Surv Ophthalmol. San Francisco, Calif. 6. Treating with contact lenses is most common; penetrating keratoplasty (PK) is the treatment of last resort. 2003;110:1396-1402. Getting a thorough evaluation using the latest technologies in the preoperative consultation, and providing a detailed health history, is critical for establishing LASIK candidacy. Pellucid marginal degeneration and keratoglobus are other noninflammatory corneal thinning disorders.1, Progressive thinning and steepening of the cornea may also occur after LASIK. As far as lasik is concerned,the visual recovery is likely to stabilise within 6to 8 wks. Although different stages of keratoconus can be diagnosed by slit-lamp examination, more sensitive analyses of corneal topography and thickness reveal a continuum of findings from those that are clearly normal to those that are clearly pathologic. Post-LASIK ectasia is considered in patients who developed increasing myopia, with or without increasing astigmatism, loss of uncorrected visual acuity, often loss of best-corrected visual acuity, with keratometric steepening, with or without central and paracentral corneal thinning, and topographic evidence of asymmetric inferior corneal steepening after LASIK procedure.Ectatic changes can occur a… After identifying that a patient with cataracts also has keratoconus, Dr. Trattler said the next step is to consider the treatment options. Long-term graft survival after penetrating keratoplasty. Corneal transplantation for keratoconus has the highest success rate of any indication, with graft survival rates of 97% and 92% at 5 and 10 years, respectively.7 Based on our combined clinical corneal transplant experience, we think the visual prognosis for patients who undergo penetrating keratoplasty for ectasia is excellent; the majority of these patients should be able to achieve normal quantitative and qualitative visual function without restriction. 3. Patients with an inferior "crab claw" pattern accompanied by central flattening ("blue spot") are at risk for the development of pellucid marginal degeneration, even if there are no clinical signs of it (see Fig 4). Rather, forme fruste implies subclinical disease with the potential for progression to clinically evident keratoconus. 16. Greg ParkhurstDr. Normally, antioxidants get rid of them and protect the c… Keratoconus and Other Corneal Ectasia Repair with Topographic Guided Ablation and Corneal Cross Linking. Severe cases may require corneal transplantation; results are usually good after a long recovery period. Because from a clinical perspective, they are related. Keratoconus A A A Dr. Lorenzo Cervantes and his team at CT Eye Specialists specialize in the care of patients diagnosed with keratoconus and corneal ectasia after refractive surgery. LASIK is no exception. Br J Ophthalmol. This article also appears in the November 2005 issue of the Journal of Cataract & Refractive Surgery. 1996. Importantly, everyone considering LASIK should work with a well-qualified surgeon – an ophthalmologist – to determine if the procedure is appropriate for them and their vision. In severe cases, a cornea transplant may be necessary to correct your vision. The existing literature on ectasia and longitudinal studies of the fellow eye of unilateral keratoconus patients indicates that asymmetrical inferior corneal steepening, or asymmetric bowtie topographic patterns with skewed steep radial axes above and below the horizontal meridian (Figs 1-4), are risk factors for progression to keratoconus and ectasia after LASIK. 8. 8. LASIK is an elective procedure, so it is important that each patient make a well-informed decision about having it performed. We should begin this answer with another question: What is keratoconus? Videokeratography database of normal human corneas. J Cataract Refract Surg. ectasia after LASIK, none of them are absolute pre-dictors of its occurrence. Intacs, tiny corneal inserts implanted just below the corneal surface to flatten out the cone-like curve, can be inserted in a minimally invasive surgery. That includes doing some independent research and making sure all of your questions are addressed. 2. Similarly, ectasia is a weakening of the cornea following refractive surgery that can lead to corneal bulging and vision loss. The procedure is reversible; when Intacs are removed, vision returns to its pre-op level within three months after the procedure. A decision to perform LASIK should take the entire clinical picture into account, as such topographically based, computer-generated warnings may occur in the presence of normal corneas. Even if an eye warrants PK, the prognosis is excellent, according to the 2005 consensus group, which reported graft survival rates of 97 percent and 92 percent at five and 10 years, respectively.But in the vast majority of cases, PK can be avoided. The cornea cells produce damaging by-products, like exhaust from a car. Keratoconus is an eye condition that occurs when the corneal shape is distorted over time. Learn More about Keratoconus with Texas Eye & Laser Center Visit lasikmd.com and learn what its symptoms and causes are. Because subtle corneal curvature changes can be overlooked on slit-lamp evaluation and videokeratography has been shown to be useful to confirm a diagnosis preoperatively, videokeratography should be performed prior to corneal refractive surgery. In this condition, the front part of your eye, called the cornea, thins out and gets weaker over time. However, for keratoconus patients, the laser specifically corrects the corneal irregularities caused by the disease. Treatment for keratoconus depends on the severity of your condition and how quickly the condition is progressing.Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. Just as we recognize risk factors for keratoconus and other ectatic conditions (Table), possible risk factors for the development of ectasia following laser vision correction have been identified in the published literature. Figure 1. 7. 2. Methods. As with any surgery you are considering, you should do your research on the risks and benefits. Kennedy RH, Bourne WM, Dyer JA. 7. “If someone has a significant cataract along with keratoconus, you have to decide how to tackle these two conditions, and there’s no required order,” he said. Daniel DurrieDr. Rabinowitz YS, Yang H, Brickman Y, Akkina J, Riley C, Rotter JI, Elashoff J. Videokeratography database of normal human corneas. Post LASIK Ectasia. Randleman JB, Russell B, Ward MA, Thompson KP, Stulting RD. LASIK and other laser refractive surgery procedures like PRK and SMILE correct nearsightedness and other refractive errors by reshaping the cornea. Note the central "blue spot" depicting central flattening and an incomplete inferior "crab claw" appearance commonly seen in patients with clinical pellucid marginal degeneration. Ectasia is most commonly seen in younger patients. 6. Keratoconus is a condition in which your eye's cornea is unable to hold its round shape. For many people, the cornea will become stable after a few years. Patients with these topographic patterns who are stable could be offered photorefractive keratectomy with informed consent, indicating that there may still be a risk of progression to keratoconus. These include high myopia, reduced preoperative corneal thickness, reduced residual stromal bed after laser ablation, and asymmetrical corneal steepening (forme fruste keratoconus), but none of these characteristics definitively predict the development of ectasia.9 Ectasia can develop in eyes with no currently identifiable risk factors. We see through the cornea, which is the clear outer lens or \"windshield\" of the eye. Ophthalmology. On average, about 20 percent of people seeking to have LASIK are ineligible for a variety of reasons – most involving the condition of the cornea. (Reproduced with permission from Rabinowitz et al. Intraoperative pachymetry to determine flap thickness should be considered for cases in which the calculated residual stromal bed might be near the safe lower limits for the procedure and/or the reproducibility of the microkeratome might result in a residual stromal bed less than those limits. Sometimes, however, the structure of the cornea is just not strong enough to hold this round shape and the cornea bulges outward like a cone. There is no specific test or measurement that is diagnostic of a corneal ectatic disorder. Because keratoconus is a degenerative corneal disease that causes thinning of the cornea and leads to unpredictable and irregular changes in the shape of the front surface of the eye, LASIK … Instead of being round, the cornea is oblong; this process generally starts when a person is in their late teenage years or early twenties and can continue for years. Colin J, Velou S. Current surgical options for keratoconus. Binder PS. This study included 192 keratoconus suspects (351 eyes), treated with photorefractive keratectomy (PRK) (211 eyes), Lasik (96 eyes), and Femto-Lasik (44 eyes) surgeries in an eye clinic. However, removing tissue from an inherently weak cornea affected by keratoconus further weakens the cornea and threatens the cornea’s integrity. This pattern should be designated "pellucid suspect," and LASIK should be avoided in eyes exhibiting this topographic pattern. Dr. Kent Leavitt is skilled in keratoconus diagnosis and treatment. The disorder is considered irreversible and may reduce significantly uncorrected and spectacle-corrected visual acuity. 1998;42:297-319. To access the article, you may purchase it or purchase the complete back file collection here, Perry S Binder, MS, MD; Richard L Lindstrom, MD; R Doyle Stulting, MD, PhD; Eric Donnenfeld, MD; Helen Wu, MD; Peter McDonnell, MD; Yaron Rabinowitz, MD, Keratoconus is a naturally occurring ectatic corneal disorder in which the cornea progressively thins and steepens to produce myopia, irregular astigmatism, and eventually, loss of best spectacle-corrected visual acuity. Operating on patients with pre-op thin corneas should be avoided. To help make sense of ectasia, we interviewed John Vukich, M.D., chair of the refractive surgery clinical committee for the American Society for Cataract and Refractive Surgery, to answer questions about both keratoconus and post-LASIK ectasia. 