Keratoconus

What keratoconus is, treatments for keratoconus, complications, ways to support students with keratoconus.

What keratoconus is

Keratoconus is an eye condition where the cornea, the front surface of the eye, thins and becomes distorted, often forming a cone shape. 

This affects the refraction of light into the eye. If the condition progresses, it can affect the ability to see clearly.

Treatment for keratoconus

Every case of keratoconus is different. Some people with keratoconus get good correction of their sight with glasses. 

Contact lenses

Hard contact lenses of various types are usually required. Good correction is often achieved for many years with lenses. 

If the condition advances, it may become increasingly difficult to fit normal hard lenses, due to the cone shape of the cornea. Another option is scleral lenses. These are large conical lenses, which cover most of the front of the eye.

Many keratoconus patients may also experience atopic conditions, such as:

  • eczema
  • asthma
  • hay fever
  • chronic allergic conjunctivitis

These can make lens wear difficult and painful. Dust, wind, pollen, smoke and air conditioning can also create problems. 

All these things can reduce daily lens wearing time and consequently the time available with good vision. Some people with keratoconus juggle a variety of different lenses and glasses over the day to manage work and studies. This takes time and effort, maintaining cleaning routines and hygiene during removal and insertion.

Surgery

Sometimes surgery becomes necessary and corneal transplants are carried out. The recovery process takes time. Stitches remain in place for about a year and new lenses cannot be fitted immediately.

Complications of keratoconus

Hydrops is a rare, but possible, complication of keratoconus. This is where the inner surface of the cornea breaks down, allowing aqueous fluid from the inner eye to flood the cornea. This results in blurred vision. 

Treatment is simply to wait for it to heal, which can take several months. The condition can be painful. At the acute stage, contact lenses cannot be worn. 

Infections and abrasions (damage to the surface) of the cornea are more common. They mean that a contact lens cannot be worn for a week or two resulting in very poor vision.

How keratoconus affects people at school and college

Keratoconus is not a visible condition, so there are no cues for others to pick up on. When someone with keratoconus is wearing glasses, they may not be getting good vision. They may also have had to remove their contact lenses and without them may be partially sighted. 

A student who can cope well in lessons or lectures in the morning may be struggling in the afternoon. Allergies, poor contact lens tolerance and corneal abrasions may also affect the pattern of contact lens use.

By the evening, the time for private study, eyes may be sore and strained, making it hard to keep up with assignments.

Emotional and psychological effects of keratoconus

When you cannot see properly you miss out on the visual cues that sighted people take for granted. 

These include: 

  • facial expression
  • body language
  • gestures

Simple activities like crossing a road, making a hot drink or inserting an electrical plug require concentration and take much longer. 

Trying to keep up with lessons or lectures with visual presentation is exhausting. 

These experiences often result in: 

  • loss of confidence
  • frustration
  • irritability

It is easy to feel excluded and to turn in on oneself. Some people with keratoconus get depressed with the constant daily struggle.

How to support students with keratoconus

Consult the individual student to understand their specific needs at different times of day and in different situations. Make all the teaching staff aware of these. 

With school students, it's helpful to: 

  • involve their parents
  • establish good practice as a routine

Suggestions for support include:

  • provide enlarged handouts (A3 from A4)
  • use black markers on whiteboards, rather than red or green
  • write large and legibly on boards
  • provide sight of hard copy of OHP slides during session, for example the originals
  • make sure that student has good lighting, a small reading lamp may be helpful
  • avoid glare from sunlight as it can be problematic
  • get advice from the LEA Special Needs Adviser on other measures, such as software packages for computers and specialist equipment
  • avoid embarrassing students, for example by asking them to read aloud from normal text, without checking whether they can see the text
  • accept homework and assignments word-processed, this allows the student to use a large font then reduce it
  • allow students to use black felt tip pen for assignments, when necessary
  • allow extra time in exams, especially open book exams
  • enlarge exam papers
  • make sure that the edges of stairs have a contrasting colour, otherwise they may look like a long ramp
  • allow more time, where necessary, for moving around the building
  • consult on ability to take part in sports
  • provide a clean place with running water and sink plug for inserting or cleaning contact lenses: student communal facilities may not be adequate

Where a student is taught IT or regularly uses a computer:

  • arrange that one computer has a large screen (19" preferably), funding for which may be available through your Special Educational Needs Co-ordinator (SENCO) and the guidance in the new Code of Practice for Special Educational Needs
  • enable one monitor in the regular room to be set with large font text wherever possible

These suggestions will vary with the individual.

With support and understanding from their schools and colleges, particularly when they're going through a difficult time, students with keratoconus can do well in their studies.

Students with keratoconus need practical support to access the curriculum and fulfil their learning potential.

A little understanding and consideration go a long way to making this possible.

Further information

For more information: 

Contact us
Sensory Support Service
Elmfield House
Greystoke Avenue
Westbury-on-Trym
BS10 6AY

Phone: 0117 903 8442
Text: 07407 814 763
Email: sensorysupportservice@bristol.gov.uk