The exact cause of keratoconus is still unknown. However, there are risk factors that may contribute to its development:

• Family history. Around 1 in 10 people with keratoconus has a parent with the condition.

• Frequent eye rubbing (especially aggressive “knuckling” eye rubbing).

• Having certain conditions such as allergies, asthma, Down syndrome, retinitis pigmentosa, or connective tissue disorders (such as Ehlers-Danlos syndrome or Marfan syndrome).

• Long term rigid contact lens wear (possibly due to irritation and inflammation).

Although keratoconus is bilateral (affects both eyes), it typically presents and progresses asymmetrically. This means that symptoms can differ between the two eyes, and they can change over time. 

Early Stages

• Mild blurring of vision.

• Distorted vision (straight lines look bent or wavy).

• Increased sensitivity to light (photophobia) and glare.

• Halos around lights and ghosting (especially at night).

• Difficulty seeing and driving at night.

• Headaches associated with general eye pain.

• Eye irritation, redness, or swelling.

Later Stages

• More pronounced blurry and distorted vision.

• Increasing myopia (nearsightedness) and astigmatism, requiring frequent spectacle prescription changes.

• Inability to wear contact lenses because they are uncomfortable and/or they no longer fit properly.

NOTE: These symptoms are very ‘vague’. A good starting point, if any symptoms are present, is to review as per protocol with your optometrist on a bi-annual basis, or then as needed if symptoms worsen.

Although there is no cure for keratoconus, there are various treatment options available to manage its progression and improve visual acuity. The treatment chosen depends on the stage of progression and the patient’s symptoms.

In the earliest stages, spectacles or soft contact lenses may be used to correct the visual distortions caused by the irregular cornea. As the condition progresses and the cornea becomes thinner and steeper, specialised contact lenses, such as rigid gas permeable lenses or scleral lenses, may be required to correct vision more adequately. 

Progressive keratoconus can be treated with corneal collagen cross-linking (CXL), a minimally invasive in-room procedure which strengthens the cornea, preventing further bulging and vision loss. More on this procedure below.

With severe keratoconus, a standard contact lens may become too uncomfortable to wear, and spectacles and specialised contact lenses may no longer correct vision adequately. In these cases, crescent-shaped devices called intrastromal corneal ring segments (ICRS) may be surgically implanted to modify the curvature of the cornea and improve vision. 

In advanced cases of keratoconus, where the symptoms are severe and the cornea is scarred, a corneal transplant may be the most effective treatment option. This surgery replaces all or part of the diseased cornea with healthy donor tissue. 

Theatre Booking

• After your consultation with Dr Botha, you will return to Reception to make your corneal cross-linking booking. 

  • This procedure will be done at our practice, unless otherwise specified

Payment and Medical Aid Authorisation

• Most medical aids in South Africa do cover this procedure.  

  • The practice will phone your medical aid on your behalf. However, full authorisation remains the responsibility of the patient.

  • Please ensure that you receive a DETAILED AUTHORISATION from your medical aid.

    • The authorisation must be sent to accounts@drtcbotha.com.

    • This information is used to prevent co-payments, if possible.

  • If the full amount is not covered by your medical aid, this will be communicated to you before the procedure.

  • If the cost of your procedure needs to be settled privately, you will be informed beforehand.

What to Bring and How to Prepare

• Whether your procedure involves one eye or both, it will be necessary to arrange transportation for after the procedure. 

• NO CHANGE in eating and medication routines is necessary.

• Avoid bringing excessive accessories.

• Be sure to dress comfortably. 

• Please do not wear ANY makeup on the day of your procedure.

Anaesthesia, Eating and Drinking 

• The procedure is done under TOPICAL ANAESTHESIA. This means that drops are used to numb the eye/s.

• You can eat and drink as normal before your procedure.

• NO PAIN is felt during the procedure.  

Admission Process

• Please arrive at Reception 15 minutes prior to the time provided to you.

• You will be given a CONSENT FORM to read and sign.

• One of our skilled Ophthalmic Assistants will then begin the procedure preparation process.

Procedure Preparation

• Numbing eye drops will be used to prepare the eye/s for the procedure. 

Procedure 

• Using the excimer laser, Dr Botha performs a quick epithelium stimulation on the involved eye/s (this facilitates easier riboflavin penetration into the cornea).

• Riboflavin eye drops are applied to the cornea for a specific period (usually 20 minutes) to allow saturation of the corneal tissue.

• A special UV-A light is then directed onto the cornea for another set period (usually 30 minutes).

• You will be awake during the procedure as you will need to fixate on a light.

• The procedure should be comfortable. NO PAIN should be present during the procedure.

  • You can verbalize if there is any discomfort and we will immediately react to this. 

CXL Post-Procedure Information

• Walk out with eyes open and antibiotic ointment administered onto the eye/s. 

• A SCRIPT for antibiotic eye drops and pain tablets will be provided immediately post-procedure. 

  • Drops are to be used until finished.

  • Pain tablets prescribed are not mandatory. You can use what you have at home, provided it DOES NOT CONTAIN IBUPROFEN.

• Our rooms will contact you the next morning to do a post-operative check-in. 

• We typically do a clinical review at 1-month post-procedure. We repeat scans to assess the efficacy of the procedure and then discuss further review dates to monitor for progression. 

NOTE: Typically, this procedure is a ‘once-off’. However, in the very rare case that we see progression afterwards, the procedure may need to be repeated if clinically indicated.

• Major post-operative expectations / issues:

  • It is common to experience some discomfort (often described as a gritty, burning sensation or foreign body sensation), dry eyes, blurry vision, and light sensitivity for a few days after the procedure. 

  • Vision should recover to baseline within 24 hours. Sometimes there are minor fluctuations the first week or so. 

  • Discomfort usually subsides within 3-5 days.

  • Dryness symptoms usually resolve in 1-3 months.

  • You may need new glasses or contact lenses once your vision stabilizes (usually at the 3-month mark).

• The most important constraint post-procedure is NO EYE RUBBING.