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WARNING: MAY BE TOO GRAPHIC FOR SOME VIEWERS. He or she may conduct other tests to determine more details regarding the shape of your cornea. Ophthalmology. Keratoconus treatment depends largely on a patient’s symptoms. This condition is called keratoconus. Another common progression is from soft contact lenses to toric or astigmatism correcting contact lenses, to rigid gas permeable contact lenses. Mas Tur V, et al. 25 examples: The medical sign is characteristic of advanced cases of keratoconus and is… A thorough and complete eye exam should be performed on any patient suspected of having keratoconus. Mayo Clinic. Specialty contact lenses have been developed to better fit the irregular and steep corneas found in keratoconus; these include (but not limited to) RoseK, custom-designed contact lenses (based on topography and/or wavefront measurements), semi-scleral contact lenses, piggyback lens use ( hard lens over soft lens), scleral lenses, hybrid lenses, and PROSE (prosthetic replacement of the ocular surface ecosystem). I was diagnosed with Keratoconus in 1994 while in my last year studying to be an American Sign Language Interpreter. All rights reserved. Variations of this conventional "epithelium-off" technique involve higher intensities of UV for shorter time periods (accelerated cross-linking) or non-removal of the epithelium ("epithelium-on") techniques. If Keratoconus is left untreated, the condition will gradually deteriorate. The FDA trial and most European data sets demonstrate a high success rate for the conventional epithelium-off cross-linking approach. Rigid contact lenses or corneal transplantation may be necessary to provide good vision. I did a bit of searching for good examples of how life looks when you have Keratoconus…. This image is for illustrative purpose only, keratoconus affects both eyes but each eye may be affected differently, and patients may experience different vision … New algorithms using computerized videokeratography have been devised which now allow the detection of forme fruste, subclinical, or suspected keratoconus. Traditional corneal collagen cross-linking involves a minimally invasive treatment through the removal of the corneal epithelium followed by soaking of the cornea in riboflavin drops and a slow exposure of the cornea to UV light. Most patients will need spectacles and/or contact lenses post-operatively for best vision but will have flatter corneas and easier use of lenses. "Progression" of keratoconus, even after corneal surgery, has been reported, but it is not clear how common or to what extent this can occur. The general health of the eye should be assessed and appropriate ancillary tests should be done to assess corneal curvature, astigmatism, and thickness. This page has been accessed 300,660 times. It generally begins to affect people between the ages of 10 and 25. This treatment, approved by the FDA in the Spring of 2016 and CE marked 10 years earlier throughout Europe in 2006, uses riboflavin and UV light to induce stiffening of the otherwise weak and flaccid keratoconic cornea. They include: See your eye doctor (ophthalmologist or optometrist) if your eyesight is worsening rapidly, which might be caused by an irregular curvature of the eye (astigmatism). Computerized videokeratography is useful in detecting early keratoconus and allows following its progression. Often the cause of keratoconus is unknown. It can worsen over time. this is called irregular astigmatism. A small number of cases of keratoconus keep getting worse, however, and, eventually, contact lenses cannot give clear vision. Keratoconus (ker-uh-toe-KOH-nus) occurs when your cornea — the clear, dome-shaped front surface of your eye — thins and gradually bulges outward into a cone shape. 5th ed. The cause of keratoconus is currently unknown. Mukhtar S, et al. It affects men and women equally. The American Academy of Ophthalmology's Pathology Atlas contains a virtual microscopy image of Keratoconus. Aug 19, 2020 - Keratoconus Group Corneal Transplant Queratocono Keratocone Cheratocono Ceratocone Ophthalmology Optometry Scleral Contact Lens Crosslinking. A new treatment called corneal collagen cross-linking may help to slow or stop keratoconus from progressing, possibly preventing the need for a future cornea transplant. Here are the images I found. 0:00 / 1:01. •. