Welcome to the Keratoconus Center
"This website was designed to provide the latest information about treatments and research for patients with keratoconus. For 35 years, Dr. Rabinowitz and I have dedicated much of our professional life to studying keratoconus and treating patients in the hope that those with keratoconus may benefit from our extensive clinical experience. We have been leaders in the research, study and advancement of Corneal Cross-Linking (CXL) and have presented our results nationally and internationally. Currently, we have an FDA trial allowing us to treat children as young as age 10 with keratoconus. We have been performing CXL in adults since 2009 with excellent results."
- Ronald N. Gaster, MD, FACS, and Yaron Rabinowtiz, MD
Clinical Professor of Ophthalmology, UCLA School of Medicine, Director of
Ophthalmology Research, Cedars-Sinai Medical Center, Principal Investigator, National Eye Institute (NEI) keratoconus research grant, entitled ‘Genetic Factors in Keratoconus'. This research grant on keratoconus, the largest grant of it's type in the world on keratoconus has been funded from 1993 to 2013.
Click below to hear a patient’s experience about collagen cross linking. A new treatment to halt the progression of keratoconus.
"Many patients with keratoconus feel their treatment options are limited, this is not correct. Two new treatments for keratoconus are INTACS with the Intralase and Corneal Transplants with the laser (I.E.K.) both provide a safe and effective means to obtain excellent vision in keratoconus patients who can no longer tolerate their contact lenses"
The Keratoconus Center is one of the few centers in the world dedicated to both research and treatment of keratoconus.
Under the direction of Yaron S. Rabinowitz M.D., expert on keratoconus and cornea specialist,
The Keratoconus Center offers consultation for the medical and surgical treatment of keratoconus. In addition,
patients may volunteer to participate in a variety of clinical trials to treat and elucidate the underlying causes of keratoconus.
To schedule a consultation, discuss surgical options, or participate in a clinical trial please call 310-248-7474 to schedule an appointment.
What is Keratoconus?
The cornea is the window of the eye. Light travels through the cornea past the lens to the retina and then the brain to form a visual image. The normal corneal surface is smooth and aspheric i.e. round in the center, flattening towards its outer edges. Light rays passing through it moves in an undistorted manner to the retina to project a clear image to the brain.
In patients with keratoconus the cornea is cone shaped (hence the name keratoconus, derived from the greek word for cornea (‘kerato’) and cone shaped (‘conus’). In patients with keratoconus the cornea is not only cone shaped but the surface is also irregular resulting in a distorted image being projected onto the brain.
Because the cornea is irregular and cone shaped, glasses do not adequately correct the vision
in patients with keratoconus since they cannot conform to the shape of the eye. Patients with keratoconus see best with rigid contact lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to
be projected clearly to the retina. Hence the vast majority of patients are treated with rigid contact lenses. There are however some excellent new surgical options for patients with keratoconus who cannot tolerate these lenses, these
options are discussed under treatments for keratoconus.
Many patients are initially unaware they have keratoconus and see their eye doctor because of increasing spectacle blur or progressive changes in their prescription. In many
instances even a good refraction yields poor vision. Keratoconus is most often diagnosed by a cornea specialist who may see typical findings when examining the patient at the slit-lamp. In early forms of the disease there may be no
obvious finding on slit-lamp evaluation and the diagnosis is made by computerized videokeratography only.
Keratoconus typically commences at puberty and progresses to the mid thirties at which time progression slows and often stops. Between age 12 and 35 it can arrest or progress at any time and there is now way to predict how fast it will progress or if it will progress at all. In general young patients with advanced disease are more likely to progress to the point where they may ultimately require some form of surgical intervention.
Keratoconus may occur in one eye only initially but most commonly affects both eyes with one eye being more severely affected than the other. Both males and females are equally affected and there is no ethnic predilection though in some parts of the world such as New Zealand and in certain parts of Finland there is a higher incidence due to genetic factors.
Despite millions of dollars being spent on keratoconus no one truly knows the cause of the disease. There have been many interesting theories but none of them have been proven conclusively neither have any of them consistently been reproduced by multiple research groups. For example one theory suggests that there is deficient collagen crosslinking caused by free radicals but there is no scientific reproducible evidence to support such a theory. Others suggest that eye rubbing causes the progression of keratoconus. The evidence for this is however anecdotal based on several case reports, but again there is no reproducible scientific evidence to support this.
Our research group was the first group to demonstrate that genetic factors play a major role in the development of keratoconus. While our scientific based evidence supports a role for genetic factors this does not mean if your
children will necessarily develop keratoconus, since only 13-15% of keratoconus patients have a family history with keratoconus. It does mean however that genes play a role in its development and understanding their role in the
development of keratoconus may one day lead to a permanent cure.
