When her vision first declined, Spokane resident Trayci Ballin shrugged it off as a sign of aging. She’d noticed a minor change in June 2019 after having 20/20 vision for about 14 years after Lasik surgery. At an eye exam, she was told her sight still was sharp enough to pass a vision exam for her driver’s license.
But by the next June, her vision had rapidly worsened to where she could no longer read, had trouble driving and had to take frequent breaks from her computer. She returned to the eye doctor and eventually got a diagnosis of keratoconus, an eye disease that causes distortion of the corneas. Left untreated, it can cause blindness.
“June the year before is the first time when I went in and said, ‘I feel like my vision is only a little worse, and maybe it’s age-related,’ ” said Ballin, 51. “At that time, they said, ‘No, you can pass a driver’s test; it’s not bad.’ In one year, it got a lot worse. That was their alarm because it got so much worse.
“At first, I assumed I needed reading glasses because that’s what happens; I’m over 50. But I couldn’t find a pair that would work. I had stopped driving for the most part, and I definitely wouldn’t drive at night. I stopped reading. I had the font on my computer like massive size. On my phone, I found out you can get two words on one line for text messages.”
Ballin’s eye doctor referred her to Empire Eye Physicians in Spokane Valley, where ophthalmologist Dr. Mark Kontos diagnosed progressive keratoconus. Kontos did a treatment for Ballin called corneal cross-linking using riboflavin-mixture eye drops and a UV light to strengthen the cornea and stop progression.
She went in during August for one eye, and then had the procedure on her other eye in September.
Today, Ballin has good vision again that’s also aided by specialty contact lenses. She enjoys doing puzzles and hiking with her husband and only relies on reading glasses for computer work and reading small print.
A success story such as Ballin’s hinges on diagnosing keratoconus early, said Kontos. The condition isn’t that uncommon, he said. “It’s a genetic condition that is also affected by external factors.”
“It varies a little bit geographically; in the U.S., I’d say the incidence is about 1 in 2,000 or 1 in 1,800.”
External factors include high exposure to the sun’s ultraviolet light and frequent eye-rubbing. “It’s highly prevalent in Eastern Mediterranean and Middle East countries where UV exposure is very high; it’s like 1 in 500 people.”
The disease typically causes the cornea to become progressively weaker over time. Keratoconus – kerato is Greek for cornea and conus for cone – creates a distorted cornea that doesn’t allow light to be focused properly inside the eye, Konos said.
The best screening is a diagnostic tool to do corneal topography, a result similar to mapping that shows contours in land terrain for hiking, Kontos added. It reveals a “little cone” protruding out.
For some, keratoconus can be mild and doesn’t worsen much, or it can be very progressive. Some people with the condition can have their vision corrected just by wearing glasses, he said. It usually affects both eyes, but one might be worse than the other.
Corneal cross-linking is done under topical anesthetic in the form of numbing eye drops. The patient is awake during the hourlong procedure that’s done in the practice’s surgical room.
“The patient is under a microscope, and a device keeps the eyelids open,” Kontos said. “After the eye has been anesthetized with eye drops, we basically smoothly remove the front surface layer of the cornea in a central area, then we put drops on the eye that have the riboflavin mixture.
“The procedure that’s done is a combination of using riboflavin drops and ultraviolet light, so the drops are placed on the cornea for about 20 minutes to saturate the cornea with riboflavin, and then the ultraviolet beam of light is shined on the surface of the cornea for a period of time, again about 20 minutes.”
The combination “bonds” in the cornea to make the corneal fibers more resistant to change in their shape, Kontos said. “The fibers kind of strengthen themselves a little bit. It reduces the progression of the condition and can halt it.”
Afterward, a contact is placed on the eye, and a patient uses drops for about one week to help healing. The contact lens is taken off in a few days. One eye is done at a time because vision might be reduced for about one week following, he said.
As far as discomfort afterward, “it’s minimal,” Kontos said, perhaps a bit of light sensitivity, minor scratchiness and soreness about a day or two, but the medication offsets that.
Keratoconus has no cure, but if treated before worsening progression, people often can have good vision again with contacts or glasses. In its extreme form, keratoconus results in the cornea becoming too thin and distorted. Then, the option is a corneal transplant, Kontos said.
“Keratoconus is the No. 1 reason why patients have corneal transplants in the United States and worldwide, so it’s a significant issue,” he said.
For progressive keratoconus, corneal cross-linking is a preferred treatment. Kontos said Empire Eye is the only regional provider doing the treatment approved by the Food and Drug Administration in 2016. Patients must be at least age 14 and no older than 65.
“The sooner we treat the patients, the better,” Kontos said. “What people should watch for and ask about is if there’s a frequent need to change prescriptions for glasses and contacts, and they notice rapid changes in vision.”
“Sometimes, we see patients with keratoconus that’s much farther along and they have a bigger change in shape of cornea. It’s best to get this thing early before it goes too far. That’s when we can make the most impact for a patient’s vision.”
The practice does many Lasik procedures, and a corneal topography prescreen is required. For some patients, they’re surprised to learn when its shows keratoconus and they can’t have the Lasik done, he said.
When Ballin had Lasik so long ago, she said it wasn’t a norm to do cornea screening. Lasik didn’t cause her keratoconus, but she now wonders if a scan then would have caught it. And she hopes sharing her story will prompt people to ask questions. “I now know three other people, all of a sudden, who are going through this or have gone through this,” she said.
“I would say to someone, if it seems like your vision is getting progressively worse, just mention to your eye doctor to check the cornea for any thinness or wrinkling.”
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