Keratoconus Treatment | What Techniques Are Available?

The cornea is the clear outer layer at the front of the eye responsible for focusing light into the eye. It is mainly made up of water and collagen, which provide both strength and flexibility, help keep its surface smooth, and maintain its naturally rounded shape. 

Certain factors can weaken the cornea and thin it out, causing it to lose its normal curvature and bulge forward into a cone-like shape. This distorts how light is bent (refracted) as it enters the eye and leads to reduced and blurred vision. 

Keratoconus is an eye disease that usually appears during adolescence and gradually worsens over time. So how can corneal thinning and keratoconus be treated?

What Causes Keratoconus?

Choosing the right treatment depends on understanding the factors that led to keratoconus and corneal thinning. Although keratoconus is relatively common, its exact cause is not fully understood.

Several studies support the idea that there is an imbalance between the amount of collagen the body produces and the amount that is broken down, especially under the effect of toxic free radicals. When the cornea loses collagen, it becomes weak and starts to protrude outward.

Symptoms of keratoconus usually appear in the teenage years or early 20s and may progress into the mid-30s. It is not possible to predict how quickly the disease will progress or how severe it may become, and there is currently no guaranteed way to prevent its progression.

Patients typically develop myopia (nearsightedness) along with astigmatism. As the corneal surface becomes more cone-shaped and irregular, symptoms worsen and patients may experience episodes of blurred or distorted vision and increased sensitivity to light. 

However, a number of risk factors are associated with a higher likelihood of developing corneal thinning and keratoconus, including:

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Symptoms of Keratoconus

Keratoconus affects your vision in two main ways:

– It causes irregular astigmatism due to the cone-shaped deformation of the cornea.

– It increases nearsightedness as the cornea becomes steeper and more protruded.

An eye specialist may detect early signs of keratoconus during a comprehensive eye exam. You should also mention any symptoms you notice, such as:

– Blurred or distorted vision

– Frequent changes in eyeglass prescription

– Halos, glare, or starbursts around lights

– Eye strain or headaches with visual tasks

– Increased sensitivity to bright light

– Difficulty seeing at night

– Sudden worsening of vision in one eye

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Conditions Associated with Keratoconus

Keratoconus is often linked to other conditions, some of which are also associated with chronic eye rubbing. These include:

– Allergic eye disease (such as vernal keratoconjunctivitis)

– Atopic diseases (eczema, asthma, allergic rhinitis)

– Down syndrome

– Connective tissue disorders (such as Marfan syndrome or Ehlers–Danlos syndrome)

– Obstructive sleep apnea

– A family history of keratoconus

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Complications of Keratoconus

Possible complications of keratoconus include:

– Progressive and significant loss of visual clarity

– Irregular astigmatism that is difficult to correct with glasses

– Corneal scarring (especially in advanced stages)

– Acute corneal hydrops (sudden corneal swelling due to a tear in Descemet’s membrane)

– Difficulty tolerating contact lenses

– Impaired ability to perform daily activities such as driving, reading, or working

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How Is Keratoconus Diagnosed?

Your eye doctor will start by asking about your medical history, family history, and the symptoms you are experiencing. They will then perform a comprehensive eye examination and may order one or more of the following tests:

– Visual acuity testing (to measure how well you see at different distances)

– Refraction (to determine the eyeglass or contact lens prescription)

– Slit-lamp examination (to look for characteristic corneal changes)

– Corneal topography (maps the surface curvature of the cornea and is the key test for diagnosing keratoconus)

– Corneal tomography (gives a 3D image and measures corneal thickness)

– Pachymetry (measures corneal thickness at different points)

(Read also: Everything You Need to Know About Corneal Astigmatism)

Intrastromal Corneal Ring Segments (INTACS) for Keratoconus

INTACS® are small, crescent-shaped ring segments that an ophthalmologist implants within the corneal stroma to improve vision or make it easier to fit contact lenses.

This procedure is usually done under local anesthesia using numbing eye drops. The surgeon creates small channels within the cornea and then inserts the ring segments into these channels. The rings help flatten the central cornea and partially correct the cone-shaped distortion caused by keratoconus.

