Understanding Keratoconus — Early Signs and Treatment Options

What is Keratoconus?

Keratoconus is a condition in which the cornea — the clear dome-shaped window at the front of the eye — progressively thins and bulges forward into a cone shape. This distorts how light enters the eye, causing blurred and distorted vision.

The condition typically begins in the teenage years or early twenties and can progress for one to two decades. In many cases, vision can deteriorate significantly if left untreated.

Early Warning Signs

The early stages of keratoconus can be subtle and are often mistaken for simple myopia (short-sightedness) or astigmatism. Key warning signs include:

• Frequent changes in glasses prescription — particularly if astigmatism keeps increasing
• Distorted or "wavy" vision that glasses don't fully correct
• Glare and halos around lights, especially at night
• Difficulty wearing contact lenses due to discomfort or poor vision
• Eye rubbing — a significant risk factor that can accelerate progression

Why Early Diagnosis Matters

The most important treatment for keratoconus — corneal cross-linking — works by halting progression. It cannot reverse damage that has already occurred. This means the earlier the diagnosis, the better the chance of preserving your current level of vision.

Corneal topography mapping is the key diagnostic test. This creates a detailed 3D map of the corneal surface, revealing irregularities invisible on standard examination.

Treatment Options

1. Optical Correction

Mild keratoconus can often be managed with glasses or soft contact lenses. As the condition progresses, rigid gas-permeable (RGP) lenses or scleral lenses provide better visual quality by masking the irregular corneal surface.

2. Corneal Cross-Linking (CXL)

Cross-linking uses ultraviolet light and riboflavin (vitamin B2) drops to strengthen the collagen bonds within the cornea. It is highly effective at stopping progression in the vast majority of cases. The procedure takes around 60–90 minutes and is performed as a day procedure.

3. Surgical Options

If vision becomes too poor to manage with lenses, or if the cornea becomes too thin for cross-linking, corneal transplantation may be considered. Options include:

• DALK (Deep Anterior Lamellar Keratoplasty) — replacing the front layers of the cornea while preserving the patient's own inner cells
• Penetrating Keratoplasty (PKP) — full-thickness corneal transplant for the most advanced cases

When Should You See a Specialist?

If you or your optometrist suspects keratoconus, prompt referral to a corneal specialist is recommended. A comprehensive assessment including corneal topography and tomography will determine whether cross-linking or other interventions are warranted.

Early action makes a significant difference to long-term outcomes. Don't wait until vision is severely affected.

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Dr Ross MacIntyre consults at Northern Eye Consultants in Bundoora. Book an appointment →