As global leaders in keratoconus treatment and improving vision in keratoconus, ELZA’s surgeons boast over two decades of experience, offering all these visual rehabilitation options.
ELZA’s medical director Prof. Farhad Hafezi officially is the most productive scientist on the topic globally, followed by ELZA’s Dr. Emilio Torres and Dr. Mark Hillen at numbers 2 and 5. ELZA’s surgeons are also in the top Expertscape global rankings for cross-linking.
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The goal is to achieve better vision and visual acuity. “Visual quality” and “Visual acuity” do not mean the same thing. Visual acuity is purely a description of how small a letter patients can see on a vision test chart (it doesn’t matter if the letter is blurred or the patient sees three of them, the smallest sized letter the patient can read defines their score. “Visual acuity” says nothing about the quality of their vision.
See this devided image: the image on the left gives an example of good picture quality. The image on the right gives an example of poor visual quality. Pick a line and you can probably read the line on both sides, and the patient’s visual acuity would be the same in both cases. However, you can see for yourself that the picture quality between the left and the right part of the image is completely different.
And this is the typical case in keratoconus: even if a certain visual acuity can be achieved, the quality can still be extremely poor. This is where we can help.
Visual quality versus visual acuity
In most cases, there is an improvement in image quality with glasses. We cannot use your precious corneal tissue to both improve visual quality and the diopters of your glasses at the same time. This would require too much tissue to be removed. So we rather focus on improving visual quality. The remaining diopters can be corrected with glasses or regular contact lenses.
There are several ways to enhancing vision in eyes with keratoconus. These include special contact lenses, Femto-CAIRS, ELZA-PACE customized cross-linking, and wavefront-guided transPRK with the excimer laser.
All options are highly customised, and which option – or combination of options – are best depends on each individual’s eye. Notably, contact lenses, Femto-CAIRS, and wavefront-guided excimer laser treatments primarily serve to improve visual quality rather than address progressive corneal ectasias.
Corneal cross-linking (CXL) is unique in its ability to halt ectasia progression. ELZA’s pioneering ELZA-PACE customized cross-linking procedure not only strengthens the keratoconus to stop disease progression but also enhances visual quality simultaneously. But what approach is right for you?
We will briefly introduce the concepts, which you can choose to explore in greater detail if required.
For instance, significant improvement in visual quality can be achieved with special contact lenses, such as rigid gas permeable (RGP) or scleral lenses, which are custom-fitted. Typically, these lenses provide superior vision compared to glasses.
Learn more about special contact lenses.
However, wearing these lenses for extended periods, up to 18 hours daily, may cause discomfort and potentially lead to severe dry eye conditions. Reducing dependence on these special contact lenses is preferable, and surgical options can offer a solution.
If we consider a “worst-case” scenario with a highly irregular cornea requiring substantial regularization, our initial strategy would be to employ Femto-CAIRS, as it has the potential for the most significant cone flattening.
After achieving a stable corneal shape, we might consider ELZA-PACE customized cross-linking and/or wavefront-guided transPRK for additional regularization.
Finally, in suitable corneas, we can perform wavefront-guided transPRK to “fine-tune” vision, aiming to reduce higher-order wavefront errors (aberrations) (e.g., blurring, ghosting, double vision) caused by the keratoconic cornea.
These highly individualized treatment approaches, whether involving one, two, or three steps, depend on the state of each person’s cornea: the shape, the thickness, the biomechanical strength, and other holistic factors we can determine together with our patients.
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