Merged Keratoconus thread
 

Nav1,

Found it! - Disregard above nonsense...

Keratoconus, also known as Conical Cornea, is a non-inflammatory condition of the cornea in which there is progressive central thinning of the cornea changing it from dome-shaped to cone-shaped. Keratoconus comes from the Greek word meaning Conical Cornea (Cone shaped- Cornea). The cornea is the clear windshield of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea can severely affect the way we see the world, including simple tasks such as: driving, watching TV, or reading a book.

Keratoconus is not a blinding disorder, per se, but does result in a greatly increasing near-sightedness (things far away are out of focus) and irregular astigmatism (things look tilted) that can significantly distort your vision.

It is almost always bilateral (affecting both eyes). It is a slowly progressive disorder, taking years to develop, and may halt at any stage from mild to severe.

Check out:-
http://www.kcenter.org/Keratoconus/w...ratoconus.html


Good luck

GV

Eye Surgery
 

Be greeted fellow aviators.

You think bad vision is a problem, try this a year ago I had a corneal transplant and have been grounded since.19 december 1999 ! The doctors and the medical board keep inventing new excuses to keep me on the ground. After all if they say I should go and fly again and I wipe out a mountain it it is their danglies on the block. Is there any body with a similar problem or with any advice ?
By the way I am a Keratoconus sufferer for the last 9 years.

4 & 5 year post op patients are now returning in worrying numbers to laser clinics across Europe and the US. One of the main areas of concern is corneal ectasia developing into keratoconus. Ther are many others such as the incidence of scleral and retinal detachments due to the high vacuums required for the micro-keratomes to cut the corneal flap.

My remarks are based on fact. Numerous papers have been presented on subjects such as these at national and international ophthalmological meetings.

The procedure is non-reversible and carries serious potential risks. This is my point. The decision to undergo refractive surgery should not be made lightly. Many patients have enjoyed tremendous results, but the long term effects are not thoroughly understood and do not let anybody tell you otherwise.

Best regards

Blindside: You do sound very knowledgable on the subject so I checked your profile, no occupation listed. Optometrist? opthamologist? I did pose the question of higher incidence of corneal extasia and keratokonus for LASIK/PRK patients vs. general public to the National Keratoconus Foundation (NKCF). I'll share their reply when I receive it. RA

Probably the best advice at the moment is to wait. A new proceedure is in development that will probably do away with most laser techniques. It is called corneaplasty and according to the Doc who is developing it, the final product will involve using eye drops to soften the cornea then a special hard contact lens to reshape the cornea and finally another set of eyedrops to return the cornea to its original firmness.

Here I have copied more detailed info.
What is Corneaplasty
Corneaplasty, is a non-surgical procedure that changes the shape of the cornea (the front part of the eye) using modern Ortho-K contact lenses as corneal molds, in conjunction with certain medications to prepare and final-set the cornea. This is a mechanico-chemical procedure.
Corneaplastytm is essentially a 3-step process. First, the cornea is “prepared” by applying a proprietary (ACS-005 enz) concentration of the human enzyme, hyaluronidase, which absorbs into the cornea, making it softer and more “malleable” for a period of time, says Hampar Karageozian, senior vice president of research and development at Advanced Corneal Systems. The drug temporarily alters the molecular bonds between proteoglycan molecules in the cornea. This enzyme has a long history of safe use in ophthalmic (eye-related) and other applications. Second, the “prepared” cornea is then molded to the desired shape with custom fitted AOK contact lenses worn during the treatment period. Thirdly, a proprietary cross-linking agent “fixative” drop is administered to “set” the cornea in its optimum shape. It effectively “glues” the collagen fibrils until they re-grout naturally.

Moreover, the procedure is reversible, i.e. it can return the cornea to its pre-altered state if desired; and, it (the cornea) is alterable indefinitely throughout life, so the procedure is repeatable. You can “fix,” “reverse” or “alter.” There is no ablation or cutting of tissue. There is only a bending of the cornea and a migration of corneal epithelium.

