in the shortest
surgery schedule
keratoconus treatment,
Preventive treatmentと
Refractive treatment
can be divided into
What is keratoconus
The cornea is the equivalent of the lens in a camera.This is a disease in which the cornea is so weak that it cannot withstand the pressure from the inside of the eyeball, causing the cornea to protrude outward.As the cornea protrudes, it becomes thinner and distorted, causing various problems.Research on keratoconus is progressing, but the exact cause has not yet been elucidated.The younger you are, the more likely it is that keratoconus will progress.Patients with atopic dermatitis or allergic conjunctivitis who have a habit of rubbing their eyes are more likely to develop the disease.
- Doctor in charge
-
-
Director/Ophthalmologist
Takashi Kojima -
Vice director/
Ophthalmologist
Yoko Yoshida -
Ophthalmologist
Kazuko Yamazaki
-
keratoconus treatment
There are two pillars of keratoconus treatment: (2) progression prevention and (XNUMX) vision correction. Since there is no effective treatment method that achieves both goals, the patient must fully understand which purpose the treatment is for. is needed.
*However, there is one exception, a revolutionary surgical treatment called custom corneal cross-linking.Custom cross-linking combines the effects of preventing progression and improving vision by improving the shape of the cornea.
Treatment policy
We offer a variety of treatment options for a variety of problems that can occur throughout your life.
Flow of keratoconus treatment
- Is there anything important in your daily life, such as food, to stop the progression of the disease?
- Food does not stop the progression of keratoconus.
- Will keratoconus go blind if left untreated?
- Keratoconus does not cause blindness.This is because keratoconus is a disease of the cornea, and the light-sensing retina and the optic nerve are normal unless the patient has another disease.
However, if the condition is extremely severe and the shape of the cornea is so severe that it cannot be corrected with hard contact lenses, or if the inner surface of the cornea is torn due to acute hydrops and cloudiness remains in the cornea, social blindness (less than 0.1 ).
Not covered by health insurance
Corneal cross-linking
(do not remove corneal epithelium)
Epyon custom cross-linking)
In the past, a method was used in which the membrane called the epithelium on the corneal surface was peeled off, but from 2018, epiion custom cross-linking, which preserves the corneal epithelium, has become possible.As a result, there is less burden on the patient, such as pain, and the risk of infection is also reduced, leading to safer surgery.
Normal corneal cross-linking (irradiating the entire cornea with UV rays of the same energy)
Custom corneal cross-linking (irradiating the affected area of the cornea with ultraviolet rays of different energies)
- mosaic system
- Introduced the Mosaic System from Avedro, USA.
By irradiating UV rays only on the weakened part of the cornea and causing a stronger cross-linking effect, it is now possible to prevent progression and improve the shape of the cornea.
- cost
-
Since it is not yet approved by the Ministry of Health, Labor and Welfare in Japan, our hospital provides treatment at our own expense after obtaining approval from the Ethics Committee.
One eye: 275,000 yen (tax included)
- risk
- Although it is a safe treatment with few major complications, there are rare risks such as infection and sterile inflammation.Although the effectiveness in preventing progression is high at around 90%, there are reports of re-progression and cases of failure.
of corneal cross-linking
Indications for surgery
Corneal cross-linking is a necessary treatment when the following progression is suspected.
1 or more: Surgery may be indicated
Let's consult with the attending physician
For minor patients
About the medical expenses support system
Nagoya Eye Clinic supports the activities of the Keratoconus Support Association, a general incorporated association, and provides support for minor patients undergoing corneal cross-linking treatment.
- Will the custom corneal cross-linking restore the normal cornea?
- It will not be completely restored.Please think that the distortion of the cornea becomes a little weaker than the current situation.
Please understand that the main purpose of corneal cross-linking is to stop the progression, and it is not a treatment that aims to fully restore vision.
- Can corneal cross-linking fail?
- If the progression of keratoconus stops, it is considered a success, and if it does not, it is considered unsuccessful (failure).One study reported that approximately 1% of patients were successful with a single corneal cross-linking procedure.However, in 90% of patients, treatment may not be effective and the disease progresses, or even if it is temporarily effective, the disease progresses over time.
Various contact lenses
As keratoconus progresses, vision correction with hard contact lenses becomes necessary.We handle several types of contact lenses for keratoconus to accommodate people with mild to severe keratoconus, and for those who are unfamiliar with hard contact lenses, we use a piggyback method in which a hard contact lens is placed on top of a soft contact lens. Masu.With this, many people can wear it without any discomfort.
