Stephen Curry’s Eye Condition: What Is Keratoconus?

What is keratoconus?

Steph Curry, the star of the NBA’s Golden State Warriors basketball team recently told the press that he has keratoconus. Keratoconus is a progressive eye disease that involves the cornea, the very front part of the eye that light rays first pass through when entering the eye (it’s the part that really hurts if you scratch it and get a corneal abrasion). Corneas are ideally round or spherical, but in keratoconus there is progressive thinning in certain areas of the cornea that cause the cornea to weaken and lose its spherical shape. This results in light not being focused as well and causes blurry vision. The only way to know if you have keratoconus is to visit an eye doctor.

Much has been made in the media since Steph Curry’s announcement that he has keratoconus, but I think some perspective is in order. Like most diseases there is an entire spectrum of pathology. Severe keratoconus is extremely visually debilitating, and often requires a corneal transplant to fix. At the other end of the spectrum is mild or early keratoconus, which I suspect better describes Steph’s eye condition. I say this because he simply wouldn’t be able to see, let alone play NBA basketball if he had untreated keratoconus that was anything but mild. I certainly don’t mean to make light of his eye condition as it is indeed serious and progressive, but the claims that he became one of the best three-point shooters in history while not being able to see are a bit overblown.

How is keratoconus treated?

Steph Curry serves as a good example that in early keratoconus the vision can often be improved with contact lenses. The contacts may either be your standard soft contact lenses or hard contacts, also known as rigid gas permeables (RGPs). Contacts ride on the cornea and serve to mask it’s irregular shape, thus creating sharp vision. Historically, when a keratoconus patient could no longer achieve acceptable visual acuity with contact lenses, a corneal transplant was required. Fortunately, today we have corneal collagen cross-linking (CXL) to help stabilize and possibly reverse keratoconus before a patient requires a corneal transplant. CXL works by saturating the cornea with a chemical (riboflavin) that is then activated with ultraviolet light; the end result is the cornea becomes “stiffer” and less prone to progressively lose its shape. CXL has been used for years in Europe with great results, and was recently approved by the FDA for use here in the US. CXL will no doubt save many patients from requiring a corneal transplant.

Can I have LASIK if I have keratoconus?

No. Keratoconus is a contraindication to having LASIK because the cornea is already weak, and during LASIK corneal tissue is lasered away to bring the eye into focus without glasses. By removing corneal tissue LASIK weakens the cornea. This isn’t an issue for the vast majority of people, but in patients with keratoconus it is a bad idea to further weaken any already weak cornea. This could lead to post-LASIK ectasia, which is similar to keratoconus as the cornea starts to lose its spherical shape and causes blurred vision. With all that said, it may still be possible to have refractive surgery (so you don’t need glasses) if you have keratoconus. Some eye surgeons are performing corneal collagen cross-linking prior to PRK (similar to LASIK but with less weakening) in the right candidates.