Treatment

Treatment for keratoconus depends on the severity of your condition and how quickly the condition is progressing.

Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. For most people, the cornea will become stable after a few years. If you have this type, you likely won't experience severe vision problems or require further treatment.

In some people with keratoconus, the cornea becomes scarred or wearing contact lenses becomes difficult. In these cases, surgery might be necessary.

Lenses

  • Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
  • Hard contact lenses. Hard (rigid gas permeable) contact lenses are often the next step in treating progressing keratoconus. Hard lenses may feel uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. This type of lens can be made to fit your corneas.
  • Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend "piggybacking" a hard contact lens on top of a soft one.
  • Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can't tolerate hard contact lenses may prefer hybrid lenses.
  • Scleral lenses. These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of resting on the cornea like traditional contact lenses do, scleral lenses sit on the white part of the eye (sclera) and vault over the cornea without touching it.

If you're using rigid or scleral contact lenses, make sure to have them fitted by an eye doctor with experience in treating keratoconus. You'll also need to have regular checkups to determine whether the fitting remains satisfactory. An ill-fitting lens can damage your cornea.

Surgery

You may need surgery if you have corneal scarring, extreme thinning of your cornea, poor vision with the strongest prescription lenses or an inability to wear any type of contact lenses. Several surgeries are available, depending on the location of the bulging cone and the severity of your condition.

Surgical options include:

  • Corneal inserts. During this surgery, your doctor places tiny, clear, crescent-shaped plastic inserts (intracorneal ring sigments) into your cornea to flatten the cone, support the cornea's shape and improve vision.

    Corneal inserts can restore a more normal corneal shape, slow progress of keratoconus and reduce the need for a cornea transplant. This surgery may also make it easier to fit and tolerate contact lenses. The corneal inserts can be removed, so the procedure can be considered a temporary measure.

    This surgery carries risks, such as infection and injury to the eye.

  • Cornea transplant. If you have corneal scarring or extreme thinning, you'll likely need a cornea transplant (keratoplasty).

    Lamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea's surface is replaced.

    Penetrating keratoplasty is a full-cornea transplant. In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue.

    A deep anterior lamellar keratoplasty (DALK) preserves the inside lining of the cornea (endothelium). It helps avoid rejection of this critical inside lining that can occur with a full-thickness transplant.

    Recovery after keratoplasty can take up to one year, and you may need to continue wearing rigid contact lenses to have clear vision. Full improvement of vision may occur several years after your transplant.

    Cornea transplant for keratoconus generally is very successful, but possible complications include graft rejection, poor vision, astigmatism, inability to wear contact lenses and infection.

Potential future treatment

A treatment called collagen cross-linking shows promise for people with keratoconus. The process involves using special eyedrops and ultraviolet A (UVA) light to strengthen (cross-link) the tissues of the cornea. The treatment is still in the testing phase in the United States, and additional study is needed before it becomes widely available.

Jan. 30, 2016
References
  1. Wayman LL. Keratoconus. http://www.uptodate.com/home. Accessed Nov. 24, 2015.
  2. What is keratoconus? American Academy of Ophthalmology. http://www.geteyesmart.org/eyesmart/diseases/keratoconus.cfm. Accessed Nov. 24, 2015.
  3. Keratoconus treatment. American Academy of Ophthalmology. http://www.geteyesmart.org/eyesmart/diseases/keratoconus-treatment.cfm. Accessed Nov. 24, 2015.
  4. van der Worp E, et al. Modern scleral contact lenses: A review. Contact Lens & Anterior Eye. 2014;37:240.
  5. Raiskup F, et al. Corneal collagen crosslinking with riboflavin and ultraviolet-A light in progressive keratoconus: Ten-year results. Journal of Cataract and Refractive Surgery. 2015;41:41.
  6. Jinabhai A, et al. Optical quality and visual performance with customised soft contact lenses for keratoconus. Opthalmic and Physiological Optics. 2014;34:528.
  7. Amayem AF, et al. Refractive and visual outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty with hydrodissection for treatment of keratoconus. Cornea. 2013;32:e2.
  8. Keratoconus diagnosis. American Academy of Ophthalmology. http://www.geteyesmart.org/eyesmart/diseases/keratoconus-diagnosis.cfm. Accessed Nov. 24, 2015.
  9. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. July 27, 2015.
  10. Keratoconus. American Optometric Association. http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/keratoconus?sso=y. Accessed Dec. 23, 2015.
  11. Keratoconus. Merck Professional Version. http://www.merckmanuals.com/professional/eye-disorders/corneal-disorders/keratoconus. Accessed Dec. 23, 2015.
  12. Yanoff M, ed., et al. Testing of refraction. In: Ophthalmology. 4th ed. Edinburgh, U.K.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Oct. 30, 2014.
  13. Yanoff M, ed., et al. Keratoconus and other ectasias. In: Ophthalmology. 4th ed. Edinburgh, U.K.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Oct. 30, 2014.
  14. Patel SV (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 5, 2016.