Understanding Keratoconus

Keratoconus is a condition in which the cornea, the clear front window of the eye, becomes thinner and develops an irregular, cone-like shape. This changes how light focuses, causing blurred or distorted vision.

It often begins in the teenage years or early adulthood and usually affects both eyes, sometimes very differently.

As a cornea surgeon, I offer treatments ranging from corneal cross-linking to tissue-addition procedures and corneal transplantation. Your treatment plan depends on your corneal shape, thickness, vision, and whether the condition is progressing.

When Should You Be Evaluated?

Common signs include:

Specialized scans map the shape and thickness of your cornea. Comparing these measurements over time helps determine whether keratoconus is progressing.

Avoid rubbing your eyes, and ask about treatment for itching or allergies. Early evaluation gives us more opportunities to protect your vision.

Treatment Has Two Main Goals

Protecting the cornea from further progression

Corneal cross-linking strengthens the cornea to help slow or stop further changes.

Improving vision

Glasses, specialty contact lenses, tissue-addition procedures, or a corneal transplant may improve vision, depending on the stage of disease.

These goals often require different treatments. Better vision does not necessarily mean the condition has stopped progressing, and stabilizing the cornea does not always eliminate the need for glasses or contacts.

Corneal Cross-Linking: Helping Stabilize Your Cornea

Corneal cross-linking, or CXL, uses riboflavin (vitamin B2) and ultraviolet light to strengthen the cornea.

Its main purpose is to slow or stop progression. Some patients also notice visual improvement, but CXL does not reliably restore a normal corneal shape or remove the need for vision correction.

Epi-off cross-linking

The thin surface layer of the cornea, called the epithelium, is removed so riboflavin can penetrate. This established approach requires the surface to heal afterward, with temporary discomfort and blurred vision.

Epi-on cross-linking

Epi-on treatment keeps the surface layer in place. Epioxa, used with the O₂n System and Boost Goggles, is an FDA-approved, oxygen-enriched epi-on treatment for keratoconus in patients age 13 and older.

This approval applies to that specific treatment system; not all epi-on techniques are FDA-approved.

I offer cross-linking and will discuss which approach fits your corneal measurements and clinical findings. Both approaches require follow-up and can cause side effects, including irritation, light sensitivity, haze, or changes in vision.

Improving Vision With Glasses and Contact Lenses

Glasses or soft contact lenses may work well in early keratoconus.

As the cornea becomes more irregular, rigid gas-permeable, hybrid, or scleral lenses may provide clearer vision. Scleral lenses vault over the cornea and create a smooth optical surface.

Specialty lenses can be helpful even after surgery. They improve vision but do not stop keratoconus from progressing.

CAIRS: Reshaping the Cornea With Donor Tissue

CAIRS stands for corneal allogenic intrastromal ring segments. These small, curved segments of donor corneal tissue are placed within channels in your cornea.

The aim is to flatten the steepened area and improve corneal regularity. For selected patients, this may improve vision or make vision correction easier.

I offer CAIRS after assessing your corneal scans, thickness, and any scarring. Results vary, and glasses or specialty contact lenses may still be needed.

CTAK: Customized Corneal Tissue Addition

Corneal Tissue Addition Keratoplasty, or CTAK, uses a customized donor-tissue inlay placed within a laser-created channel in the cornea.

The tissue is shaped and positioned according to your corneal measurements, with the goal of improving its contour and visual quality.

CAIRS and CTAK do not replace cross-linking when stabilization is needed. These procedures have risks, including infection, inflammation, tissue displacement, and an unpredictable visual result. Long-term evidence is still developing.

When Is a Corneal Transplant Needed?

A transplant may be considered when advanced keratoconus, significant scarring, or poor vision despite other treatments interferes with daily life.

DALK: Preserving Your Healthy Inner Cornea

Deep anterior lamellar keratoplasty, or DALK, replaces the affected front and middle layers of the cornea while preserving your own healthy inner membrane and endothelial cells.

I perform DALK when the deeper layers are suitable for preservation. Keeping your own endothelial cells avoids endothelial graft rejection, an important advantage over a full-thickness transplant. Other types of rejection and surgical complications can still occur.

Full-thickness transplantation

A penetrating keratoplasty, or PK, replaces all layers of the central cornea. It may be necessary when DALK is unsuitable or cannot be completed safely.

Both procedures require sutures, prescribed drops, and ongoing follow-up. Vision improves gradually as the cornea heals, and glasses or specialty contact lenses still are needed.

Choosing the Right Approach for Your Eyes

There is no single treatment that suits every stage of keratoconus. Some patients need monitoring and specialty lenses; others benefit from cross-linking, tissue addition, or transplantation.

During your consultation, we will review:

I will explain the options, their benefits and limitations, and how they may work together to protect and improve your vision.

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