The term “Corneaplasty,” as determined by the U.S. Department Of Commerce Patent And Trademark Office, is merely a conjunction of the two descriptive words, “cornea” and “plasty.” Corneaplastytm (both REFRACTIVE CORNEAPLASTYtm and THERAPEUTIC CORNEAPLASTY), are marks sought after by the founding company, Advanced Corneal Systems, and are defined as follows:

REFRACTIVE CORNEAPLASTY: Goods and services to non-surgically change the deficient vision in a healthy eye by changing the shape of the cornea in individuals suffering from refractive error including myopia, hyperopia and astigmatism.

THERAPEUTIC CORNEAPLASTY: Goods and services to non-surgically change the shape of a damaged or diseased eye in individuals suffering from optic diseases such as ocular herpes, keratoconus, or extreme astigmatism resulting from corneal transplant surgery or cataract surgery.

The Attorney for the Trademark Trial and Appeal Board (T.T.A.B.) contends that the word “refractive” is a descriptive adjective that refers to correcting refractive errors of the human cornea. The applicant’s (ACS, Inc.) “pharmaceutical preparations” have a refractive purpose, because they are used to correct refractive errors of the eyes. So, for now, we have a new non-surgical category of refractive correction, know as “corneaplastytm,” which may or may not undergo a future semantic change.

The Procedure:

This is the probable case scenario.

The treatment period lasts approximately 2 weeks with 5–7 patient visits.

Day 0: Patient examined, then trial fit with AOK lenses, then enzyme administered and patient sent home.

Day 1-3, or when cornea is prepared: Patient returns and lenses are dispensed. This procedure will most likely be a Nightwear, End Result Ortho-k (NERO, a term coined by Roger Tabb, O.D.) or worn daytime and removed at night. Expect 4-5 diopters change from 8 hours to a few days. 1-3 diopters can change in a matter of hours.

Day 4-10: Stabilizing drops or gel is administered by the patient QID (4 times a day) in conjunction with a custom contact lens retainer.

Day 11-14: D/C stabilizing drops and lenses when stroma is altered and “set” to new desired contour.

Since the procedure deals with altering the stroma, greater degrees of refractive change are possible, as compared to Ortho-K, which only deals with about a 50 micron layer of epithelium.

The procedure can apparently be repeated, if necessary, throughout one's lifetime of refractive changes, without any damage done to the cornea. The tissue is said to remain pristine, as the hyaluronidase only temporarily alters proteoglycen bonds between the lamellae to soften the tissue, and does not actually affect the collagen lamellae themselves.

Who started Corneaplastytm?
Corneaplastytm is the brainchild of Advanced Corneal Systems (renamed ISTA Pharmaceuticals, Inc. in July 2000), Irvine, CA 92618; (949) 788-6000; (949) 788-6010 fax., the proprietary company seeking patents and marks initiated circa 1994. Introduced to the international community, circa 1995, lectures by Ortho-K pioneers such as Don Harris, OD, Charles May, OD and Stuart Grant, OD, presented materials and unpublished information at UAB and NERF conferences. At that time, mathematical functions for corneal molding, including tear layer plots, design comparisons, and computational methods were also discussed by such notable optometrists as Jim Day, Roger Tabb, the Roger Kame, and Joe Barr.

Where Is The FDA Investigational Status?
In the off-shore clinical trials that started in January 1994, phase I and II have been completed in 1997 and 1998 and yielded exceptionally good results. Expected in the first quarter of 2000, large scale clinical studies will enter 3rd phase in US and so far, right on track. Optimum lens design as well as dose/response studies are ongoing. A new stabilizing agent has been added to the trials that dramatically shorten the time from months to weeks to stabilize the cornea after it has been reshaped. Reducing the recovery time should also limit noncompliance.

When Will Corneaplastytm Be Available?
The large pharmaceutical company, Sandoz, is helping Advanced Corneal Systems, through the FDA clinicals. They expect approval (from what I have been led to believe) within a year or two. They are also working on an alternative drug delivery systems such as a "needle patch," to try and keep this procedure totally within the scope of optometry.