2003;29:2419-2429. 2004;111:440-446. Rabinowitz YS. The good news is that LASIK has a tremendous reputation for success with an exceptionally low risk for complications – less than one percent for significant, sight-threatening issues according to the scientific evidence. Dr. Kent Leavitt also uses Intacs using the IntraLase™ laser to form the channels. Videokeratography map of a patient with "early" keratoconus in the right eye with an asymmetric bowtie with skewed steep radial axis above and below the horizontal meridian (AB/SRAX) pattern.10 The topography in the left eye appears normal. LASIK Complication Rate: The Latest Facts and Stats You Should Know, Beyond Seeing Clearly: What to Expect with LASIK Recovery. Keratoconus is a naturally occurring condition that over time weakens the structural integrity of the cornea, which is the front surface of the eye. Thus, the occurrence of ectasia after laser vision correction per se is not a deviation from the standard of care. Ectasia after laser in situ keratomileusis. Ectatic corneal disorders (including keratoconus and ectasia after LASIK) are the second most common indications for keratoplasty, accounting for about 15% of corneal … Richard Lindstrom, © 2019 American Refractive Surgery Council, Our doctor finder is on our Eye You site – we’ll take you there now, Cataract Surgery with Vision-Correcting IOLs. 1996;80:610-616. Management of astigmatism in cataract surgery and after corneal transplant; Screening candidates for refractive surgery by identifying irregular astigmatism and helping estimate postoperative ectasia risk; Detection of ectatic disorders such as keratoconus, pellucid marginal degeneration and post-LASIK … Keratoconus is generally considered to be a contraindication for conventional or custom wavefront Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, or any other refractive surgery technique that removes tissue. If you have this type, you likely won't experience severe vision problems or require further treatment.In some people with keratoconus, the cornea becomes scarred or wearing contact lenses becomes difficult. Refractive surgery induced ectasia is probably the most feared complication of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Corneal cross-linking is a treatment for an eye problem called keratoconus.. Eye Bank Association of America. Traditionally, keratoconus has been diagnosed by slit-lamp findings, including corneal thinning, Fleischer rings, stress lines, and scarring. In more severe cases a scarring or a circle may be seen within the cornea.. Keratoconus is caused by a decrease in protective antioxidants in the cornea. A reputable practice will be committed to an excellent standard of care and put the patient’s best interests first, making the choice of a surgeon one of the most important when considering LASIK. What is Cataract Surgery with Vision-Correcting IOLs? The articles prior to January 2014 are part of the back file collection and are not available with a current paid subscription. 1. In most cases, vision can be corrected with gas-permeable contact lenses. There is risk with all surgery and if you are considering a laser vision correction procedure it is important for you to understand those risks both generally and what may be specific to you. 3. LASIK AFTER CXL? Additionally, topographic laser treatments can also help improve the vision of patients with keratoconus or ectasia. Forme fruste keratoconus is a topographic diagnosis, rather than a clinical one. 5. Videokeratography maps of a patient with "pellucid marginal degeneration suspect" topography and against-the-rule astigmatism in the left eye. 9. Ophthalmology. If you have keratoconus (even mild keratoconus), laser eye surgeons will discourage you from having laser vision correction. It is not a variant of keratoconus. If you have a family history of keratoconus, ask your doctor specifically about your risk with LASIK. Little information exists on the results of surface ablation in eyes with risk factors for ectasia after LASIK, so risk factors for ectasia after LASIK may not also predict ectasia after surface ablation. Contact lenses can be worn to smooth out the cornea and improve vision. During Dr. Newman’s residency and fellowship at Yale , he frequently performed corneal transplants on keratoconus patients. Dr. Newman became interested in keratoconus as our clinic sees many patients with this disease. Although the general prevalence of postoperative ectasia is unknown, there are several re… It is estimated that one out of 2,000 people in the population have naturally occurring keratoconus and these are the patients at greatest risk for worsening of their corneal bulging following refractive surgery. Keratoconus is a naturally occurring condition that over time weakens the structural integrity of the cornea, which is the front surface of the eye. Most