If this does not work, we may prescribe scleral lenses or soft contact lenses for correcting irregular astigmatism (Usoft, soft contact lenses for correcting irregular astigmatism approved in Japan), which will be described later.
- Contact lenses are becoming more difficult to see than before.
- Since it is difficult to imagine that hard contact lenses will deform, it is natural to assume that the condition of the cornea has changed (keratoconus has progressed), so we recommend that you see an ophthalmologist.
Additionally, even if keratoconus has not progressed, vision becomes difficult when the cornea becomes cloudy.The protruding part of the cornea easily rubs against the contact lens, and if this continues day after day, it will become cloudy.
It is effective to change to contact lenses that place less stress on the cornea or to use piggyback lenses.
- What is a piggyback?
- If you wear non-prescription soft contact lenses and then wear hard contact lenses, in other words, if you stack two lenses, the hard lenses will not touch the cornea directly, so the comfort of wearing will be dramatically improved.
Soft contact lenses are generally used for one day, so they have the disadvantage of being more expensive.
Compatible with keratoconus
Soft contact lenses
usoftHealth insurance coverage
- Benefit
- The advantages over hard contact lenses are that they are comfortable to wear and do not come off easily.
Domestically produced lenses, consultations covered by health insurance
- Demerit
-
- ・Because the lens is thick, it is easy to become deficient in oxygen.
- ・It is difficult to remove.
You cannot remove them by pinching them like regular soft contact lenses; instead, you remove them by pinching them between your upper and lower eyelids like hard contact lenses.
- Patient's voice
- Most of the patients who have been troubled by the feeling of a foreign body with hard contact lenses say that they have become considerably relieved.
- One eye: 38,500 yen (tax included)
- Binocular: 77,000 yen (tax included)
special contact lenses
scleral lens
- Features
-
- ●Because the cornea is supported by the sclera (the white part of the eye) without touching it, there is almost no feeling of a foreign object unlike normal hard contact lenses.
- ●Basically, the scleral lens does not come off naturally.
- Prescription example
-
- If you were able to wear regular hard contact lenses without any problems when you were young, but as you age, your eyes become sore and dry and you cannot wear them.
- ●When the severity of keratoconus is so severe that hard contact lenses cannot be worn for a long time.
- ●Those who find it difficult to wear normal hard contact lenses due to their work, etc.
- Appearance
- If the visual acuity of ordinary hard contact lenses is insufficient, it is often the case that scleral lenses cannot improve the vision.
- risk
-
- ●The whites of the eyes may become bloodshot. There are many conjunctival blood vessels on the surface of the whites of the eyes (sclera). Scleral lenses are fixed to the whites of the eyes (sclera) rather than the cornea, so they put a certain amount of pressure on the blood vessels while wearing them. As a result, when you remove the lenses, blood flow increases suddenly and the whites of the eyes may appear bloodshot. This will return to normal if you stop wearing the lenses, but bloodshot eyes may be a concern while you are using them.
- ●The amount of oxygen supplied to the cornea may be less than with normal hard contact lenses. The materials used are the same as normal hard contact lenses or have better oxygen permeability, but because saline (tear fluid) accumulates between the cornea and the lens, the amount of oxygen supplied may be less than with normal hard contact lenses. However, oxygen dissolves in water and is supplied to the cornea, so it is safe to use them.
There is a possibility that vision will be worse than with hard contact lenses. In addition to the corrective effect of the lens itself, hard contact lenses can also change the shape of the cornea, improving vision. Scleral lenses form a lens using saline (tears), so the shape of the cornea does not change, but since they do not touch the cornea, you can expect improved comfort when wearing them. - ●Neglecting to clean and care for your lenses can lead to corneal infections. If you follow the correct care methods, the chances of this happening are slim, but there is a risk if you neglect to clean your lenses or use the same case for a long period of time without replacing it.
Handling lens
Viewno Supreme
(Mini-scleral lens)
Health insurance coverage
- Benefit
-
- Easy to wear even for those with small eyes.
- ●Price is lower than Boston lenses
- ●Approved in Japan, so medical treatment covered by insurance is possible
- Demerit
-
- Not suitable for severe keratoconus
- ●It is not possible to change the design freely like a Boston lens.
- cost
-
- One eye: 110,000 yen (tax included)
- Binocular: 220,000 yen (tax included)
boston lens
*These days it is officially called PROSE.Not covered by health insurance
*These days it is officially called PROSE.