Yaron S. Rabinowitz M.D. is a corneal surgeon and expert in the treatment and diagnosis of keratoconus. He has published more articles on the diagnosis and treatment of keratoconus than any other practicing eye surgeon in the world. He is Clinical Professor of Ophthalmology at U.C.L.A. School of Medicine and the Director of Eye Research at Cedars-Sinai Medical Center. His research on the early detection and genetics of keratoconus has received funding from the National Eye Institutes of Health and for the past 15 years.
His research has provided new insights into the understanding and treatment of keratoconus. Among the insights provided into the understanding of keratoconus are:
- The first to describe that mild topographic abnormalities occur in family members of patients with keratoconus.
- Authored one of the first text books on corneal topography.
- The first to demonstrate through a research study that keratoconus has a genetic basis.
- The first to demonstrate which keratoconus suspect patterns progress to ultimately develop keratoconus.
- Most recently published the first article which demonstrates that the femtosecond laser is accurate and preferable for creating channels to insert INTACS a novel new treatment for patients with keratoconus.
He has been a recipient of multiple awards to acknowledge his contributions to keratoconus research, these include:
- The American Academy of Ophthalmology Honor Award.
- The Jules Stein/UCLA Research Alumni Award.
- The 3rd American to be the honored guest of the French Eye Society.
- The recipient of the International Society of Refractive Surgery and the American Academy of Ophthalmology– Kritzinger Memorial Research Award for contributions to refractive surgery research.
Dr. Rabinowitz sees patients in consultation at his Beverly Hills office and performs surgery on patients with keratoconus at the Eye Surgery Center Beverly Hills. To contact Dr. Rabinowitz or to schedule an appointment call our office at 310-248-7474.
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Keratoconus Genetics Research Program
The Keratoconus Genetics Research Program at Cedars-Sinai Medical Center is the largest research program on Keratoconus of its kind in the world. It has been funded by the National Eye Institutes of Health for the past 15 years and recently the Principal Investigator Yaron S. Rabinowitz M.D. was awarded a 3.5 million dollar grant from the National Eye Institutes to continue this research until 2013.
The goal of the research project is to identify genes contributing to the development of Keratoconus and using this information to ultimately to devise a cure by for this disease by means of gene therapy.
Click here to review publications supported by this grant
Recruitment and Eligibility
We are actively recruiting patients for this study. Any patient with Keratoconus is eligible and typically there is no out of pocket cost for any patient choosing to participate
Benefits of Participation
There are several benefits awaiting individuals who participate in the Keratoconus Genetic Research Program:
- We will supply your eye doctor with a computerized map of your cornea so as to facilitate obtaining a far better fit for your contact lenses.
- We will monitor the status and/or progression of your Keratoconus, on an annual basis.
- We may be able to identify which of your family members (if any) are at risk for developing Keratoconus.
- We can give you advice on the very latest treatments for Keratoconus currently available
- You will be eligible to be placed on a waiting list for a trial for gene therapy if this comes to fruition
How to Participate
To schedule an appointment, please contact our research coordinator Martha Bucaram at (310) 248-7471. or email her at firstname.lastname@example.org.
During your visit, which should take about 30 to 60 minutes, you will be asked to complete a questionnaire. An eye exam will
be performed and computerized photos of your corneas will be taken. We may also request a blood sample from you which is optional and is not a requirement for participation in this study. You will be given a complete
evaluation by a cornea specialist and an expert in Keratoconus.
Convenient validated parking is available at our Beverly Hills office.
We can arrange for your to meet other patients with keratoconus who have had many contact lens changes or corneal transplants, so that you can discuss problems of common interest, share information, and better understand the treatment options that are available.
Keratoconus Research Overview
The Keratoconus Center is proud to offer more clinical trials for both treatment and understanding the basis of this disease than any other center in the world. Our clinical trials include:
- The early treatment of keratoconus with INTACS and the Intralase laser.
- Identifying genes in families with keratoconus.
- PRK (photorefractive keratectomy) for keratoconus.
- Treatment of mild to moderate keratoconus with INTACS and the Intralase laser.
- Treatment of keratoconus with the Visian ICL.
- Lamellar transplants in the treatment of keratoconus.
- Developing a molecular genetic test to diagnose keratoconus.
- Videokeratography indices for detecting early keratoconus.
To date our research has significant contribution to the medical understanding, advances, and treatment of keratoconus. Our achievements include:
- Developed a computer software to early detect keratoconus.
- Identified the first molecular defect in keratoconus.
- The first group to demonstrate keratoconus has a genetic basis.
- The first group to publish and demonstrate that inserting INTACS with the Intralase laser is safer and more accurate than the mechanical technique.
- The first group in Los Angeles to offer the Intralase laser for corneal transplants in patients with keratoconus.
To participate in our clinical trials please contact our research coordinator Martha Bucaram at 310-248-7471 or email@example.com.
