Times of India
18 July 2011
By Sharanya Gautam
Chennai, India

Keratoconus Shows Up In Younger Children
Opthalmologists are now seeing more cases of children with distorted vision due to bulging cornea disease, which normally occurs in the late teens.

Keratoconus, a progressive disease, may be mistaken for an allergy as children constantly rub their eyes. Doctors say such children also complain of distorted vision or have constant changes in eye prescriptions. While the condition is usually seen among those in their late teens and early twenties, more recently, it is being spotted in children as young as nine years of age, says Dr Anand Parthasarathy, consultant and head of cornea services at the Vasan Eye Care Hospital group.


"Almost 50% of the patients who are diagnosed with this condition in my clinic are in the age group of 12-16 years," he adds. Doctors recommend frequent eye check-ups among children to identify the condition early. While advanced cases may require a corneal transplant called as Keratoplasty, more recently, implantable contact lenses, intra corneal ring segments and increasing the strength of the cornea using ultraviolet rays have been used.

Dr Mohan Rajan, the chairman and medical director of Rajan Eye Care Hospitals, says that the condition is more probable in children who suffer from vernal or seasonal conjunctivitis as a child. "I see this allergy in children as young as five years old and they experience redness and itching. These children may rub their eyes vigorously," he says. "This allergy is seen in Indian children in the summer season," he adds.

While a normal cornea is spherical in shape, the cornea of a person suffering from Keratoconus is conical. Symptoms of the condition also include blurred vision. The afflicted may have problems reading and driving. "Frequent changes in the power of the eye may also be an indication of this condition," says Dr Anand.

Doctors say the causes of the condition are largely unknown and may be genetically caused in some patients. "Till a few years back, we used to dismiss cases of Keratoconus as advanced astigmatism (cylindrical vision). But, now due to the availability of better equipment, the condition is diagnosed in its earlier stages among children," says Dr K Vasantha, director of the regional institute of ophthalmology and government eye hospital in Chennai. "Our youngest Keratoconus patient is 11. Till two years ago, our patients were in the age group of 18-20 years," she says.

Deep Focus
What is Keratoconus?
Keratoconus is a progressive eye disease in which the cornea thins and bulges into a cone-like shape. This change in shape deflects light as it enters the eye on its way to the lightsensitive retina, causing distorted vision. Keratoconus can occur in either or both eyes and often begins during a person’s teens or early 20s. But city doctors are seeing it in younger children.

Warning Signs
In many cases, Keratoconus is difficult to detect because it develops slowly. In some cases, however, the disease may progress rapidly.

Such children complain of nearsightedness, distorted and blurred vision, itchy eyes and require changes in their eyeglass prescription.

Causes
Studies suggest that imbalances in enzymes within the cornea could be one of the reasons. The imbalance makes the cornea weak and bulge forward. In some cases, it could be genetic. Doctors say that the condition is more likely to be seen among those who have a history of chronic eye irritation or cylindrical vision (astigmatism)

Treatment
In the initial stages, the doctor may prescribe specialty contact lenses or glasses. In advanced cases, patients may have to undergo a procedure called ‘corneal collagen crosslinking’ that involves the strengthening of the cornea using riboflavin drops and low amounts of ultraviolet radiation. In some cases, special contact lenses are implanted in the eye to provide a uniform refracting surface to improve vision. Others may require a non-invasive procedure to strengthen corneal tissue and halt bulging. In rare cases, corneal transplant is the only option.