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Complications or Side Effects of Keratoconus Treatments

Potential complications of corneal cross-linking (CXL) may include:

– Temporary eye pain, burning, or discomfort after the procedure  

– Hazy or blurred vision during the healing period  

– Delayed epithelial healing (slow healing of the corneal surface)  

– Corneal infection (rare but serious)  

– Corneal scarring in some cases  

– Light sensitivity for a period after treatment  

Potential complications related to corneal transplantation (corneal graft) include:

– Graft rejection (immune rejection of the donor cornea)  

– Infection  

– Elevated intraocular pressure (glaucoma)  

– Recurrence of astigmatism or irregular curvature  

– Need for long-term steroid eye drops  

– Suture-related problems until the stitches are removed  

Complications or side effects from glasses or contact lenses are rare but can occur, such as:

– Eye redness or irritation  

– Contact lens intolerance  

– Infection if lenses are not cleaned or used properly  

You should inform your eye care provider if you experience any redness, pain, or persistent discomfort in your eyes.

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How Can Keratoconus Be Treated?

In mild cases, prescription glasses or soft contact lenses may be enough to correct vision and maintain good eyesight. However, keratoconus often progresses, so regular follow-up is necessary, and the treatment plan may need to be adjusted according to the latest vision measurements.

When the cornea becomes more protruded and irregular, glasses or standard soft lenses may no longer provide adequate vision, and more advanced medical interventions become necessary.

Treatment of Mild to Moderate Keratoconus

The irregular shape of the cornea in keratoconus scatters light as it enters the eye and degrades image quality. To address this, treatment aims to reshape how light is focused and to create a smoother optical surface.

Management is individualized and depends on the patient’s eye measurements and the severity of symptoms. In the early stages, a patient may achieve clear, functional vision with:

– Prescription glasses  

– Soft contact lenses  

As the disease progresses and the cornea becomes more conical, these options often become insufficient, and more specialized lenses or procedures are considered.

Managing Advanced Keratoconus

In advanced stages, more aggressive or surgical approaches may be needed to stabilize the cornea and improve vision.

Corneal Cross-Linking (CXL)

Corneal cross-linking is a procedure that strengthens the cornea to prevent further bulging and thinning. It is typically performed once.

During CXL, riboflavin (vitamin B2) eye drops are applied to the cornea and then activated with ultraviolet (UV) light. This process creates new bonds (cross-links) between collagen fibers in the cornea, increasing its stiffness and, in many cases, its functional thickness.

Cross-linking does not correct existing refractive errors or fully reverse internal corneal irregularities, but it significantly slows or halts the progression of keratoconus, and in some patients, it modestly improves vision. It is considered a promising treatment, especially when combined with other techniques, and it can reduce the likelihood of needing a corneal transplant.

Intrastromal Corneal Ring Implants

Intrastromal corneal ring segments are small, ring-like implants surgically inserted into the cornea to flatten its central portion and improve vision.

They are usually considered when glasses and contact lenses fail to provide adequate visual correction in keratoconus. The procedure typically takes about 10 minutes per eye. One advantage is that these rings are removable and replaceable if needed.

This technique often improves visual acuity and delays disease progression, but it does not cure keratoconus or eliminate the condition entirely.

Contact Lenses for Keratoconus

Overall, the goal of all contact lens options is to provide the clearest possible vision, especially for patients who are not suitable candidates for surgical procedures.

A wide range of specialty contact lenses can be used for keratoconus, including:

– Rigid gas permeable (RGP) lenses  

– Hybrid lenses (rigid center with a soft skirt)  

– Scleral and mini-scleral lenses (rest on the sclera and vault over the cornea)  

– Custom soft lenses designed specifically for keratoconus  

Your eye care specialist will determine the most appropriate type based on the shape and severity of your cornea.

