Treatment of Keratoconus

Introduction

Keratoconus is a progressive eye condition that causes the cornea to thin and bulge into a cone-like shape, leading to blurry vision, sensitivity to light, and difficulty with everyday tasks like reading or driving. Early diagnosis and timely treatment can help protect eyesight and prevent severe complications. With advancements in modern eye care, multiple treatment options are now available that can slow the disease, stabilize the cornea, and improve vision.

What Is Keratoconus?

Keratoconus is a non-inflammatory eye disorder where the cornea normally smooth and dome-shaped begins to weaken and thin out. Over time, it protrudes forward, forming a cone shape. This distorted corneal structure prevents light from focusing properly on the retina, causing significant vision problems.

The condition often starts during teenage years or early adulthood and may progress over a period of 10–20 years. In advanced stages, it can lead to corneal scarring and severe vision loss. Because keratoconus progresses differently in each person, selecting the right treatment depends on the severity, age, and rate of progression.

Top Treatment of Keratoconus

Modern eye care has introduced various treatment choices ranging from simple contact lenses to advanced surgical techniques. Below are the most commonly recommended and effective treatments.

1. Eyeglasses and Soft Contact Lenses (For Early Stages) :- In the initial stages of keratoconus, vision distortion is usually mild. Eyeglasses or soft toric contact lenses help correct nearsightedness and astigmatism caused by irregular corneal shape. Although they do not stop the disease from progressing, they offer temporary vision clarity.

Ideal for:

• Mild keratoconus
• Patients with early vision distortion
• Those with minimal corneal thinning

2. Rigid Gas Permeable (RGP) Contact Lenses :- RGP lenses are firmer than regular lenses and help maintain a smooth corneal shape to improve vision. Instead of adjusting to the shape of the cornea, they create a new, even surface for light to enter the eye. This significantly enhances clarity.

Benefits of RGP lenses:

• Sharper vision
• Better stability
• Affordable compared to surgical options

However, they may require an adaptation period because of their rigidity.

3. Scleral and Semi-Scleral Lenses :- These are specialized large-diameter contact lenses designed to vault over the cornea entirely and rest on the sclera (white portion of the eye). For moderate to advanced keratoconus, scleral lenses provide exceptional comfort and vision stability.

Why scleral lenses are preferred:

• They do not touch the cornea
• Provide superior comfort
• Offer stable, high-quality vision
• Suitable even for highly irregular corneas

This option is especially beneficial for patients who cannot tolerate RGP lenses.

4. Corneal Cross-Linking (CXL) :- Corneal Collagen Cross-Linking is one of the most revolutionary treatments available today. It strengthens and stabilizes the cornea, preventing keratoconus from worsening.

How Cross-Linking Works:

• Vitamin B2 (riboflavin) eye drops are applied.
• The cornea is exposed to controlled UV light.
• This triggers natural collagen fiber cross-linking, making the cornea stronger and more rigid.

Benefits of CXL:

• Stops or slows progression
• Reduces the risk of advanced complications
• Preserves vision
  
• Quick outpatient procedure
• Long-lasting results

Who should consider CXL?
People between ages 12–40 with documented progression of keratoconus often benefit the most. It is one of the only treatments proven to halt the disease.

5. Intracorneal Ring Segments (ICRS) :- These are small, crescent-shaped plastic implants inserted into the cornea to flatten its shape and improve vision. The procedure is minimally invasive and reversible.

Ideal for Patients With:

• Moderate keratoconus
• Difficulty using contact lenses
• Irregular corneal surface
• Vision not fully corrected with glasses

ICRS improves corneal symmetry and may reduce dependency on glasses or lenses.

6. Topography-Guided Photorefractive Keratectomy (TG-PRK) :- TG-PRK is an advanced laser procedure used to reshape the cornea in certain keratoconus cases. It works best when combined with corneal cross-linking for long-term stability.

Advantages:

• Smoothens corneal surface
• Reduces halos and glare
• Improves quality of vision
• Effective for selected mild to moderate cases

However, it is not suitable for patients with very thin corneas.

7. Corneal Transplant (Keratoplasty) :- When keratoconus becomes severe and vision cannot be corrected with lenses or less invasive options, a corneal transplant may be necessary. Two main types are performed:

1. Deep Anterior Lamellar Keratoplasty (DALK) :- Removes only the damaged corneal layers, preserving the healthy endothelium.
2. Penetrating Keratoplasty (PK) :- A full-thickness corneal transplant.

Success Rate:

Over 90% of patients experience significant visual improvement. However, recovery may take several months, and long-term care is essential.

Which Treatment Is Right for You?

The best treatment depends on:

• Age
• Stage of keratoconus
• Corneal thickness
• Previous treatments
• Rate of disease progression

A detailed corneal mapping test (corneal topography) helps doctors determine the most suitable plan. Early detection remains the key to preventing severe vision loss.

Lifestyle Tips for Managing Keratoconus

While treatments help preserve vision, daily habits also play a crucial role:

• Avoid eye rubbing as it worsens corneal thinning
• Follow-up with your ophthalmologist regularly
•  Maintain proper contact lens hygiene
•  Use lubricating eye drops for dryness
• Protect eyes from dust and UV exposure

Conclusion

Keratoconus is a progressive condition, but with the right treatment at the right time, its progression can be controlled, and vision can be preserved effectively. Modern options like corneal cross-linking, scleral lenses, and intracorneal ring segments have transformed patient outcomes, making it possible to maintain stable, clear vision for many years.