Why is Corneaplasty So Significant?
Extremely low complication rate, especially when compared to refractive Surgery. Corneaplasty is a Non invasive, non-surgical, procedure. The cornea is never cut and no tissue is ablated. There is no pain, no risk of infection, haze, starbursts, double vision, glare, ghosting, etc. associated with laser or other refractive surgeries. Anthony B. Nesburn, MD, director of Ophthalmology Research Laboratories at Ceders-Sinai Medical Center and clinical professor of ophthalmology, Jules Stein Eye Institute, University of California, states, “The beauty of this technique is that Bowman’s layer remains intact.” His studies indicated that the collagen fibrils themselves are untouched, just the substance that holds them together is affected. Nesburn added that the clarity of the cornea is unchanged pre- to post-treatment.

An additional noteworthy benefit is that the new corneal surface is more pristine than ever before. That is to say that the corneal molding smoothes out the natural anatomical undulations found on the cornea and facilitates an improvement in VA to 20/10ths (i.e. two lines better than 20/20) in some cases. The treatment zone with Corneaplasty is bigger and better than LASIK.

How Much Will This Procedure Cost?

The cost for this procedure is significantly less that LASIK and PRK because there are no laser, facility or royalty costs. However, just like all new procedures, the cost will be in line with what the free market allows. It will probably range from $750.00 to $1,250.00 per eye to begin with, roughly half the cost of LASIK. Enhancements and further alterations will carry modified fee schedules.

The major deterrent to LASIK is both cost and fear related. Corneaplasty is safe, effective and relatively inexpensive. It is destined to become more main stream than the invasive surgeries existing now. As it becomes more commodity-like and delivered in a more ubiquitous fashion, costs will seek a lower level.

don't rub your eyes too much ..it could distort the cornea and distort vision by causing a condition called keratoconus.

in myopia , your eye balls is longer than usual so things are out of focus. but mypoia is generally stable .
keratoconus is weakeness of the cornea of the eye ..and the cornea being thin bulges and becomes irregular. ...the cornea is the clear window that you see outermost in the eye...... or rather , becoz it is transparent ..you don't see !
the problem with keratoconus is that it may progress. it behaves differently in people . in most in progresses and then stops ...but in some it goes on progressing.
many can be corected with contact lenses , but some will need a corneal transplant.

you can join some of these friendly email discussion groups dealing with keratoconus:

http://groups.yahoo.com/group/keratoconics/


or send an email to these friendly and focussed groups .... each dealing with an specific aspect of keratoconus ...

[email protected]

[email protected]

[email protected]

keratoconus resources
 

if you have keratoconus ....some places to visit ....



http://groups.yahoo.com/group/keratoconics/


or send an email to these friendly and focussed email discusion groups .... each dealing with an specific aspect of keratoconus ...

[email protected]

[email protected]

[email protected]

Sorry but have to ask !
 

I know this has come up before, but the search did not come up with anything conclusive.

Basically I have today been told that I have a mild form of Keratoconus in my left eye, which can be corrected by wearing contact lens. Can anyone please shed any light as to how this will affect my current medical 1 status.

Your help and advice will be appreciated

ox

gas_man, did you get your licence back.

I am an ATCO that needs this treatment following 13 years of keratoconus.

Keratinous / Keratoconus
 

Hi there!

Is there a chance to pass the medical with this eye disorder? (FAA or even JAA)?

I found this on the CAA website,

http://www.caa.co.uk/default.aspx?ca...90&pageid=4764

Yet to be approved I presume but a step in the right direction :cool:

KERATOCONUS
 

I am in my late 20's and fly for a major U.S. airline. I recently was diagnosed with mild-advanced Keratoconus. I was fitted for RGP (Gas Permeable) contacts, but could not tolerate those when duty days were between 10 - 15 hours. I opted to have whats called the intacs procedure and my vision although not a whole lot better has improved and now I am able to wear soft contact lenses. This condition is rare and it happens to 1 out of every 2000 people. Just curious to see if any one else is in this elite club, and would like to share their thoughts.