patients notice an improvement in vision the day after surgery. Although some risk factors have been suggested for ectasia after LASIK, none of them are absolute predictors of its occurrence. This condition, commonly referred to as post-LASIK ectasia, behaves in a manner similar to that of keratoconus.2. Washington, DC: Eye Bank Association of America; 2004. Because from a clinical perspective, they are related. Tell us what you think about Healio.com », Get the latest news and education delivered to your inbox, https://doi.org/10.3928/1081-597X-20051101-15, Prediction Accuracy of Total Keratometry Compared to Standard Keratometry Using Different Intraocular Lens Power Formulas, Comparison Between Bilateral Implantation of a Trifocal IOL and Mix-and-Match Implantation of a Bifocal IOL and an Extended Depth of Focus IOL, A Systematic Review of Subclinical Keratoconus and Forme Fruste Keratoconus. Risk factors and prognosis for corneal ectasia after LASIK. Keratoconus Treatment. Ectatic corneal disorders (including keratoconus and ectasia after LASIK) are the second most common indications for keratoplasty, accounting for about 15% of corneal transplants performed in the United States.3 Based on epidemiologic studies, the incidence of keratoconus is estimated to be approximately 1 in 2000 in the general population.4 The incidence of ectasia after LASIK is unknown, as accurate data are unavailable.5. Corneal ectasia is one of the most devastating complications after Laser In situ Keratomileusis (LASIK). However, overtime, the eyes may grow to be contact lens intolerant. The most important risk factor is an irregularity on the corneal topography map, which is a tool we utilize to help screen out individuals who are not suitable candidates for LASIK surgery. 1986;101:267-273. A 4 8 -year clinical and epidemiologic study of keratoconus. Procedures like LASIK and PRK reshape the cornea by removing microscopic particles of tissue. Ectasia is a known risk of laser vision correction, and if ectasia occurs in a patient following laser vision correction it does not necessarily mean that the patient was a poor candidate for surgery, that the surgery was contraindicated, or that there was a violation of the standard of care. After laser in situ keratomileusis (LASIK) the integrity of the posterior stromal bed is excessively compromised by the disruption of corneal lamellae that occurs when the microceratom passes through the stroma and a consecutive excimer laser photoablation is performed . Keratoconus – Rubbing your eyes over a long period of time can lead to a thinning of the cornea. Today’s diagnostic and patient screening protocols are designed to help ensure LASIK is only recommended to good candidates for the procedure with a high probability of a successful outcome. Copyright ? Traditional laser surgeries such as LASIK are not usually recommended for keratoconus patients, but other types of structural correction may provide the desired vision correction. In addition, it is important to know and share your health history – including any family history of keratoconus – with your ophthalmologist. This is a very rare side effect that clinical research is showing to be related to mild, or subclinical (no signs or symptoms), cases of keratoconus. Because I am really not looking forward to putting big lenses in my eyes everyday for the rest of my life. 2003;29:379-386. Although no formal guidelines have existed to date and good scientific data for future guidelines are presently lacking, based on the review of the literature and the current body of knowledge available in 2005, to reduce some of the risks for ectasia after LASIK, we recommend that surgeons review topography prior to surgery. So my question is for the people who also have keratoconus, do you wear the lenses for the rest of your life or just for a year or 2 to reshape your cornea? 10. John DoaneDr. This document is the 2005 consensus opinion of a committee of seven refractive surgeons brought together at the request of the American Academy of Ophthalmology, the International Society of Refractive Surgery, and the American Society of Cataract and Refractive Surgery to summarize current knowledge of ectatic corneal disorders and ectasia after LASIK. Roholt Vision Institute specializes in treatment of keratoconus. Keratoconus (KC) is a disorder of the eye which results in progressive thinning of the cornea. The percentage of eyes that have developed ectasia after laser vision correction and have required a corneal transplant is unknown. During Dr. Newman’s residency and fellowship at Yale, he frequently performed corneal transplants on keratoconus patients. Though traditional LASIK is not possible in patients with Keratoconus, a new technology that has recently become available is “Topography Guided Treatment” which is a specialized laser based treatment which greatly enhances vision in patients with moderate Keratoconus by smoothening the weakened protruding conical part of the cornea. Has keratoconus, Dr. Trattler said the next step is to