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Treatments and drugs
By Mayo Clinic staffThe treatment of keratoconus depends on its severity and rate of progression. Mild or moderate keratoconus can be treated with corrective glasses or contact lenses, but surgery may be necessary for advanced cases or scarring of the cornea.
Lenses
- Glasses or soft contact lenses. Early keratoconus can be treated with glasses or soft contact lenses to correct blurry or distorted vision. But because the condition is progressive, most people find they frequently need to change the prescription of their lenses as their corneas' shape changes.
- 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 wearers grow accustomed 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 get fitted by a doctor experienced with keratoconus.
- 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. These rigid gas permeable lenses are custom created for each individual based on topographical measurements of your corneas.
- Scleral contact lenses. These lenses are useful for irregular cornea changes, because they rest on the white part of the eye (sclera) and vault over the cornea, instead of resting on the cornea like traditional lenses.
If you're using rigid or scleral contact lenses, be sure that they're fitted by an eye doctor with experience in treating keratoconus, and that you go in for checkups and re-fittings. A poor-fitting hard contact lens can make keratoconus worse.
Surgery
You may need surgery if you have corneal scarring, extreme thinning of your cornea, or you can't tolerate the contact lens options. Several surgeries are available, depending on the location of the bulging cone and the severity of the disease. Surgical options are:
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Intrastromal corneal ring segments (ICRS). During this surgery, your doctor inserts small, synthetic arcs into your cornea to flatten your cornea's cone, support the cornea's shape and improve vision. First, you are given local anesthetics around your eye. Your surgeon makes an incision in your cornea, either with a precision blade or a laser, and inserts the two arcs 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 as it heals.
Although this surgery can restore a more normal corneal shape and halt the progression of keratoconus, many people still need to wear corrective lenses following the procedure. However, the surgery makes it easier to fit and tolerate contact lenses. Since the surgery is reversible, some people try ICRS before considering keratoplasty.
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Keratoplasty. If you have corneal scarring or extreme thinning, you will need a corneal transplant, called keratoplasty, which can be performed in a number of ways. Intralamellar 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.
During a keratoplasty, you may have a general anesthetic, or just 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 will likely continue to need rigid contact lenses to have clear vision.
Emerging treatments
A new treatment for keratoconus, called collagen cross-linking, is showing promise. After having riboflavin drops applied to your corneas, you receive 30 minutes of exposure to ultraviolet A (UVA) light. The procedure hardens and stabilizes the corneas, with the goal of preventing further thinning or bulging. The treatment is still in its testing phase and additional study is needed before it's widely available.
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