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Patients are usually given a cycloplegic agent, sodium chloride (Muro) 5% ointment, and may be offered a pressure patch. This site complies with the HONcode standard for trustworthy health information: verify here. Search for: Search. Most cases of keratoconus become apparent during a person's teens or early 20s. Maximum corneal thinning corresponds to the site of maximum steepening or prominence. Keratoconus is caused by a decrease in protective antioxidants in the cornea. Patients with associated medical conditions should have these attended to properly. Example of Early Keratoconus as evidenced on a Placido-disc based topographic evaluation, Example of Keratoconus as evidenced on a Pentacam Scheimpflug evaluation. Kunimoto, Kanitkar, & Makar. Eye refraction. Survey of Ophthalmology. June 16, 2020. 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. Yanoff M, et al., eds. This content does not have an English version. Rizutti’s sign or a conical reflection on the nasal cornea when a penlight is shone from the temporal side, Fleischer ring, an iron deposit often present within the epithelium around the base of the cone. After the pressure patch is removed patients may still need to continue sodium chloride drops or ointment for several weeks to months until the episode of hydrops has resolved. He or she may also look for signs of keratoconus during routine eye exams. This allows the physician to determine if the cross-linking treatment is indicated. However, the changes to the cornea will make it impossible for the eye to focus well even with glasses or soft contact lenses. Help other patients by sharing your keratoconus experiences. This can cause blurry, distorted vision. The goals of treatment are to provide functional visual acuity and to halt changes in the corneal shape if progressing. The best potential vision should also be evaluated. Lippincott, 2004. Any type of refractive procedure is considered a contraindication in keratoconic patients due to the unpredictability of the outcome and risk of leading to increased and unstable irregular astigmatism. Keratoconus. Those patients that become contact lens intolerant or do not have an acceptable vision, typically from central scaring, can proceed to surgical alternatives. All surgical patients need to be followed to ensure wound healing, evaluation for infection, suture removal, and other routine eye care, such as testing for glaucoma, cataracts, and retinal disease. Eyeglasses can correct vision for patients with mild symptoms, for example, and for those in the early stages of keratoconus. keratoconus changes vision in two ways: * as the cornea changes from a ball shape to a cone shape, the smooth surface becomes wavy. Atopic or vernal conjunctivitis should be treated using topical anti-histamines, mast cell stabilizers, or anti-inflammatory/immunomodulatory treatments such as topical steroids, cyclosporine, tacrolimus, or lifitegrast. In other cases, the keratoconus or the use of contact lenses over the years will have side effects. It usually affects both eyes but may be worse in one eye than the other. It causes your cornea to become thin and bulge into a cone-like shape, resulting in distorted vision. Corneal thinning, especially in the inferior cornea. Examples of Keratoconic Vision Simulations - Keratoconus and my DALK Corneal Transplant. American Optometric Association. Specially made soft contact lenses may also correct vision. Keratoconus is an uncommon corneal disorder where the central or paracentral cornea undergoes progressive thinning and steepening causing irregular astigmatism. Examples of keratoconus in a sentence, how to use it. The advantage of ICRS is that they require no removal of corneal tissue, no intraocular incision, and leave the central cornea untouched. There are several techniques utilized including, manual dissection and big bubble technique to remove the anterior stroma while leaving Descemet’s layer and endothelium untouched. The primary treatment for progressive keratoconus, or keratoconus in young patients likely to progress at some point, is corneal collagen cross-linking. ICRS can provide long-term success for patients with keratoconus, but this is typically in conjunction with contact lens use, and some may ultimately require a corneal transplant to reach their goals of visual rehabilitation. AskMayoExpert. Munson’s sign, a protrusion of the lower eyelid in downgaze. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Keratoconus Vision Example - Power Light 195,220 Participate in our blog! A scarred cornea causes worsening vision problems and may require cornea transplant surgery. This is caused by a condition in which the inside lining of your cornea breaks down, allowing fluid to enter the cornea (hydrops). A review of keratoconus: Diagnosis, pathophysiology, and genetics. Keratoconus is a progressive eye disease that causes a thinning of the clear front surface of the eye (cornea) and distorts the cornea into a cone-like shape.. Keratoconus causes distorted vision that cannot be corrected with eyeglasses.. 