% UV blocking sunglasses with the wrap-around design. The wrap-around design minimizes light coming in from the sides. It's also important to avoid eye-rubbing and have a comfortable contact lens fit if contacts are being worn.

Some doctors misadvise their patients that "hard contact lenses hold the cornea and stop it from progressing."  Unfortunately, this is not the case.  If someone's head is expanding, wearing a baseball cap will not stop the head from expanding.

The ONLY method to stop the progression of Keratoconus is with corneal crosslinking treatment.

Patients come to us from all over the United States and from many other countries to have Dr. Brian improve their lives with Intacs^®, Holcomb C3-R^® and CK.  Please click below to listen to patients share in their own words how the process was for them and the ways their lives have been changed.

Keratoconus is the thinning and bulging of the cornea. Keratoconus treatments include Intacs®, Holcomb C3-R®, corneal crosslinking, and if keratoconus symptoms progresses to a serious level, corneal transplantation. Dr. Brian Boxer Wachler is a keratoconus expert in evaluation and treatment.