Keratoconus Treatment Options, Stage by Stage

Stopping progression: cross-linking

Cross-linking is the only treatment that changes the course of the disease, and it is recommended whenever tomography shows the cornea is progressing, and may be discussed early in young patients with clear disease. It does not sharpen vision; it preserves the cornea so that the vision options below keep working. Everything else on this page manages vision and does nothing to progression.

Vision in early disease: glasses and soft lenses

Mild keratoconus with mostly regular astigmatism can be corrected with glasses or standard soft toric lenses for a time. Custom soft lenses designed for keratoconus, thicker in the center to mask irregularity, extend this stage for some patients. Vision with glasses becomes less satisfactory as the cornea grows more irregular.

Vision in moderate disease: rigid, hybrid and scleral lenses

• Rigid gas permeable lenses: a small rigid lens that replaces the irregular front surface with a smooth one, giving sharp vision; comfort and stability on a cone can be issues
• Hybrid lenses: a rigid center with a soft skirt, combining rigid optics with soft lens comfort
• Scleral lenses: large rigid lenses that vault entirely over the cornea and rest on the white of the eye, holding a reservoir of fluid; a common choice today for moderate and advanced keratoconus, giving excellent vision and all day comfort

Fitting these lenses is a specialist skill; our specialty contact lens service, led by Dr. Arbi Melikian, OD, our medical optometrist, fits all three from your corneal maps.

Surgical options short of transplantation

• Intracorneal ring segments: small arcs implanted in the cornea to flatten and regularize the cone, improving lens tolerance and sometimes glasses vision, in selected corneas without central scarring; they are placed in our office, and the cornea specialist evaluates whether they are appropriate
• Topography guided PRK: a limited surface laser treatment that smooths the most irregular part of a cornea that has been stabilized by cross-linking, in carefully selected cases; the cornea specialist discusses whether it is appropriate
• EVO ICL: an implantable lens that corrects the nearsightedness and regular astigmatism of a stable keratoconic eye without touching the cornea, in carefully selected stable eyes after physician evaluation; it does not correct irregularity but can reduce dependence on lenses in suitable patients

Corneal transplantation

For the minority of patients whose cornea is scarred centrally or too steep and thin for any lens, a transplant replaces the diseased tissue. Deep anterior lamellar keratoplasty replaces the front layers and keeps the patient's own endothelium, reducing rejection; full thickness penetrating keratoplasty is used when the deeper layers are also affected. Vision recovers over a year, usually with lenses afterward. With cross-linking now available, the proportion of keratoconus patients who ever need a transplant is falling steadily. Dr. Youssefzadeh personally performs corneal transplant surgery.

Do not rub your eyes

Eye rubbing is the most important modifiable factor in keratoconus and is associated with progression. Treating the allergy or dry eye that drives the rubbing, and breaking the habit, is part of every treatment plan.