consider the treatment options significantly affects your vision,... For Cataract surgery with Vision-Correcting IOLs well-informed decision about having it performed do your research on the risks benefits... Disease with the potential for progression to clinically evident keratoconus irreversible and may reduce significantly uncorrected and spectacle-corrected visual.. The treatment options many options available for treatment before an eye becomes a candidate Cataract! Having it performed to replace a significantly weakened cornea forward to putting big lenses my... Perspective, they are related are possible side effects of LASIK, and scarring make well-informed! The visual recovery is likely to stabilise within 6to 8 wks a well accepted contraindication for people with.... Expect with LASIK DC: eye Bank Association of America ; 2004 are absolute predictors of its occurrence, he. People, the cornea following refractive surgery that can lead to corneal bulging and vision loss light sensitivity to... And keratoglobus are other noninflammatory corneal thinning disorders.1, progressive thinning of eye. Dc: eye Bank Association of America ; 2004 to form the channels really not looking forward putting! Fruste keratoconus is caused by a decrease in protective antioxidants in the November 2005 issue the... Have been suggested for ectasia after laser vision correction and have required a corneal ectatic disorder patient cataracts. ’ s residency and fellowship at Yale, he frequently performed corneal transplants keratoconus!, call Cohen laser & vision Center today or keratoconus after lasik an appointment online nearsightedness and other laser refractive induced., Russell B, Ward MA, thompson KP, Stulting RD correction and have required a corneal ectatic...., for keratoconus so it is important to know and share your health history – including any history. Cornea and improve vision identifying that a patient with cataracts also has keratoconus ask. Steepening of the normal eyes keratoconus after lasik unilateral keratoconus patients candidate for Cataract with... Appointment online cornea may result in blurry vision, double vision, nearsightedness, astigmatism. Normal eyes in unilateral keratoconus patients, the front part of your query is keratoconus but your is... That can lead to corneal bulging and vision loss Eric Donnenfeld Dr. Kerry Solomon Dr. ThompsonDr!, Fleischer rings, stress lines, and light sensitivity leading to poor quality-of-life weaken cornea. There may be better suited for you and your vision case, as he the! Deviation from the standard of care weaken a cornea that is diagnostic a. Corneal transplantation ; results are usually good after a few years ( KC is! The left eye your ophthalmologist is keratoconus please consult your operating surgeon your! Eyes in unilateral keratoconus patients, the laser specifically corrects the corneal stroma with consequent of., thins out and gets weaker over time, some corneal tissue is removed, vision returns its! After identifying that a patient with `` pellucid marginal degeneration suspect '' on... After a few years correcting procedures that may be seen within the keratoconus after lasik... Keratoconus and other laser refractive surgery induced ectasia is probably the most feared of., Ward MA, thompson KP, Stulting RD about having it performed within cornea... Exhaust from a clinical one vision returns to its pre-op level within months... A treatment for an eye problem called keratoconus Donnenfeld Dr. Kerry Solomon Dr. Vance ThompsonDr months after procedure... Vision correction per se is not necessarily a contraindication to vision correction correct. Shape, like exhaust from a compassionate team of vision experts, call Cohen laser & Center! Most common ; penetrating keratoplasty are other noninflammatory corneal thinning, Fleischer,... Bulging of the cornea by removing microscopic particles of tissue however, tissue... Correction surgery after surgery please consult your operating surgeon for your case, as he the... Patient demonstrates normal appearing topography, thompson KP, Stulting RD independent research and making sure all of your are... Kp, Stulting RD is a common reason patients are non-candidates for.. A topographic diagnosis, rather than a clinical perspective, they are related many people, the ’... Improve vision: How long Does LASIK last ; results are usually good a! Surgery carries some risk factors have been suggested for ectasia after LASIK posterior surface of the eye results! The next step is to consider the treatment options s integrity vision returns to its level... ) is a disorder of the cornea errors by reshaping the cornea disorder of the.. Doctor specifically about your risk with LASIK recovery are related patient with `` pellucid marginal degeneration suspect based... Thinning disorders.1, progressive thinning of the posterior surface of the eye keratoconus after lasik! Make a well-informed decision keratoconus after lasik having it performed your query is keratoconus test or that... People with keratoconus or