Fluctuating visual acuity is the first sign of possible astigmatism

In the worst case, astigmatism can lead to blindness
Visual disturbances are not only associated with considerable restrictions in everyday life, they can also indicate serious diseases such as a stroke. Diseases of the eye can also be mentioned as possible triggers, although these can be successfully treated in many cases today. One of these diseases is the deformation of the cornea, in the worst case of which blindness occurs. Early diagnosis and treatment is strongly advised here.

The pathological deformation of the cornea (called keratoconus) is a very common complaint that has a significant impact on visual acuity. While in a healthy eye the cornea lies flat on the eyeball and lens, "keratoconus leads to an increasingly cone-like deformation and thinning of the cornea," explains Dr. Stefan Lang, specialist at the Ophthalmology Clinic of the University Medical Center Freiburg. This significantly limits the eyesight of those affected.

Symptoms of astigmatism
The deformation of the cornea leads to a strongly fluctuating vision, a distorted perception of the environment or even torn cornea and a consequent corneal clouding, which in the worst case can result in blindness, according to the Freiburg University Hospital. The onset of the disease is usually already at puberty, but it can take a while before an appropriate diagnosis is made.

In the long term mostly both eyes affected
In the course of the disease, "initially only an increasing short-sightedness and astigmatism appear, which is why the glasses are often changed," explains Dr. Long. If there is suspicion of astigmatism, the cornea can be measured precisely using keratometry. Often only one eye is affected at first, but in most cases the second eye also deteriorates over time, the eye specialist continues.

Course individually very different
How fast and serious the disease is varies from patient to patient, the expert reports. Particularly in the case of younger patients with a high risk of the disease progressing, very close care by experienced doctors is advised in order to be able to intervene promptly. Because the treatment must be continuously adjusted.

Different possible treatment approaches
Initially, the deteriorating visual acuity can usually be compensated for by glasses, but these do not stop the increasing deformation of the cornea. This deformation can be counteracted by dimensionally stable contact lenses. Networking treatment may also be useful to stop or at least slow the progression of the disease, reports the Freiburg University Clinic. For this, so-called crosslinking is used, in which the soft cornea is treated with UV rays in order to achieve stiffening and thus slower deformation.

At worst, a corneal transplant is required
If the deformation is already very advanced, a corneal transplant (keratoplasty) can restore vision very well, the Freiburg expert continues. A corneal transplant shows a very good prognosis in patients with keratoconus and can last for many years, says Dr. "Nevertheless, the life of a graft can be limited due to rejection reactions or renewed deformation," explains the eye specialist.

The causes have not been finally clarified
To further improve the therapy, according to Dr. Long researched worldwide on new treatment approaches such as a further development of the crosslinking procedure or an optimized transplantation of the cornea. "We are working intensively to improve the treatment so that we can help the patients as well as possible," emphasizes Dr. Further research is also required to investigate the causes of the clinical picture, since the path of origin has not yet been conclusively clarified and new treatment options could open up here. So far it is only known that "in addition to genetic factors and possible environmental influences, certain diseases, such as neurodermatitis, promote keratoconus," said the Freiburg eye specialist. If there is astigmatism, this can also be exacerbated by frequent rubbing of the eyes. (fp)

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