Innovative Treatments for Keratoconus: Preserve Your Vision

New Treatments for Keratoconus: Advancing Patient Care

Keratoconus is a progressive vision disorder in which the cornea becomes thinner and gradually develops a cone-like shape. This abnormal curvature distorts light entering the eye, causing blurred and irregular vision that can be challenging to correct with standard glasses or soft contact lenses. Fortunately, advances in diagnosis and treatment now provide options to preserve vision and even improve the optical quality for patients with keratoconus.

In recent years, the landscape of keratoconus management has evolved dramatically—from its early detection with advanced imaging to new treatment modalities such as corneal collagen cross-linking and innovative refractive procedures. Today’s eye care providers play a crucial role in identifying the red flags, beginning treatment early, and customizing therapies for individual needs.

Let’s explore these breakthrough treatment options and understand how they are reshaping keratoconus care.

Understanding Keratoconus and Its Impact

Normally, the cornea is dome-shaped and provides much of the eye’s focusing power. In keratoconus, weakening of the collagen structure causes the cornea to thin and bulge forward. This leads to two common refractive errors:

• Myopia: Increased nearsightedness as light focuses in front of the retinal plane.
• Astigmatism: Irregular curvature leads to multiple focal points, producing blurred and distorted images.

Early symptoms may include subtle blurring of vision, increased sensitivity to glare, and frequent changes in prescriptions. As the disease progresses, patients can develop irregular astigmatism, halos, ghost images, and even starbursts around lights.

Advances in Diagnosis: Tools for Early Detection

Accurate diagnosis is critical to the management of keratoconus. Traditional methods such as retinoscopy may reveal a “scissoring” reflex—a highly suggestive sign of a cone-shaped cornea. Today, high-resolution imaging technologies provide greater detail:

• Corneal Topography: Uses placido disk technology to create an elevation map, highlighting areas of uneven curvature. A consistently steep keratometry reading—often above 50 diopters—can indicate pathology.
• Tomography (e.g., Pentacam): Provides a three-dimensional imaging of both the anterior and posterior cornea, along with pachymetry maps to assess corneal thickness. Abnormal “float” values reveal deviations from the normal corneal contour.
• Anterior Segment OCT: Offers cross-sectional views of the cornea and assists in mapping epithelial thickness. Epithelial mapping can sometimes detect subtle changes even before the full cone is evident.
• Ocular Biomechanics: Instruments like the ocular response analyzer measure corneal hysteresis and resistance, reflecting how well the cornea absorbs shock. Lower values are associated with a weakened, more “floppy” cornea.
• Genetic Testing: Emerging tests now analyze multiple gene variants to assess a patient’s risk profile. Although not a standalone diagnostic tool, genetic data can support clinical findings and guide early intervention.

Corneal Collagen Cross-Linking (CXL): Halting Disease Progression

One of the major breakthroughs in keratoconus treatment over the past decade is corneal collagen cross-linking (CXL). This minimally invasive procedure is the only treatment currently approved by the FDA to halt the progression of keratoconus.

How It Works: In the standard “epithelium‑off” Dresden protocol, the surgeon removes the corneal epithelium (the outermost layer) to facilitate penetration of riboflavin (a form of vitamin B2) into the corneal stroma. After a 30‑minute riboflavin soak, the cornea is irradiated with ultraviolet-A (UV‑A) light for approximately 30 minutes. This interaction generates reactive oxygen species, which induce additional molecular bonds (cross-links) between collagen fibers, thereby stiffening and stabilizing the cornea.

Although the removal of the epithelium may cause temporary discomfort and requires a bandage contact lens during healing, studies from the pivotal trials have shown that treated eyes not only stabilize but many even experience mild flattening of the cone, leading to improved visual outcomes.

Newer Protocols: Research is underway on “epithelium‑on” (transepithelial) cross-linking techniques. These methods preserve the epithelium, aiming to minimize postoperative pain and risk of infection. While widely used outside the U.S., the epithelium‑on approach is still being evaluated in clinical trials for FDA approval.

In addition, customized or topography-guided cross-linking protocols are emerging. These approaches tailor the UV‑A treatment to the specific curvature and thickness profile of each cornea, potentially combining stabilization with refractive improvements.