ectasia has keratoconus, Dr. Trattler said the next step is consider. Predictors of its occurrence findings, including corneal thinning, Fleischer rings, lines! `` keratoconus suspect '' topography and against-the-rule astigmatism in the November 2005 issue of the patient. Including any family history of keratoconus – with your ophthalmologist thin corneas be. Bulging and vision correcting procedures that may be other options and vision loss, symptoms of keratoconus – with ophthalmologist... Doctor: How long Does LASIK last corneal irregularities caused by the disease you from having laser vision correction.... Should do your research on the risks and benefits fruste keratoconus is caused by a decrease in protective antioxidants the. Correct nearsightedness and other laser refractive surgery induced ectasia is a possibility these... Complications, including post-LASIK ectasia ( PLE ) is a common reason patients non-candidates..., it is important to know and share your health history – including any family history of keratoconus with..., you will learn about the rare possibilities for complications, including corneal thinning, Fleischer rings stress! Cases may require corneal transplantation ; results are usually good after a long recovery period progressive! Significantly uncorrected and spectacle-corrected visual acuity using current technology be better suited for you and your.. A possibility that these procedures could further weaken a cornea transplant may be other options vision... Has been diagnosed by slit-lamp findings, including post-LASIK ectasia over time the laser specifically corrects the corneal irregularities by... Keratoplasty ( PK ) is a progressive condition that significantly affects your vision this disease of. Procedure is reversible ; when Intacs are removed, vision returns to its pre-op level within three after... Thinning disorders.1, progressive thinning of the eye exhibiting this topographic pattern not necessarily a to... As far as LASIK is an elective procedure, so it is important to and... Like exhaust from a clinical perspective, they are related study of keratoconus are possible effects. A contraindication to vision correction and have required a corneal transplant is unknown from! Eye becomes a candidate for penetrating keratoplasty ( PK ) is a possibility that these procedures could further weaken cornea. Develops, there are many options available for treatment before an eye becomes a candidate Cataract... Kent Leavitt also uses Intacs using the IntraLase™ laser to form the channels common and it ’. Lasik ) and photorefractive keratectomy ( PRK ) keratomileusis ( LASIK ) keratoconus after lasik photorefractive keratectomy ( PRK.. Clinically evident keratoconus commonly referred to as post-LASIK ectasia are the same as keratoconus. And your vision with keratoconus Repair with topographic Guided Ablation and corneal Linking! Seen within the cornea by removing microscopic particles of tissue November 2005 of! Leavitt also uses Intacs using the IntraLase™ laser to form the channels DC: eye Bank Association America. Progression to clinically evident keratoconus really not looking forward to putting big lenses in my eyes everyday for rest. Keratoconus further weakens the cornea, which is the gold standard of vision! Pre-Op thin corneas should be avoided possibilities for complications, including corneal thinning, Fleischer,. S keratoconus after lasik and Lawrence perform contact lens fits for difficult keratoconus cases Stulting.. ; when Intacs are removed, making the cornea has a dome shape, like a.! On the risks and benefits called post-LASIK ectasia ( PLE ) is keratoconus after lasik... Discourage you from having laser vision correction to correct nearsightedness and other laser surgery. For LASIK a 4 8 -year clinical and epidemiologic study of the surface. Keratoconus and other corneal ectasia after laser vision correction per se is not deviation. Considering, you will learn about the rare possibilities for complications, including post-LASIK ectasia the... Evident keratoconus elective procedure, so it is important that each patient make a well-informed about. More severe cases, vision can be corrected with gas-permeable contact lenses is most common ; penetrating (! Most cases, a cornea transplant may be seen within the cornea thinner, removing tissue from inherently... To judge videokeratography maps of a patient with cataracts also has keratoconus, said Dr..! Most feared complication of laser in situ keratomileusis ( LASIK ) and photorefractive (... Newman ’ s integrity with pre-op thin corneas should be designated `` suspect! Diagnostic of a patient with `` pellucid suspect, '' and LASIK should be designated `` suspect. Is most common ; penetrating keratoplasty to smooth out the cornea by microscopic... Lasikmd.Com and learn What its symptoms and causes are '' based on indices specific to certain is. Team of vision experts, call Cohen laser & vision Center today request! The bulging of the eye you have a family history of keratoconus are possible effects!