2018;38:2257. A cone-shaped cornea causes blurred vision and may cause sensitivity to light and glare. Since the incidence of sleep apnea is very high in keratoconus, and because this condition may contribute to the pathogenesis of keratoconus and other medical conditions, all keratoconus patients should be questioned regarding sleep habits. These devices may allow better screening of patients for prospective refractive surgery. 2. The Associations of Floppy Eyelid Syndrome: A Case Control Study. The cornea can swell suddenly and start to scar. https://www.aao.org/eye-health/diseases/what-is-keratoconus. Unfortunately, Keratoconus is not curable at this time. Many of the potential exam components are listed below: Progressively poor vision not easily corrected with eyeglasses. H.E., Barron, L., McDonald, M.B., eds., The Cornea, 2d ed., 1996. This treatment may be offered in addition to the vision correction options above. If a patient does not gain the expected results, ICRS can be removed, and then other surgical options can be considered. Keratoconus usually affects both eyes and generally begins to first affect people ages 10 to 25. It is brown in color and best visualized with a cobalt blue filter. Admin. Etiology is unknown. Measurement of best-corrected visual acuity with spectacles and hard or gas permeable contact lenses (with refraction when indicated), Retinoscopy to check for scissoring reflex, Slit-lamp biomicroscopy of the anterior segment including lid tightness and papillae in upper tarsal conjunctiva, Keratomety/Computerized Topography/Computerized Tomography/Ultrasound Pachymetry, Asymmetric refractive error with high or progressive astigmatism, Keratometry showing high astigmatism and irregularity (the axis that does not add to 180 degrees), Scissoring of the red reflex on retinoscopy, Inferior steepening, skewed axis, or elevated keratometry values on K reading and computerized corneal topography. Bisbe L, Deveney T, Asbell PA. Big Bubble Keratoplasty, Expert Rev Ophthalmol. This procedure, also called corneal collagen cross-linking or CXL, strengthens … Many patients after PK may still need hard or gas-permeable contact lenses due to residual irregular astigmatism. 2017;62:770. In: Ophthalmology. Patients are usually followed on a 3 to 6-month basis to monitor the progression of the corneal thinning, steepening, the resultant visual changes, and to re-evaluate the need for cross-linking and patient contact lens fit and care. If you have any questions be free to comment below. For some people, though, keratoconus can get worse quickly. The hereditary pattern is neither prominent nor predictable, but positive family histories have been reported. In some patients, avoidance of allergens may help decrease eye irritation and therefore decrease eye rubbing. ICRS have also been approved for the treatment of mild to moderate keratoconus in patients who are contact lens intolerant. keratoconus meaning: 1. an eye problem that changes the shape of the cornea (= the transparent outer covering of the…. Medical therapy for patients who have an episode of corneal hydrops involves acute management of the pain and swelling. Sleep studies and CPAP mask wear if found necessary are recommended for at-risk patients. EyeMed’s present claim form connects moderate/advanced disease with the ICD-10 classification for “unstable” disease, even though severity and stability are independent characteristics. Computerized videokeratography is also useful in detecting early keratoconus and allows following its progression. When the cornea has scar tissue, it loses its smoothness and becomes less clear. For example, EyeMed Vision Care currently reimburses contact lens services and materials for keratoconus at a higher level if the patient has “moderate/advanced” disease. It’s not entirely clear what causes keratoconus. A complete ocular and medical history should be taken, including change in eyeglass prescription, decreased vision, history of eye rubbing, medical problems, allergies, and sleep patterns. Is Conductive Keratoplasty the Treatment of Choice for Presbyopia? Patients should be informed not to rub their eyes. The less affected eye may show a high amount of astigmatism or mild steepening. Accessed Jan. 7, 2019. The majority of patients that can wear hard or gas-permeable contact lenses have a dramatic improvement in their vision. Treatment options for keratoconus focus on correcting the distorted vision caused by the thinning and bulging of the cornea. Morrow ES Jr. Allscripts EPSi. Basic and Clinical Science Course, AAO, 2006. sleeping with the hand against the eye) can cause and/or lead to the progression of keratoconus. Diagnosis can be made by slit-lamp examination and observation of central or inferior corneal thinning. Keratoconus makes fitting contact lenses much more tricky and these lenses have to fit like a glove in order to give you the best comfort and vision. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. While my left eye's keratoconus stopped progressing, the eye vision quality was still very bad, that's until I undergone topography-guided PRK on it in 2015, after which I could see 20/20 with hyperopic correction (or 20/20 unaided by manually focusing my eye). To diagnose keratoconus, your eye doctor (ophthalmologist or optometrist) will review your medical and family history and conduct an eye exam. It may be more common in certain ethnic groups, for example, keratoconus affects about 1 in 450 South Asian people. Patients are advised to avoid vigorous eye rubbing or trauma. Patients with hydrops are seen more frequently until it resolves. Keratoconus may also be more common in certain ethnic groups, for example, keratoconus affects about 1 in 450 South Asian people. Keratoconus is a little-understood disease with an uncertain cause, and the course of its progression following diagnosis is unpredictable. Stromal scarring after the resolution of acute hydrops, which paradoxically may improve vision in some cases by changing corneal curvature and reducing irregular astigmatism. The prognosis for penetrating keratoplasty in a keratoconic patient is excellent, with most patients able to return to an active lifestyle and the pursuit of personal goals. Keratoconus. Examples of a normal-shaped eye and a dome-shaped keratoconus eye are shown here. Keratoconus – Essay Sample. Histopathology studies demonstrated breaks in or complete absence of Bowman’s layer, collagen disorganization, scarring, and thinning. While a genetic predisposition to keratoconus is suggested, a specific gene has not been identified. Learn more. The majority of patients with keratoconus can be fitted with contact lenses, and their vision significantly improves with that. Graft rejection can occur after penetrating keratoplasty, requiring prompt diagnosis and treatment to ensure graft survival. Keratoconus, let's fight this disease together. Keratoconus
KC is a progressive and degenerative disease of the cornea
Vision is affected in several ways simultaneously, including ghosting, blurring, double vision, and a haloing effect
Both genetic factors and mechanical strain have been hypothesized to lead to the disease
Course of treatment varies from mild KC (glasses) to moderate KC (special contact … [citation needed]. Keratoconus (ker-uh-toe-KOH-nus) occurs when your cornea — the clear, dome-shaped front surface of your eye — thins and gradually bulges outward into a cone shape.A cone-shaped cornea causes blurred vision and may cause sensitivity to light and glare. Corneal crosslinking. This page was last modified on June 28, 2020, at 08:30. However, when patients become intolerant or no longer benefit from contact lenses, surgery is the next option. Live. Keratoconus usually affects both eyes, though it often affects one eye more than the other. Examples of Keratoconic Vision Simulations By RC On February 23, 2011 August 28, 2015 In Interesting Stuff , Surgery-Story Tagged surgery-story 8 Comments facebook The advantages are that the risk of endothelial graft rejection is eliminated, and there is less risk of traumatic rupture of the globe in the incision, since the endothelium and Descemet’s and some stroma are left intact, and faster visual rehabilitation. These follow-up visits also allow for re-evaluations of contact lens fit and care. Keratoconus is an eye condition in which the shape of the cornea becomes distorted. Most patients still require vision correction with spectacles or contact lenses, and often hard or gas permeable lenses are required if high levels of astigmatism are present. Later, you may have to be fitted with rigid, gas permeable contact lenses or other types of lenses, such as scleral lenses. However, the procedures can be technically challenging requiring conversion to penetrating keratoplasty, and post-operatively there is the possibility of interface haze leading to a decrease in BCVA; it is not clear if astigmatism is better treated with DALK vs PK. Join us at 10:30 on. This condition is called keratoconus. Some surgeons will use phakic IOLs to address high myopia and some of astigmatism. The etiology of these changes is unknown, though some suspect changes in enzymes that lead to the breakdown of collagen in the cornea. Basic and Clinical Science Course, AAO, 2006. For visual improvement and astigmatism management, spectacles or soft toric contact lenses can be used in mild cases. Mayo Clinic, Rochester, Minn. Oct. 9, 2018. Signs and symptoms of keratoconus may change as the disease progresses. International Ophthalmology. [2]. 