Identifying Genes for Keratoconus
This is part of an ongoing study supported by the National Eye Institutes of Health over the past 15 years. In this study all patients with keratoconus and their family members under videokeratography (detailed topographic pictures of their cornea) and family pedigrees and data are entered into a database. Blood is also drawn from family members for molecular storage and molecular genetic analysis. We hope one day to identify a gene for keratoconus and find a means of retarding its progression early on in the disease. To date we have identified a gene locus on chromosome 5 in one large family with keratoconus (click here to view PDF of publication for details) and multiple other loci in sib pair analysis of keratoconus families. These loci may all contain genes providing clues to the underlying mechanism of the disease process in keratoconus. We are particularly interested in individuals who have a family history of keratoconus or at least one family member with keratoconus. All study related costs are free, however, if patients opt to have treatment, they will be charged a discount off normal costs.
By examining corneal transplant buttons on patients upon whom we performed corneal transplants we detected a molecular defect in patients with keratoconus – the absence of a water protein – Aquaporin 5 (AQP5). We hope to develop this into a molecular genetic test for ‘early’ detection of keratoconus. This will be particularly useful in family members of patients with keratoconus and patients with suspicious topography labeled ‘keratoconus suspect’. We ask all our patients upon whom we perform corneal transplants to donate their diseased corneas for molecular genetic analysis. If we perform your transplant and you agree to donate your cornea you will be making a critical contribution toward increasing our knowledge and understanding of keratoconus.
Videokeratography Indices for Detecting ‘Early’ Keratoconus
Our center is a large referral center for patients who are suspected for having keratoconus with either suspicious topography or clinical signs. We see approximately 20 such consults each week. We have developed computerized software with indices, which are critical in helping us make a decision as to whether it is safe to recommend patients proceed with laser refractive surgery. Development of this software has been dependant on developing a large database of normal patients and patients with suspected ‘early’ disease’ and following such patients longitudinally over time. Data from all patients who visit us for referral are entered into databases for ongoing evaluation and refinement of these indices.
If you are interested in participating in our clinical trials please contact our research coordinator Martha Bucaram at 310-248-7471 or firstname.lastname@example.org.
Treatment Options for Keratoconus
Patients with very mild disease may initially be corrected with glasses or soft contact lenses, however the vast majority of patients need rigid contact lenses for adequate vision correction. There are a variety of types of specialized rigid contact lenses and depending on the contact lens fitters experience or expertise they will describe the one best suited for you. The very latest contact lens for treating keratoconus is the “synergize hybrid contact lens” which is rigid in the middle and soft on the edges. This has the potential to give you the good quality vision of the rigid lens with some of the comforts of the soft lens. We don’t fit contact lenses, but we do work with several excellent optometrists who specialize in fitting lenses for keratoconus in the Los Angeles area and would be happy to refer you to one should you so desire. It is always a good idea to try several different contact lenses and fitters before giving up on them and embarking on surgery.
Many patients find their contact lenses uncomfortable and can only tolerate their contact lenses for a short period of time. The reason this happens is that the cornea steepens and rubs against the lens causing an abrasion and light sensitivity . Another reason is patients with keratoconus often have very dry eye and as the eye dries out there is no lubricating barrier between the lens and the cornea contributing to the patient being uncomfortable. There are now many ways to treat dry eyes to improve contact lens tolerance. This includes the use of artificial tears, treating the lids for lid disease, Restasis– for increasing tear production and the use of punctal plugs to prevent tears from draining down your nasolacrimal ducts and keeping the eye moist.
Sometimes a little scar or nebulous appears on the tip of the cornea that constantly rubs against the lens making it difficult to tolerate contact lenses, this scar can be removed with a blade or with the Excimer laser to return patients to contact lens tolerance – this procedure is called phototherapeutic keratectomy(PTK) or nebulectomy.
A method for flattening the cornea that is too steep and making a patient more contact lens tolerant is the insertion of INTACS into the cornea. This procedure is good for patients who are contact lens intolerant and who want to avoid a corneal transplant and whose K readings are not in excess of 58 Diopters. It is also useful for individuals with keratoconus who want to improve their present vision with or without contact lenses. This technique involves the insertion of two arc like plastic segments into the middle of the cornea to flatten the cornea. This procedure was pioneered 8 years ago in France, and is routinely being done by many cornea specialists in the United States. It is FDA approved under an HDE protocol and many insurances cover all or part of the cost. Our center pioneered the use of the Intralase laser for making the channels to insert the plastic segments this makes it a much safer and simpler technique for the patient compared to the mechanical technique which involves using metal blades, our finding have been confirmed by several other large research groups. We have now done several hundred of these procedures with the Intralase with excellent results. In many instances we have had to remove INTACS that were too superficially placed elsewhere using the mechanical technique only to get an excellent result when it is inserted with the safer and more accurate Intralase technique.