Keratoconus
 

Hello all,

I am 26 years of age and an Air Traffic Controller. I have keratoconus in both eyes for the past 7 years approx. I don't wear correcting lenses and the condition is relatively stable. I am wondering if there is anyone out there who has this condition and is either a pilot or controller. I would be very interested to know your experience with medicals etc.

Many thanks

The dreaded "K" (keratoconus)
 

Hi all,

I am 27 years of age...an air traffic controller and have keratoconus for the past 7 years. I don't wear correcting lenses, however, i do have my medical at the end of the month and may be asked to get some!! I am waiting to go to Germany for Crosslinking treatment to stop the progression. I am desperately trying to find someone who has this eye condition so as I can get their experience of it as eithera controller or pilot.

Many thanks

I had keratoconus - successfully treated, although that was back in the early eighties. I have PM'd you.

(PS: I'm not a controller or a qualified pilot - although I've had some lessons recently - but it's quite a rare condition, so you might not find anyone with it who is...)

Hello, I am a pilot and I also have been suffering from keratoconus. I wear a correcting lense on my right eye althought I usually don't wear it because I wear it with difficulty. What is the C3R treatment ? Does it give good results ? Is this treatment allowed by a civil aviation authority ?
I intend to convert my ICAO commercial licence into JAR licence (British CAA). Did someone experience a class 1 medical check in CAA with a keratoconus ?

Many thanks

cross linking for Keratoconus
 

Hello Everyone:

I have recently been diagnosed with Keratoconus so you are certainly not alone guys! I have discussed the possibility of undergoing collagen cross-linking (C3-R) with my ophthalmologist. After doing a full set examinations, she thinks that I could be a very good candidate for this treatment especially as the corneas in both of my eyes still have enough thickness. I am in real need of feedback from those of you who have had this treatment and/or recommendations for a specialist in cross-linking who I can go to. As I am pressed for time (my health insurance expires soon) I would appreciate feedback from anyone as I need to have the treatment done as soon as possible. Many thanks in advance!

collagen corsslinking for keratoconus
 

Hello Everyone:

I have recently been diagnosed with Keratoconus so you are certainly not alone guys! I have discussed the possibility of undergoing collagen cross-linking (C3-R) with my ophthalmologist. After doing a full set examinations, she thinks that I could be a very good candidate for this treatment especially as the corneas in both of my eyes still have enough thickness. I am in real need of feedback from those of you who have had this treatment and/or recommendations for a specialist in cross-linking who I can go to. As I am pressed for time (my health insurance expires soon) I would appreciate feedback from anyone as I need to have the treatment done as soon as possible. Many thanks in advance!

Stable & slight keratoconus (prospect)
 

Hi,

I have diagnosed slight but stable Keratoconus (right eye) but have perfect vision with normal glasses. It is not even clear if it is Keratoconus but they assume so. I also have good vision without glasses. I have PPL(A) with NVFR and I'm active private pilot. I feel kind of frustrated as my vision is great but regulations say I can't have Med Class 1.

Have you guys heard any changes for this issue as it says in original post? I really would like to go through ATPL-scheme as I'm now 29 years old.

Will EASA ease these regulations? Anyone? Please, keep us updated.

Thank You!
-Qnh78

The dreaded "K" (keratoconus)
 

Hey all,

Does anyone else on here suffer from this ?

I have it in my left eye, im 26 and it doesnt effect me when using my both eyes, i have glasses but only use them on the computer and they give me normal vision in the effected eye.

My question, is it possible to get a commercial pilots licence with this condition ?

If its not possible with the JAA then how about the FAA ?

Idealy im looking for advice from pilots out there who also have this condition, as flying for a career has being my dream for years, i started training on fixed wing when i was 17 but stopped when i was 18 as i noticed a change in my left eye and was afraid of spending a fortune on training and then being told down the line that i couldnt fly anymore.

Any help would be great.

I used to suffer from kc, fixed back in the eighties by corneal grafting, but there is another treatment these days - there was a thread about this a few months ago. I'll try to find it for you...

Edited to add link to previous thread:

http://www.pprune.org/forums/showthr...ht=keratoconus

In fact, use of the Search facility has turned up a surprising number of other kc threads/sufferers on PpRuNe, some with medical/licence issues...give it a try!