Specialty Contact Lenses: Enhancing Vision Quality

Although stabilization with CXL is fundamental, many keratoconus patients still experience visual distortions that require optical correction. Traditional eyeglasses or soft contact lenses often cannot fully correct the irregular astigmatism present in these eyes. As a result, specialty contact lenses have become a mainstay in keratoconus management.

• Rigid Gas Permeable (RGP) Lenses: These lenses create a smooth refractive surface over the irregular cornea by maintaining a fixed curvature that masks the underlying cone. Despite their excellent optical performance, some patients find RGP lenses less comfortable.
• Scleral Lenses: Scleral lenses vault over the entire corneal surface and rest on the sclera (the white of the eye). This design establishes a tear-filled reservoir between the lens and the cornea, providing both comfort and a stable optical surface that often leads to dramatic improvements in vision.
• Hybrid and Piggyback Systems: Hybrid lenses feature a rigid central zone for optics and a soft skirt for comfort, whereas piggyback systems combine a soft lens beneath an RGP lens. These options serve patients who are unable to tolerate standard hard lenses.

Fitting these lenses requires advanced diagnostic tools such as topography and sometimes even impression-based or scan-based design systems. When successfully fitted, specialty lenses enable many keratoconus patients to achieve crisp, comfortable vision—often delaying or even avoiding the need for surgical intervention.

Surgical Options for Advanced Keratoconus

For patients whose corneas have become severely scarred or who can no longer tolerate contact lens correction, surgical options remain an important part of the treatment spectrum. Although less common today because of early intervention with CXL, procedures have been refined over the years:

• Intrastromal Corneal Ring Segments (ICRS): Inserting arc-shaped plastic segments into the mid-corneal stroma can help flatten the cone, thereby regularizing the corneal surface and improving glasses-corrected vision. ICRS do not halt disease progression but can enhance spectacle or contact lens outcomes.
• Corneal Transplantation: When keratoconus reaches its most advanced stages and the cornea is heavily scarred, a corneal transplant (penetrating keratoplasty) or a lamellar transplant (deep anterior lamellar keratoplasty, DALK) may be necessary. These surgeries replace diseased corneal tissue with donor tissue, and while they are often highly successful, patients usually continue to require glasses or contact lenses after surgery.

Innovations on the Horizon

The field of keratoconus treatment is rapidly advancing. Areas receiving significant research attention include:

• Customized Cross-Linking: Topography-guided cross-linking uses detailed corneal maps to modulate the UV‑A energy delivered to different areas of the cone, allowing simultaneous stabilization and refractive improvement.
• Enhanced Epi-On Protocols: With further development of penetration enhancers and modified riboflavin solutions, transepithelial cross-linking may eventually offer outcomes comparable to the traditional epithelium‑off method—with superior patient comfort.
• Combination Procedures: Surgeons are beginning to combine treatments—such as performing cross-linking followed by topography-guided PRK—to not only stabilize the cornea but also optimize its shape for enhanced vision.

These innovative approaches are still in various stages of clinical testing and refinement. However, they promise to improve both the safety profile and the refractive outcomes for patients.

Working Collaboratively for Optimal Outcomes

Optimal care for keratoconus is a multifaceted process. Early identification by dedicated eye care professionals is critical, as is the ability to monitor disease progression over time. Using advanced diagnostic devices—combined with patient history factors such as age, changes in prescription, and eye rubbing habits—enables customized treatment plans that preserve vision and maintain quality of life.

Our team of experienced eye doctors works collaboratively with cornea specialists and contact lens experts to determine the most appropriate therapy for each patient. We encourage patients who exhibit any signs or symptoms of keratoconus to schedule a comprehensive eye examination. Personalized care can ensure that treatment is initiated at the earliest stage possible, thereby preventing irreversible vision loss.

Taking the Next Step

If you are experiencing fluctuating vision, increased sensitivity to light and glare, or a frequent need for new glasses or contact lens prescriptions, these can be indicators of keratoconus. Early intervention—whether through specialty contact lenses, corneal collagen cross-linking, or other surgical methods—can help preserve your vision and improve your overall quality of life.

We invite you to contact our office for a thorough evaluation. Our state-of-the-art diagnostic tools and individualized treatment plans are designed to provide you with the best possible outcomes. Reach out today to learn more about our keratoconus management services and take the first step toward preserving your vision.