Treating and Managing Keratoconus
Understanding Keratoconus
Keratoconus often starts during the teenage years and can slowly get worse over time. Learning about what causes it and how it affects your eyes helps you get the care you need quickly.
In a healthy eye, your cornea is round like a basketball. In keratoconus, it slowly becomes thinner and weaker, causing it to bulge out like the tip of a football. Since your cornea helps focus light into your eye, this new cone shape scatters light instead of focusing it clearly, which makes your vision blurry or wavy.
Keratoconus usually starts between the ages of 10 and 25 and can run in families. People with allergies or those who rub their eyes a lot are also at higher risk. While it can seem rare, about 1 in every 2,000 people will develop the condition, though modern testing suggests it may be more common.
Early signs include vision that keeps getting blurrier even with new glasses, seeing halos or streaks around lights, and being extra sensitive to bright light. You might also notice that straight lines look bent or wavy, or that you need frequent changes to your glasses prescription.
Your eye doctor uses special machines to map the exact shape and thickness of your cornea. A test called corneal topography creates a detailed, colorful map that shows if your cornea is becoming cone-shaped. These tests are completely painless and help catch keratoconus in its earliest stages.
The condition progresses through different stages. In the early or mild stage, your vision can often be corrected with glasses or soft contacts. As it becomes moderate or advanced, the corneal shape grows more irregular, requiring specialty contact lenses or other treatments to help you see clearly.
If keratoconus is not managed, it can lead to severe vision problems, corneal scarring, or a rare complication called hydrops where the cornea swells suddenly. However, with modern treatments and regular monitoring, most people can maintain good, functional vision throughout their lives.
Treatment Options to Protect Your Vision
Your treatment plan will depend on how severe your keratoconus is and how much it affects your daily life. The goal is to slow down the condition and help you see as clearly as possible.
In the very early stages, regular glasses or soft contact lenses may be enough to correct the mild vision changes caused by keratoconus. These work best when your cornea has not changed shape too much yet, but they cannot stop the condition from getting worse.
When glasses are no longer effective, special contact lenses are the next step.
- Rigid Gas Permeable (RGP) lenses are hard lenses that create a smooth, clear surface over your irregular cornea, often providing much sharper vision.
- Scleral lenses are larger lenses that rest on the white part of your eye, vaulting over the cornea for extra comfort, especially if you have dry eyes.
- Hybrid lenses combine a hard center with a soft outer skirt for the clear vision of an RGP lens and the comfort of a soft lens.
This treatment strengthens your cornea to stop keratoconus from getting worse. Your doctor puts special vitamin B2 drops in your eye, then uses a controlled UV light to create stronger bonds between the collagen fibers in your cornea. The procedure helps to halt or significantly slow down the progression of the cone shape.
These are tiny, transparent arcs that are placed inside your cornea to help flatten its shape. This procedure can improve your vision and make it easier and more comfortable to wear contact lenses. Intacs are less invasive than a transplant and can be removed or replaced if needed.
If your cornea is severely scarred or other treatments do not work, you might need a corneal transplant. This surgery replaces your damaged cornea with healthy tissue from a donor. Modern techniques often preserve parts of your own cornea for faster healing, and most people see much better afterward.
Daily Management and Care
Taking good care of your eyes every day and following healthy habits can help keep your keratoconus stable and your vision as clear as possible.
Visit your eye doctor for checkups every 6 to 12 months, or as often as they recommend. Regular exams allow your doctor to track any changes in your cornea's shape with mapping technology and adjust your treatment plan before your vision is significantly affected.
Eye rubbing is a major risk factor for making keratoconus worse because it can weaken your cornea even more. If your eyes itch or feel irritated:
- Use a cool, clean cloth on your closed eyelids for relief.
- Try allergy eye drops if your doctor confirms you have allergies.
- Talk to your doctor about managing allergies to reduce the urge to rub.
Dry eyes can make symptoms worse and contact lenses uncomfortable. Use preservative-free artificial tears throughout the day to keep your eyes lubricated and feeling good. Your doctor can recommend the best eye drops for your specific needs.
Wear sunglasses that block 100 percent of UV rays whenever you are outside. UV light may contribute to weakening the cornea over time. Good sunglasses also reduce the glare and light sensitivity that are common with keratoconus.
Eating a balanced diet rich in antioxidants, found in leafy greens, colorful fruits, and fish, may support your overall eye health. Getting enough sleep, managing stress, and following your doctor's advice will help your eyes stay as healthy as possible.
Frequently Asked Questions
Here are answers to some of the most common questions patients have about living with and managing keratoconus.
Keratoconus usually progresses most in the teens and twenties and often slows down or stops on its own by age 30 or 40. Treatments like corneal cross-linking are designed to stop this progression much earlier to preserve your vision.
Currently, there is no cure that can reverse the changes to the cornea. However, modern treatments can effectively stop the condition from getting worse, and vision can almost always be improved to a high functional level with specialty lenses or surgery.
Fitting contact lenses for a cone-shaped cornea requires special training and patience. It may take several visits to find the perfect lens that provides clear vision and comfort, but an experienced fitter can help almost everyone succeed with contact lenses.
Cross-linking is meant to stop progression, not instantly improve vision. Your eye may be uncomfortable for a few days after the treatment, and your vision may be blurry at first. Vision typically stabilizes within 3 to 6 months as the cornea heals.
No, most people with keratoconus will never need a transplant. With today's effective treatments like cross-linking and specialty lenses, transplants are needed much less often than in the past, for only about 10 to 20 percent of patients.
Yes, there is a genetic link. If you have keratoconus, your close family members have a slightly higher chance of developing it too. It is a good idea for them to have regular eye exams, especially during their teenage years.
Most people with keratoconus can drive safely with the right vision correction. However, night driving can be challenging due to glare and halos around lights. Ensure your prescription is up to date and talk to your doctor about lenses designed to reduce glare.
Call your eye doctor right away if you notice any sudden decrease in vision, severe eye pain, or new cloudy areas in your sight. These could be signs of a complication that needs immediate medical attention.
Hormonal changes during pregnancy can sometimes cause keratoconus to progress. If you are pregnant or planning to become pregnant, let your eye doctor know so they can monitor your eyes more closely during this time.
The condition itself usually does not cause pain. You might experience eye irritation, dryness, or discomfort from poorly fitting contact lenses, or headaches from straining to see. Proper treatment and lens fitting usually relieve these symptoms.
Getting the Help You Need
If you have been diagnosed with keratoconus or are worried you might have it, the most important step is to work with an eye care team experienced in this condition. With a good treatment plan and regular monitoring, most people with keratoconus maintain excellent vision and live full, active lives.