April 11, 2026
As a disorder that arises from abnormal corneal biomechanics, keratoconus causes thinning and subsequent protrusion of the cornea. The resulting optical irregularities lead to a progressive reduction in visual function. Growing global awareness, increasing research, improved diagnostic capabilities, and expanding treatments have made it possible to detect keratoconus at earlier stages. As a result, available therapies are now able to meaningfully reduce or even halt the progression of the disease.
A comprehensive assessment is required when evaluating a patient for keratoconus. "We'll typically begin with a detailed history, vision testing and a clinical corneal examination," says Ashlie A. Bernhisel, M.D., an ophthalmologist and cornea surgeon at Mayo Clinic in Rochester, Minnesota. "This is followed by advanced corneal imaging to confirm the diagnosis, stage the disease and determine whether progression is occurring."
Patient evaluation includes refraction, slit-lamp examination, keratometry, corneal tomography and corneal topography. "Because these tools measure corneal shape and thickness, they can detect keratoconus even in its earliest stages," Dr. Bernhisel says. "Serial imaging over time can also help determine whether the disease is stable or the rate at which it's progressing."
Research has shown that genetic and environmental factors play a role in the pathogenesis of keratoconus. However it remains a complex and highly variable condition. "Along with the genetic component, there are additional risk factors that are not yet fully understood," says Keith H. Baratz, M.D., a cornea surgeon at Mayo Clinic in Rochester, Minnesota. "Having certain conditions such as Down syndrome, Ehlers-Danlos syndrome and severe allergies can also increase the risk of developing keratoconus. A lot of eye rubbing may also contribute to worsening of keratoconus."
While there is no known cure for keratoconus, advancements in early detection can significantly improve a patient's prognosis. "If it starts during childhood or teen years, progression tends to be faster," Dr. Baratz says. "Early detection is crucial and allows us to offer certain treatments, such as corneal cross-linking, at an earlier stage and prevent further visual decline."
Though keratoconus often emerges during puberty and progresses through the third decade of life before stabilizing, pediatric-onset keratoconus tends to be more aggressive. "Keratoconus can have a major impact on a young patient with the potential to cause serious visual disabilities," Dr. Baratz says. "The earlier the intervention, the greater the potential we have to prevent that."
Treatment is tailored for each patient and is dependent on disease stage and symptoms. "Early cases may be managed with glasses or soft contact lenses, while more irregular corneas often benefit from rigid, gas-permeable, hybrid or scleral lenses," Dr. Bernhisel says. "For progressive disease, corneal collagen cross-linking is used to stabilize the cornea, and advanced cases may require surgery such as corneal transplantation."
Since its inception in the late 1990s, corneal cross-linking has grown from a compelling concept to the standard of care for eligible patients. In this procedure, the cornea is saturated with riboflavin eye drops and treated with ultraviolet light. This stiffens the cornea to prevent further shape changes, potentially reducing the risk of progressive vision loss by stabilizing the corneal collagen early in the disease.
"Treatment has moved from primarily surgical solutions to less invasive, preventive approaches," Dr. Bernhisel says. "Cross-linking can halt progression in many patients, while modern contact lens designs provide excellent visual rehabilitation without surgery. As a result, long-term outcomes and quality of life have improved for many patients."
For more information
Refer a patient to Mayo Clinic.