Early to Intermediate Stages

The irregular shape of the keratoconus cornea degrades image quality so vision correction is needed in most keratoconus patients. This task is particularly challenging in keratoconus patients and often requires a personally-tailored approach. As a rule of thumb, patients in the early stages of keratoconus can have excellent vision with glasses or soft contact lenses. As the disease progresses and the corneal cone protrudes more, glasses or soft contact lenses no longer provide sufficient vision correction.

Corneal Collagen Cross-linking (CXL)

Recently approved for use in the United States, cross-linking has been performed successfully around the world for the past decade. The minimally-invasive, advanced therapy slows down or stops the progression of  the corneal deformation of keratoconus, by making collagen bonds in the cornea stronger, allowing it to become stiffer and usually stop bulging out.

Learn more about CXL here.

Advanced stages

Corneal Transplantation

Once the treatments mentioned above have been exhausted, corneal transplant may be performed to restore vision.

Corneal transplants are often performed on an outpatient basis, and take about an hour to complete. In a corneal transplant, the cornea of the patient is carefully removed, and the cornea of a donor is sewn into place, using stitches about a third of the width of a human hair. Corneas are received from recently deceased persons, with the permission of their next of kin. 

After a corneal transplant, vision may remain blurry for months. Medication must be taken continually to avoid rejection of the cornea as with any transplanted tissue. This usually includes an anti-inflammatory eye drop. In almost all cases, glasses or a contact lens are necessary to provide the clearest vision after corneal transplant surgery.

Specialized Contact Lenses

As the disease progresses and the corneal cone protrudes more, glasses or soft contact lenses no longer provide sufficient vision correction. There are a few specialized contact lenses that may provide improved vision for patients with advanced keratoconus.

• Rigid Gas Permeable Contact Lenses. These hard lenses overcome the abnormal optics of the misshapen cornea as they do not assume the corneal shape when placed on the surface of the cornea. Hard contact lenses are an excellent optical solution; however, they may sometimes be uncomfortable to wear. Wearing the hard contact lens on top of a soft contact lens or using a hybrid lens (hard in the center, soft in the edges) can be helpful.
• Scleral Lenses. In extremely protruding cones, fitting a hard contact lens may become difficult.  Patients may benefit from larger diameter lenses that lie on the white part of the eye (the sclera) and vault over the cornea without touching its surface. Such hard contact lenses are referred to as scleral lenses. In general, these lenses are very comfortable to wear and provide excellent vision in select patients.
• PROSE Lenses. A special subtype of scleral lenses is called PROSE (prosthetic replacement of the ocular surface ecosystem). This prosthetic device may be especially useful in extreme cases of keratoconus, and is generally reserved as a last resort before a corneal transplant is considered. 

Intracorneal Ring Segments

Intracorneal ring segments are plastic, C-shaped rings that are used to flatten the surface of the cornea, allowing it to refract light better.

The procedure, which takes about 15 minutes, is performed by creating small tunnels between layers in the stroma, into which the implants may be placed. Depending on the severity of keratoconus, patients may need to wear contacts to further correct their eyesight after implants. In addition, implants will not halt the progression of the disease, so while it is an effective treatment option, it is not a cure.