- Features
- Speaking of scleral lenses, it is a lens with a long history called a Boston lens.These special contact lenses were introduced to Japan after Dr. Kojima learned about them while studying abroad in Boston.
Currently, Nagoya Eye Clinic serves as a base for Boston lens prescriptions in Asia, and also prescribes to patients from overseas.
- Benefit
-
- The design can be changed freely so that even the most severely ill people can be placed on it.
- Demerit
-
- ・High price
- cost
-
- One eye: 300,000 yen (tax included)
- Binocular: 550,000 yen (tax included)
For new customers, the above amount includes a one-year consultation fee
1 yen (tax included) per sheet when creating a new one for an existing person
intracorneal ring
An intracorneal ring, as the name suggests, is a method of correcting the distortion of keratoconus by inserting a ring of hard plastic-like material into the cornea.
- Benefit
- Surgery alleviates the protrusion of keratoconus, making it easier to wear hard contact lenses.In mild keratoconus, unaided vision can be improved.
- Demerit
- It is impossible to predict how effective an intracorneal ring will be unless you try it.Recently, according to various studies, it is possible to determine the shape of the cornea to some extent.
- Precautions after surgery
- If you have a hard time breaking the habit of rubbing your eyes or have severe allergic conjunctivitis, the ring may become misaligned after surgery, or the ring may protrude from the cornea due to inflammation.Therefore, it is important to get allergy treatment before applying an intracorneal ring.
* Although the name is similar to corneal cross-linking, the intracorneal ring is a treatment to shape the cornea and does not have the effect of preventing progression like corneal cross-linking.
- cost
-
Since it is not yet approved by the Ministry of Health, Labor and Welfare in Japan, our hospital provides treatment at our own expense after obtaining approval from the Ethics Committee.
One eye: 242,000 yen (tax included)
CAIRS
Similar to custom corneal cross-linking, intracorneal rings, and corneal transplants, this is a procedure to improve the shape of the cornea.
- Benefit
-
- •No risk of popping out when rubbing the eye like with intracorneal rings
- •Since the intracorneal ring can be inserted into the middle layer of the cornea, it can improve the shape of the anterior cornea.
- •Compared to intracorneal rings, the corneal shape changes more smoothly (as it is a graft, it blends in with the surrounding area)
- •Faster recovery than corneal transplants (recovery within 1 month)
- •Insurance treatment is available
- Demerit
-
- •Donor corneas are needed
- •No long-term results (approximately 12 months)
- cost
-
Approximately 200,000 yen (tax included)
- *If surgery is performed using a domestic donor with a 3% copayment
- *Fees differ for overseas donors, so please inquire.
Corneal transplant
Corneal transplantation is performed when treatment with drugs or contact lenses is ineffective.
A corneal transplant is a procedure in which a deceased person's healthy cornea is transplanted to replace a diseased or injured cornea.
Up until now, the mainstream surgery has been to replace the entire layer of the cornea, but since the corneal endothelial cells in keratoconus are not bad, we perform a deep transplantation called DALK, which leaves only that part intact.
Recently, femtosecond lasers have been used to perform corneal incisions and transplants, making it possible to perform more precise surgeries.
Keratoconus is said to have good results after transplantation, but the transplant also has a limited lifespan, and 15-40% of patients require retransplantation after 50 years.You may also need contact lenses for astigmatism after corneal transplant surgery.Donor corneas are provided domestically and internationally (USA).
- Can a corneal transplant cure keratoconus?
- Corneal transplantation is a treatment that can significantly improve vision, but since the entire cornea cannot be replaced, corneal distortion may remain and keratoconus may recur, so it is not a complete cure.
Therefore, long-term follow-up is necessary even after corneal transplantation.
- cost
-
- One eye: 180,000 yen (tax included)
*In the case of 3% copayment
* If you wish to use an overseas donor, you will be charged a separate cornea fee.
Related Videos
-
Cross-linking surgery (epion) explanation
(8 minutes 23 seconds) -
Explanation of cross-linking surgery (epiof)
(7 minutes 24 seconds) -
eyeball channel
(keratoconus related videos) -
What is CAIRS?
(10 minutes 45 seconds)
Related books and goods
-
- Do not give up!keratoconus treatment
- Takashi Kojima (Author)
Dr. Kojima, a leading expert in keratoconus, explains in an easy-to-understand Q&A format with Medama-chan, a must-read book that explains the causes of onset, treatment options, and the reality of surgery.