:ok:

Hi folks. Failed my medical there about four months ago after being diagnosed on the day with keratoconus. Real shock as I'm sure some will know. Could anyone who has had a similar experience shed light on any steps I could now take? I've been seeing an opthamologist, but that's still in the early stages. What's the consensus on how likely it is to pass an initial medical having previously failed one? All and any musings appreciated...

I just came across the following and I quote it from page 4 of Vol.42, No. 1 of the "Federal Air surgeon's medical Bulletin" issued by the US FAA. It's a bit dated as it goes back to 2004 but it indicates that it is possible for pilots with Keratoconus to continue flying provided certain requirements are met. Below is the relevant excerpt. If you want to read the whole thing you can go to:
http://www.faa.gov/library/reports/m...ia/F2004_1.pdf


"The Aerospace Medical Certification

Hi,

any news form anyone about EASA side? I'm looking forward to these liberalizations http://www.caa.co.uk/default.aspx?ca...90&pageid=4764 speaking of Keratoconus.

Thanks!
-QNH78

Hi,

I am really interested in working as a pilot!!!! Actually I am cabin crew in the Middlea East and I have a slight keratoconus whoch is treated with high gas permable rigid contact lenses! I do not have any problems and my prescription has not changed within the last 4 years after I was diagnosed with this condition! I fullfill the visula acuity standards and I understand in the CAA Homepag ethat Keratoconus will no longer be disqualifying if applicants meet the visual acuity!!! Who can help me by confirming this? I just checked the above link in the last posting!

Thank you and all the best for our eyes:-)))))

Hello guys.... as my experience.... keratoconus is a little thin into cornea.
To identify it, is necessary a corneal topography as to identify any laser surgery as well.
At Gatwick they didn't use corneal topography when they've check my eyes and I didn't saw any equipment for this test.
So I think if you have a keratoconus they will never know it.

Whats the CASA stance on Keratoconus ?

I heard that once you can get 20/20 with glasses you can pass the class 1 eyesight test for the australian medical, any truth to this ?

You can fly FAA Class I with keratoconus as long as you still meet the vision requirements. Check out C3-R corneal collagen crosslinking, it's not approved yet in the states but it is in europe and I hear it will stop the progression of keratoconus

Great Bucks,

I'm going to have mine crosslinking done in a month. Was it any painful? Did you get any kind of eyeband or anything? How was the following day?

Anyways, I heard that EASA will release new flight crew licensing rules (ex- JAR-OPS3) in March 2008. Have anyone has any news if Keratoconus will be no more disqualifing for initial Class1 medical?

BR,
QNH78

Any idea on what the new regulations will include ( removing keratoconus as a fail for initial class 1 perhaps ?? )

Hi,

I would also like to know about keratoconus "removal". I'm suffering keratoconus but I have perfect vision with eyeglasses and good vision (Class 2) without eyeglasses. I will go for C3-R crosslinking operation soon and still wanting to fly for living.

Any news about new regulations...please, share!
Thanks!

-Qnh78

Just found today that i have Keratoconus
 

Guys and Girls,

Just about to start my IR next week but been for an eye test today as i felt my vision is degrading and have been told i have Keratoconus in both eyes.

My Eyes are

SPH CYL AXIS

RIGHT +1.75 -2.50 65
LEFT +3.25 -3.50 105


:mad: :mad::mad:

They are refering me to the eye hospital next week. I had my initial C1 medical 1 year ago and i cant believe this was not detected. What i would like to know is:

Is this going to be a problem, should i continue with my IR. Is their anyone else out there with this rare problem??.

Any help advice would be much appreciated.

Cheers
Danny

Danny, Welcome to the KC club! (PPRuNe chapter).

There have been a number of threads covering KC (a couple quite recent). You could search for 'keratoconus' or I'll find some links and post them here.....

Treatment is available these days which seems to be very successful. If you get the chance to get it treated (i.e. stop it progressing) I'd definitely do it.

When I had mine treated back in the eighties I was told it was a "very rare condition" but thanks to the power of the internet, I've discovered quite a number of pilots and ATCOs have this condition...