2009 Jun; 93(6):820-4. International Ophthalmologists contest rules, https://www.aao.org/eye-health/diseases/keratoconus-list, National Institutes of Health Clinical Trial Registry, https://www.aao.org/resident-course/pathology-atlas, https://eyewiki.org/w/index.php?title=Keratoconus&oldid=58700, Eye rubbing, associated with atopy or vernal keratoconjunctivitis. In these cases, patients must have a clear central cornea and a corneal thickness of > 450 microns where the segments are inserted, approximately at 7 mm optical zone. Mayo Clinic is a not-for-profit organization. Intracorneal Ring Segments and Alternative Treatments for Corneal Ectatic Diseases. Around 1 in 10 people with keratoconus also have a parent with the condition. I went from wearing soft contact lenses to correct a slight astigmatism, to not being able to see the color of stop lights, people’s faces, or stairs. The cornea cells produce damaging by-products, like exhaust from a car. Piggybacking a Rigid Gas Permeable Lens on a Soft Contact Lens This is not routinely done but worth mentioning because some patients still use this modality of contact lense wear. About 1 in 2000 people develop keratoconus. For most people with keratoconus, the only treatment needed is the correct prescription for eyeglasses or contact lenses. Keratoconus usually takes years to go from early- to late-stage. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Refractive Surgery, Section 13. : Intacs Corneal Rings Segments. Colin J., Ertan A., eds. Krachmer, Palay. 2009; 4(5):553-561. Acute hydrops, a condition where a break in Descemet’s membrane allows aqueous enter into the stoma causing severe corneal thickening, decreased vision, light sensitivity, tearing, and pain. Keratoconus is a common corneal disorder where the central or paracentral cornea undergoes progressive thinning and steepening causing irregular astigmatism. A single copy of these materials may be reprinted for noncommercial personal use only. Edinburgh, U.K.: Elsevier; 2019. https://www.clinicalkey.com. For a small number of people, about 10-14 per cent, keratoconus can run in the family, but this means that most people have no family history of keratoconus. Jan. 7, 2019. Keratoconus can show the following pathologic findings; fragmentation of Bowman’s layer, thinning of stroma and overlying epithelium, folds or breaks in Descemet’s membrane, and variable amounts of diffuse corneal scarring. 2010; 117: 831-838. Lema I, Sobrino T, Durán JA, Brea D, Díez-Feijoo E. Br J Ophthalmol. Examples include conditions such as keratoconus, keratoglobus, pellucid marginal degeneration, and corneal ectasia after surgery. https://www.uptodate.com/contents/search. Keratoconus is a vision disorder that start s developing during your teens or early 20s. The Wills Eye Manual, 4th Edition. No preventive strategy has been proven effective to date. Accessed Jan. 7, 2019. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, FREE book offer – Mayo Clinic Health Letter, New Year Special -  40% off – Mayo Clinic Diet Online. No one knows what causes keratoconus, although genetic and environmental factors are thought to be involved. DALK involves the replacement of the central anterior cornea, leaving the patient’s endothelium intact. Elsevier, 2006. The majority of cases of keratoconus are bilateral, but often asymmetric. There is often a history of frequent changes in eyeglasses prescription that do not adequately correct vision. Kudret Eye Hosital, Kavaklidere-Ankara, Turkey.Asbell, P.A. Zoom Coffee Morning. In keratoconus, your cornea thins and gradually bulges outward into a cone shape. Cornea Atlas, 2nd Edition. American Academy of Ophthalmology. The condition may progress slowly for 10 years or longer. Vision Examples. As a result, vision grows even more distorted and blurry. Risks of this procedure include infection and cornea rejection and risk of traumatic rupture at the wound margin. The disease usually does not cause blindness. Since the availability of corneal collagen crosslinking, patients are usually followed on a 3 to 6-month basis to monitor the progression of the corneal thinning and steepening and the resultant visual changes. Keratoconus and other ectasias. Post-Keratoplasty: A keratoplasty is also known as a corneal transplant. Onset is typically in early adolescence and progresses into the mid-20’s and 30’s. Make a donation. Here are some examples of what a person with Keratoconus sees: For a full range of Images of Keratoconus on Google – Click Here. These generally disappear with firm pressure applied over the eyeball and re-appear when pressure is discontinued. Other approaches have shown some promise and success but overall have been less consistent and reliable in their abilities to halt keratoconus. Vogt’s striae, fine, roughly vertically parallel striations in the stroma. Keratoconus, pronounced KEHR-a-toh-kohn-nus, is a vision disorder that occurs when the normally round, dome-shaped cornea progressively thins, causing a cone-like bulge to develop. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Ezra DG, Beaconsfield M, Sira M. et al. However, cases may begin much earlier or later in life. In the early stages of keratoconus, you might be able to correct vision problems with glasses or soft contact lenses. We have been able to significantly improve vision in Keratoconus patients and having a complete eye examination by our laser eye doctor experts can diagnose the condition early, making it easier to treat and correct. Normally, the cornea has a dome shape, like a ball. Advanced keratoconus also may cause your cornea to become scarred, particularly where the cone is most prominent. In: Probst, L.E., Doane, J.F., Refractive Surgery: A color synopsis. It seemed to pop-up overnight. Infection, poor wound healing, cornea transplant rejection, corneal neovascularization, graft-host junction thinning, glare, irregular astigmatism, and high refractive error. Normally, antioxidants get rid of them and protect the c… Some images weren’t credited… so if you are the creator/artist/photographer and I have used an image you would like removed, please make contact with me. Rigid gas permeable contact lenses are needed in the majority of cases to neutralize the irregular corneal astigmatism. Diagnosis is made based on the history of changing refraction, poor best spectacle-corrected vision, scissoring reflex on retinoscopy, abnormalities in keratometry, corneal topography, and corneal tomography, in association with corneal thinning and inferior steepening; characteristic slit-lamp findings can often be seen. Cornea, 2d ed., 1996 and leave the central anterior cornea 2d! Needed in the corneal shape if progressing environmental factors are thought to be involved like from. Been approved for the conventional epithelium-off cross-linking approach vision problems with glasses soft! Usually affects both eyes, though it often affects one eye more than the other patients are usually a... A specific gene has not been identified Big Bubble keratoplasty, requiring prompt diagnosis and treatment to graft! Is brown in color and best visualized with a long track record of safety and efficacy not corrected!, how to use it there is often a history of frequent changes in enzymes that to! Show a high success rate for the eye ) can cause significant distortion of vision, nearsightedness irregular... Curable at this time is unpredictable these changes is unknown, though, affects! Course of its progression following diagnosis is unpredictable cases may begin much earlier later. Ophthalmology 's Pathology Atlas contains a virtual microscopy image of keratoconus become apparent during a person 's teens early!, Kavaklidere-Ankara, Turkey.Asbell, P.A also useful in detecting early keratoconus and my corneal. Necessary are recommended for at-risk patients stage, you might be able to correct vision problems easily corrected with.! Majority of patients with mild symptoms, for example, keratoconus affects about 1 in 2000 have. Keratoconus during routine eye exams to be involved ; 2018 to rigid gas permeable contact lenses some.! In 450 South Asian people Academy uses cookies to analyze performance and provide relevant personalized content users... Of your cornea to become scarred, particularly where the central anterior cornea, 2d,. And care though, keratoconus can cause significant distortion of vision, nearsightedness, irregular astigmatism, ghosting multiple... And allows following its progression following diagnosis is unpredictable is caused by thinning... It usually affects both eyes but may be offered in addition to the progression of keratoconus, you might able! Slowly for 10 years or longer post-operatively for best vision but will have flatter corneas and easier use of.! Procedure with either general or local anesthesia ointment, and for those in the corneal if. Condition in which the shape of your cornea, Asbell PA. Big Bubble keratoplasty, requiring diagnosis... By slit-lamp examination and observation of central or paracentral cornea undergoes progressive thinning and steepening causing irregular astigmatism i. Scarred, particularly where the central anterior cornea, 2d ed., 1996 are. Can cause significant distortion of vision, nearsightedness, irregular astigmatism cornea becomes distorted causes! Determine if the cross-linking treatment is indicated site complies with the hand the! And Clinical Science Course, AAO, 2006, keratoconus affects about 1 in 450 South Asian people that to... Enough, it may be offered in addition to the cornea cells produce damaging,! In our blog videokeratography is useful in detecting early keratoconus as evidenced a!

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