
Solo Eye Drop Treatment in Development for Keratoconus - miduil
https://crstodayeurope.com/articles/2018-feb/solo-eye-drop-treatment-in-development-for-keratoconus/
======
miduil
Thank you @mods for re-upping my submission!

Judging by the Keratoconus sub-reddit [reddit], there are probably plenty of
undiagnosed people out there - maybe not even noticing their eye-sight is
constrained.

Keratoconus is a disorder which describes the middle cornea to thin, bulge
outward, and form a rounded cone shape, causing plenty of issues - most
noticeably double vision, astigmatism and red dry eyes. According to Wikipedia
it affects about 1 in 2000 people.

The disease can progress in irregular speed and so far I understand only
Corneal Cross-Linking (CXL) OPs showed positive results in reducing/stopping
the progression, but it's not side-effect free and at least for me the CXL was
a rather traumatic experience and it renders your eye-sight pretty bad for the
next weeks and even a year after I could still notice difference in my vision.

Having a Eye Drop instead of CXL would mean more people could be cured and the
cure would be way less invasive. So this news is a big deal for everyone who's
affected and didn't had CXL yet.

If you notice double vision on high-contrast sharp images such as white text
on black background, chances are you are affected. [0], [1]

[0]:
[https://en.wikipedia.org/wiki/File:Kc_simulation.jpg](https://en.wikipedia.org/wiki/File:Kc_simulation.jpg)

[1]:
[https://en.wikipedia.org/wiki/File:Kc_simulation2.png](https://en.wikipedia.org/wiki/File:Kc_simulation2.png)

[reddit]:
[https://www.reddit.com/r/Keratoconus/](https://www.reddit.com/r/Keratoconus/)

~~~
kstrauser
Wait, what? Your first link is exactly how I see things. I even photoshopped
this for my optometrist to show her what oncoming car lights look like at
night.

I wear glasses so I've had any number of people examine my eyeballs over the
years. Is this something I should worry about, or should I expect that someone
would have caught it by now?

~~~
kmm
I have similar complaints and no optometrist has been of help. It's really
annoying at night, or simply when watching TV, the subtitles are always subtly
doubled.

I did get a corneal topography scan a few years ago, and they ruled out
keratoconus. Perhaps you can ask for it, it takes like 5 seconds.

~~~
kstrauser
It's slightly annoying during the day, but I can write software without my
glasses. The worst time is while driving at night, when I can't tell which
pair of oncoming headlights is the one I'm actually supposed to avoid.

------
jorge-d
I was diagnosed with an early stage Keratoconus a few months ago. It appears
that rubbing your eyes is one of the main factors[1].

The lack of warning about it is quite concerning as I learned how bad rubbing
your eyes was when I got the diagnostic.

[1] [https://www.gatinel.com/en/recherche-
formation/keratocone-2/...](https://www.gatinel.com/en/recherche-
formation/keratocone-2/frottements-oculaires-cause-sine-qua-non-keratocone/)

~~~
maxerickson
Not rubbing eyes is folk knowledge in my family, but I guess it's more about
scratching the eyeball than anything about Keratoconus.

------
nness
As someone who has undergone keratoplasty (corneal graft) to treat fairly
progressed Keratoconus, news like this fills me with the hope that the disease
will eventually disappear and no one will need to go through the same physical
and emotional discomfort.

~~~
andrewingram
How was the graft? I had CXL last year, and the pain was pretty excruciating.
But i'm now scheduled in for a graft and the consultant said that in terms of
pain and discomfort, it's nowhere near as bad.

~~~
tnjm
I had a deep lamellar graft 15 years ago, for keratoconus, and it wasn't
painful, just uncomfortable for a while. The followup appointments also
involved some discomfort, but were fine.

As with any transplant, I'd say it might be helpful to prepare yourself for
the fact you'll have someone else's body part (I'll be celebrating my cornea's
centenary before that long).

And don't have huge expectations for the result -- I can't comfortably read a
book with my operated eye, though no doubt the vision would be acceptable with
contacts. They're such a pain and the vision in my unoperated eye is still
good enough that it's better to rely mostly on that eye than bother with them.

I still won't drive in the dark, won't play contact sports and my eyes get
tired fairly easily, but overall it was a big win and I'd go for it again in a
heartbeat. Good luck!

~~~
andrewingram
Thanks, I hadn't given the whole "someone else's body part" aspect much
consideration, but I imagine it does feel a bit odd.

They're going to be aiming for a partial thickness graft, which is apparently
much harder to do, but if they pull it off there's much lower risk of
complications. Surgeon says his rate of achieving noticeable improvement in
vision is 95% compared to the average of 50%.

------
interestica
This story is true.

I was diagnosed about 15 years ago. Eyes (mostly right eye) were getting
progressively worse. Reached the point where soft (toric xr) lenses were no
longer working. I was going to get fitted for hard lenses in the coming week.

I stayed at a friend's house. I had an allergic reaction to her cat. My eyes
got severely swollen.

The next day, I could see with my soft lenses again. Optometrist didn't
believe me. Until I went in and she tested.

My eyes had been 'relatively' stable since that...but have recently started to
get worse again.

I always thought it was something to explore scientifically. I had another eye
doc say it was all in my head. (If only one could will themselves to see
better...). The best treatment when I was diagnosed was the implantation of
plastic rings into the eye to change its shape. I always suspected that there
could have been a shape change. Or maybe just fortunately-placed deterioration
of my corneas from the reaction.

------
amelius
Attempt at TL;DR. I'm not a biologist, but I gather from the article that they
found the drug this way. Please correct me if I'm wrong.

\- From a large group of people with the symptoms, they sequenced the DNA, and
looked for patterns. It was found that the LOX gene is commonly affected in
these people, leading to a LOX enzyme that is less efficient.

\- The LOX enzyme is known to depend on the presence of a bunch of molecules
(aka cofactors). If the presence of one or more cofactors is boosted, then
even a compromised LOX enzyme can still be made to function efficiently in a
lot of cases.

\- The substance they found is one of these cofactors. The formulation was
probably refined so that uptake in the eyes is ensured.

Note: the LOX enzyme has more roles in the body than in the eye, for example
it plays a role in the skin. So I would assume that people with these specific
eye symptoms are likely to have also skin problems. Perhaps the presence of
these skin problems could predict whether the therapy could be successful (?)
See
[https://en.wikipedia.org/wiki/Lysyl_oxidase#Biological_funct...](https://en.wikipedia.org/wiki/Lysyl_oxidase#Biological_function)

------
danellis
My keratoconus is quite mild. It's the kind of thing your brain mostly
compensates for I'm ideal conditions, but when reading white-on-black, reading
text at a distance and especially driving at night, it does make things more
difficult.

Apart from all that going away, it would be nice to be able to wear those
soft, jelly-like contact lenses that feel so comfortable.

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zimablue
If I've interpreted the article correctly, this is to try and duplicate the
effect of cross linking, which is a preventative step that isn't useful once
your keratoconus has stopped developing. If I've interpreted right, if you're
past your early twenties this probably isn't relevant to you

~~~
andrewingram
That doesn’t seem right, I was diagnosed in my early twenties, but the
condition was continuing to progress into my thirties. At which point they
decided that CXL was necessary to prevent my cornea from eventually rupturing.
The reason they didn’t do it sooner was at the time improvement in contact
lens technology was outpacing the progression of the disease (or so they
said).

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striking
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