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Treatments and drugs

Treatment for keratoconus depends on how severe it is and how fast it's progressing. Mild to moderate keratoconus can be treated with eyeglasses or contact lenses. For most people, the cornea will stabilize after a few years, without causing severe vision problems. In about 10 to 20 percent of people with keratoconus, however, the cornea becomes scarred or they're unable to continue wearing contact lenses. In these cases, surgery might be necessary.

Lenses
For most people with keratoconus, contact lenses are the most effective treatment.

• Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
• Rigid gas permeable contact lenses. Hard contact lenses are often the next step in treating progressing keratoconus. Rigid lenses may feel uncomfortable at first, but many people get used to them.
• Piggyback lenses. If you don't like the feel of rigid lenses, your doctor may recommend "piggybacking" a hard contact lens on top of a soft one. Fitting a combination of lenses takes a lot of precision, so be sure you work with a doctor experienced with this technique.
• Hybrid lenses. Also for people who can't tolerate hard contact lenses, these contacts have a rigid center with a softer ring around the outside for increased comfort.
• Customized contact lenses. Rigid gas permeable lenses can be custom made based on topographical measurements of your corneas.
• Scleral contact lenses. These lenses are useful for irregular changes in your cornea. Instead of resting on the cornea like traditional lenses do, scleral contacts sit on the white part of the eye (sclera) and vault over the cornea.

If you're using rigid or scleral contact lenses, make sure to have them fitted by an eye doctor with experience in treating keratoconus. You'll also need to have regular checkups and refittings. A poor-fitting hard contact lens can further damage your corneas if you have keratoconus.

Surgery
You may need surgery if you have corneal scarring, extreme thinning of your cornea or poor vision even with the strongest prescription lenses, or if you can't wear any type of contact lenses. Several surgeries are available, depending on the location of the bulging cone and the severity of the disease. Surgical options are:

• Corneal inserts (intrastromal corneal ring segments). During this surgery, your doctor inserts two tiny, clear, crescent-shaped plastic inserts into your cornea to flatten the cone, support the cornea's shape and improve vision. First you're given a local anesthetic around your eye to numb it. Your surgeon makes a small cut in your cornea, either with a precision blade or a laser, and places the inserts in specific locations based on your cornea's shape. The incision is closed with stitches, and a soft lens is placed over your eye to protect it while it heals.

  Although corneal inserts can restore a more normal corneal shape and keep keratoconus from progressing, many people still need to wear corrective lenses following the procedure. But the surgery makes it easier to fit and tolerate contact lenses. Since the surgery is reversible, some people choose to have corneal inserts before considering keratoplasty.

• Cornea transplant (keratoplasty). If you have corneal scarring or extreme thinning, you'll likely need a corneal transplant, called keratoplasty. Lamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea's surface is replaced. Penetrating keratoplasty is a full-cornea transplant, in which an entire portion of your cornea is replaced. A deep anterior lamellar keratoplasty (DALK) preserves the inner layer of the cornea, called the endothelium. It helps avoid rejection caused by the endothelial cells in a full-thickness transplant.

  During a keratoplasty, you may have a general anesthetic or your eye may be numbed with a local anesthetic. Your doctor removes a button-shaped portion of your cornea, replacing it with a similar-sized button from a donor cornea. Stitches and a soft lens are placed to protect your eye as it heals. Recovery after keratoplasty can take up to one year, and you'll likely continue to need rigid contact lenses to have clear vision. It might take several years before you receive the full benefit of the transplant for improved vision. Corneal transplant is generally very successful, but possible complications include graft rejection, a dilated or fixed pupil, infection, cataract, and glaucoma.

Emerging treatment
A treatment for keratoconus, called collagen cross-linking, shows promise. After having riboflavin drops applied to your cornea, you're exposed to ultraviolet A (UVA) light. The procedure strengthens the cornea, with the goal of preventing further thinning or bulging. The treatment is still in the testing phase in the United States, and additional study is needed before it becomes widely available.

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