An Eye Doctor Weighs In
- April 17th, 2019
Regarded by many sports commentators and basketball players as the greatest shooter in NBA history, Steph Curry recently disclosed that he has the eye disease, keratoconus. This disease, which affects about 1 in 375 individuals, can dramatically impair vision. It is characterized by abnormal distortion of the corneas – the clear, outer tissue of the eyes responsible for focusing vision. In some cases, keratoconus can even lead to corneal transplant surgery. The fact that Curry has succeeded at the highest level of basketball, despite having keratoconus, is astounding. Even more impressive is that only recently has he started wearing special contact lenses to enhance vision. Keratoconus generally requires custom rigid-surface contact lenses to restore a smooth light-bending surface and good vision. Glasses and common soft contact lenses are often inadequate while LASIK eye surgery is unsafe for those with keratoconus.
Since starting to wear special contact lenses, Curry has significantly improved his shooting percentage, to the chagrin of opposing teams. Of course, while vision is an important facet for shooting a basketball, it is not the only factor.
How has Curry managed to shoot so well with keratoconus?
At age 31, Curry likely has had keratoconus for much longer but just has not known about it. Keratoconus commonly develops during the teenage years and progresses in subsequently before self-arresting by the third to fourth decade of life. The severity of keratoconus can run the spectrum from barely impacting vision to severely affecting activities of daily living. The fact that Curry has made it so long before proper treatment testifies to having milder keratoconus and an off-the-chart level of talent and athleticism.
Those with reduced vision often don’t realize it is abnormal until they are shown the difference. Many, including Curry, adapted by squinting.
Will Curry go blind?
Keratoconus alone does not lead to blindness, just vision impairment. Furthermore, it is unlikely that his keratoconus will progress because he is in his 30s, when the condition generally stabilizes.
Can Curry have surgery to fix his eyes?
LASIK eye surgery cannot be done safely for keratoconus because the procedure would further thin the already weak cornea, worsening the corneal distortion.
Corneal cross-linking (CXL) – a procedure that stiffens the corneal tissue – can be performed to stabilize his corneas, although there may not be much role if his keratoconus has already stabilized on its own. CXL has a greater role for managing progressing keratoconus during the adolescent years and early 20s. The role of CXL is to prevent further corneal distortion, not so much to enhance vision. In fact, in mild cases of keratoconus where unaided vision is already good, the risk of CXL harming vision may be unacceptable.
Intacs surgery, where plastic segments are buried underneath the corneal surface, can reduce corneal distortion in keratoconus to some degree. It is often best-suited for keratoconus patients that are also mildly nearsighted. Intacs surgery does not predictably restore vision to the level of a rigid surface contact lens. Most patients after Intacs and other corneal surgeries still require special contacts for the best vision. For that reason, contact lenses remains the primary treatment for restoring vision in keratoconus and this most likely applies for Curry as well.
Will Curry’s contact lenses fall out?
The mouthpiece that Curry dangles from his mouth while shooting free throws is a reminder of how basketball is a physical sport. Indeed, a hard foul could make a contact lens fall out. In fact, NBA fans will remember in the 1980s it was common for players to stop play and to get onto the hardwood in search for an ejected contact lens. While this is common for the older rigid gas permeable (RGP) lenses, today’s hybrid, large scleral contact lenses, and scleral shells, simply do not displace or eject. Curry is almost certainly wearing a newer generation type of lens.
Will his family get keratoconus?
There is a known genetic predisposition for keratoconus. This means there is an elevated likelihood that his blood relatives may have keratoconus, including his brother, Seth Curry, who also plays in the NBA. If one of his family members has undetected keratoconus and it is caught before significant progression occurs, corneal cross-linking can minimize further distortion to the eye. It is also important for his family members to be screened, because signs of keratoconus also rule-out the safety of undergoing LASIK eye surgery.
What impact will Curry have for those with keratoconus?
Interestingly, Curry is not the first NBA player to have keratoconus. Former NBA star, Jerry Stackhouse, also has worn special contact lenses for keratoconus. Yet in the age of social media, the popularity of Curry directs much-needed and favorable attention to this eye disease. There has not been a celebrity of Curry’s stature to come forth with keratoconus. The keratoconus community is rejoicing at Curry’s disclosure of having keratoconus because he is a positive role model.
By comparison, take the disgraced comedian, Bill Cosby, who announced in 2016 that he has keratoconus. Age 78 at the time, the oddity is that keratoconus does not suddenly develop at a late age. Keratoconus onset is usually during adolescence, and it stabilizes on its own well before the geriatric years. Instead, it is more likely that Cosby’s announcement of having keratoconus was to gain public sympathy.
The buzz about keratoconus created by Curry is welcome, especially since the available treatments for keratoconus over the past two decades has blossomed to the degree where they can compellingly help. For longstanding sufferers of keratoconus, now is a good time to schedule an evaluation with a qualified eye doctor to reassess whether there is an improved and suitable treatment.
ReVision Optometry is a private optometric practice in San Diego dedicated to restoring the vision and lives of patients with keratoconus. The clinic is directed by Brian Chou, OD, FAAO, a nationally-recognized authority on keratoconus.