Keratoconus is an eye condition where the front surface of the eye, the cornea, becomes warped and irregular in shape.  The front of the eye does most of the focusing, so this irregularity can cause vision to be smeared and ghosted.  We see the big things well, but details become difficult.  When driving, we can see the car ahead, but can’t read the bumper sticker.  

Most with keratoconus have trouble seeing details clearly, even with glasses, and just have a feeling that they are not seeing as well as others.

Many have to update their glasses and soft contact lens prescriptions more often.  

Night vision problems, glare, and difficulty with low-light vision are common.

Keratoconus is variable. Some cases stabilize, others worsen over time. It can have a significant emotional impact, affecting self-esteem and quality of life.

Diagnosis

Topography creates a “hill map” or “heat map” of the front cornea.  Eyes with keratoconus have big peaks and valleys.  Topography is ideal for identifying keratoconus, tracking progression over time and guiding treatment options.

Non surgical treatment options

It is best to not rub the eyes.  When they feel itchy and irritated, use a good lubricating drop like Refresh and an allergy eye drop.  Pataday is our favorite.  

Glasses and soft contact lenses can work well for mild cases.  

For more significant keratoconus, rigid contact lenses work best.  They provide a uniform, regular surface to focus light.  

Smaller diameter lenses (9-10mm) are called rigid lenses, gas permeable or RGPs and are modern hard contact lenses.  Comfort can be difficult because the eyelids need to blink over the edges.  

Wearing a soft lens (14-15 mm) under the rigid lens can help with comfort, and this is often called a “piggyback” lens.  

A hybrid lens combines the rigid lens centrally with a soft lens skirt.  

The best option for most patients is a Scleral Lens (16-17 mm).  This is a rigid lens that tucks under the eyelids and is very comfortable.  The more customized the lens, the better the comfort.  Using topography of the white part of the eye, the sclera, to design the lenses is a game changer.

Surgical options

Eyes that continue to change can benefit from cornea cross-linking.  This is an outpatient surgical procedure that strengthens the cornea and “locks in” the current shape.  Most medical insurance plans now cover this surgery.  Most who have cross-linking still benefit from rigid contact lenses.  

The CAIRS procedure uses donor tissue that is implanted into the cornea to strengthen and even out the curvature.  It is the modern version of INTACS that uses plastic rings.  Patients who struggle with contact lenses or prefer glasses typically find their vision is better after CAIRS.

If the cornea becomes very thin or scarred, a complete or partial corneal transplant can be necessary.  Donor tissue replaces the cornea and vision is improved, although contact lenses and ongoing medication are often required.

LASIK is not recommended for keratoconus due to the irregularity of the cornea

Early detection helps, especially for those with a family history.  If you think you may have keratoconus, please call for an appointment!  

The National Keratoconus Foundation is a good resource for more information https://nkcf.org/

We would love to help!

We can evaluate your eyes and talk through all the options.  Most eyes with keratoconus enjoy good comfort and vision with scleral contact lenses.  Some eyes benefit from surgery and we work with the top surgeons in Atlanta.