EDIT: Actually, having just used the Search function, there are a large number of KC related threads, so probably best to check it out that way. :ok:

Hi Bucks,

It's been a few month since your treatment, how are your eyes going?

I'm 23 and was first diagnosed with this condition at the age of 17, and was then only just was able to obtain my initial Class 1 medical without eye correction. I obtained my CASA PPL(a) when I was 19, but have not flown for the past 18 months due to angst caused by this condition. My current vision is 6/7.5 left and 6/6 right corrected with spectacles. As you can see my vision has deteriorated over the past 5 years.

Distance correction: SPH CYL AXIS

RIGHT -0.25 -1.00 80
LEFT -0.50 -1.75 105

My question is directed to professional pilots who have keratoconus in regards to night flying. While driving at night I see halos extending down from around the head lights of on coming traffic, from around a distance of 200-500 metres. I work airside at Melbourne Airport, which includes driving on the taxiways and aprons but these lower intensity lights don't seem to produce any significant halos at all. I'm wondering if anybody else has similar problems with their keratoconic eyes from lights they encounter while flying at night?

I have 250 hrs TT and would like to begin flying again and study for a CPL. My condition is not advanced enough to be considered for intacs surgery due to the associated risks and I will have an initial consultation in the coming months for C3-R collagen cross linking.

mm

Hey colt_pa22,

I just had another checkup two days ago and the increase in vision in my affected eye has been amazing. I dont have my current exact figures to hand but i can now see 6/9 un corrected in the eye with keratoconus.

(I got a small bit of laser followed by the crosslinking)

The doctor was very impressed at the improvement and as my eye is not 100% healed yet there is a chance of further improvment.

Im delighted i got the procedure done and it was worth every cent. It pays to go to the best aswell !!

Hey Danny,

I was training for my PPL when i was first diagnosed with the condition, one day my eyesight was fine then the next my left eye had become weaker then my right. Gradually over time it became worse.

I assume there is a "no fly time" following the procedure but you would be best to find out from Gatwick as to what length of time this is and whether they approve the procedure or not.

If your condition has only recently started then i would suggest getting crosslinking done as soon as possible to ensure your sight doesnt degrade further. Im sure you already know but rubbing your eyes will help deteriorate your eyesight so its a big no no..

I got the procedure carried out in the Wellington Eye Clinic in Dublin and its costs around €1500 per eye, the procedure is quick and pain free.

http://www.wellingtoneyeclinic.com/treatments/cccl.asp

Luckily you already have a class 1 so getting a renewal with this condition should not be a problem, unfortunately for me i have to live in the hope that the CAA will one day allow initial class 1 applicants who have keratoconus gain a medical.

Regards,
John.

Hi guys, just an update... I just learned from a friend who is also a pilot in Canada that people with Keratoconus can pass a Category 1 medical provided that they meet the Visual and medical requirements as set by the standards of Transport Canada. Therefore, just like in the US, Keratoconus is not a disqualifying factor. I am not sure if the JAA in Europe still considers it a disqualifying factor??

I've have keratoconus symptoms since I was teenager, but wasn't diagnosed until my mid-20s. It's been over a dozen years since then, and my condition has not degraded. Of course, I've never flown anything.

Keratoconus as a disease has enjoyed a renaissance of late. Corneal topography has allowed even minor forms to be diagnosed with incredible accuracy, whereas in the past, only severe cases would be noted. I'm serious: I went through several years of being told it was "normal" to see ghost images of everything. At the same time, they now make keratoconic RGP lenses that are considerably more comfortable than the old bog-standard ones, so they don't pop out or bring dust right to the cornea as easily as they used to. Although, to be honest, I've done just fine with glasses the last three years, and my job requires extreme visual acuity.

Effectively, the increase in diagnosis rate has revealed that, alongside the "old school" keratoconus, the chronic, degenerative cornea disease that ultimately requires transplants, there's a much more common version with an onset in the teenage years that stabilizes in the mid-twenties with minor cornea degradation. It's a nuisance, but shouldn't be an obstacle.