Topography-Guided Conductive Keratoplasty

Topography-guided conductive keratoplasty (CK) is still being studied as a potential treatment option for keratoconus. In this procedure, the cornea is reshaped by applying energy (often radiofrequency or laser-based) at specific points along its periphery, guided by corneal topography, to tighten the tissue and reduce the cone shape.

The main goal of this technique is cosmetic and optical regularization of the corneal shape. It may improve the cornea’s appearance and provide some visual benefit, but it does not address the underlying cause of keratoconus and does not reliably stop disease progression.

Corneal Transplantation (Keratoplasty)

If the patient has severe symptoms and previous methods have failed to provide adequate vision or corneal stability, corneal transplantation may be recommended.

In this procedure, the damaged cornea is replaced with a donor cornea from a deceased volunteer. This is an elective surgery, and the patient is usually responsible for the full cost unless insurance coverage applies.

Vision often remains blurred for several months after the transplant while the eye heals and sutures remain in place. Long-term use of immunosuppressive or steroid eye drops is required to reduce the risk of graft rejection. Some patients may still need glasses or contact lenses for optimal vision for the rest of their lives.

Can Keratoconus Damage Vision?

If left untreated, keratoconus can lead to permanent vision loss. The structural changes in the cornea make it increasingly difficult for the eye to focus light properly, with or without glasses or standard soft contact lenses.

Keratoconus can also be dangerous if you undergo laser vision correction surgery such as LASIK, because these procedures remove corneal tissue and can significantly worsen the condition.

If you are considering any form of laser vision correction, your refractive surgeon will perform specific tests to determine whether you are a suitable candidate. Even if you have only early or mild keratoconus, you should not undergo LASIK unless your ophthalmologist specifically recommends an alternative, carefully selected procedure based on your case.

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Frequently Asked Questions

There are many common questions patients ask about keratoconus and its treatment. Here are answers to some of them:

Does Keratoconus Cause Blindness?

Keratoconus does not usually lead to complete blindness or total loss of sight, but it can cause a significant reduction in visual clarity. Patients often see hazy, blurred images and have difficulty distinguishing fine details. The eyes may become very sensitive to light, and you may notice glare, halos, or sudden bursts of white light.

Can Keratoconus Be Treated with Laser?

Standard LASIK and most laser refractive procedures are not suitable for keratoconus, because keratoconic corneas are already thin and structurally weak. These surgeries work by removing some corneal tissue, further thinning the cornea and potentially worsening the disease.

Is Keratoconus Genetic?

There is a strong genetic component associated with keratoconus. It has been observed that multiple members of the same family may suffer from corneal thinning and cone-shaped corneas. Genetics is one of the likely contributing factors, but it is not the only cause. Environmental factors such as eye rubbing and allergies also play a role.

How Much Does Corneal Cross-Linking Cost?

Corneal cross-linking is relatively expensive, but some health insurance plans may cover part of the cost. The final price depends greatly on the level of equipment, technology, and expertise available at the center you visit.

Ask your ophthalmologist for detailed information about the cost, what is included, and whether cross-linking is suitable for your specific condition.

What Can I Expect If I Have Keratoconus?

With appropriate treatment, the outlook for most people with keratoconus is generally good. If your vision or prescription is very different between your two eyes, you may experience imbalance or difficulty with depth perception. Discuss this with your eye care provider; they can help you find a suitable solution.

Every case is different. Some people have mild keratoconus that does not progress significantly, while others experience continued progression over time. No one can predict exactly how the disease will behave in each individual.

If you have been examined and diagnosed with keratoconus, it is essential to stop rubbing your eyes, as this can worsen the condition and increase corneal weakening and protrusion. After that, visit us as soon as possible so you can receive the appropriate care and treatment at the earliest opportunity. Protect your vision and maintain healthy eyes.

Whatever type of visual disturbance, refractive error, or eye problem you are experiencing, these delicate conditions require a thorough examination and proper management by a skilled, experienced ophthalmologist using effective medical tools that provide a real benefit.

Whatever eye disease or complaint you may have, you can book an appointment at Al-Batal Specialty Complex for a full eye examination and to begin addressing your eye problems, no matter how complex they may be.