What is Keratoconus?
Keratoconus, pronounced (KAIR-ah-toh-KOH-nus), is a progressive eye disease that causes the normally round cornea to become thin and bulge into a cone-like shape. Keratoconus can form in one or both eyes and it’s usually diagnosed in younger patients. Many patients are commonly diagnosed with mild astigmatism at the onset of puberty and are later diagnosed with keratoconus in their teens or early 20’s. Since keratoconus is a usually a progressive disease (gets worse with time) it’s important to have an early diagnosis so eye doctors have the opportunity to treat the disease as early as possible.
What is it? What are your Options?
LaserVue Eye Center offers innovative keratoconus diagnoses and treatment options in the San Francisco Bay Area. Our keratoconus treatment options include specialty contact lenses, Intacs, and Collagen Cross-Linking which can slow or even stop progressive keratoconus.
Corneal collagen cross-linking, or CXL, is a revolutionary noninvasive outpatient treatment for progressive keratoconus patients and corneal ectasia patients. This treatment requires a riboflavin-containing solution and an ultraviolet light delivery device to strengthen the cornea. CXL treatments slow or halt progressive keratoconus for about 90% of patients and may also improve vision in some patients treated.
How Does Keratoconus Affect my Vision?
Because the cornea is responsible for focusing light into the eye, any abnormalities can cause vision to blur. Common conditions such as nearsightedness, and/or astigmatism can be caused by the cornea being too steep, too flat or football shaped. Since keratoconus causes the cornea to weaken or bulge into a cone-like shape, vision becomes very blurry and very unstable. This can severely affect vision and make simple everyday tasks such as driving a car, reading a book or watching television difficult or impossible.
Keratoconus Symptoms and Diagnoses
At first, keratoconus is often diagnosed as mild astigmatism when a patient is in their teens or early 20’s. When the patient returns for an annual exam, their eye doctor will notice a larger than normal change in their eyeglass prescription and/or corneal curvature. As the disease progresses, so does the severity of their myopia and astigmatism, with progressive decrease in vision.
Below is an example what keratoconus induced astigmatism and myopia (nearsightedness) might look like.
How is Keratoconus Treated?
When the disease is initially diagnosed, many patients will require glasses or gas permeable contact lenses in order to maintain clear vision. As keratoconus progressively worsens, Intacs implants may be needed. Intacs are small subcircular rings that are inserted into the cornea that can help stabilize the cornea. If the disease continues to progress, a corneal transplant may be required. However, Collagen Cross-Linking or CXL is now available, which has shown tremendous success in slowing or stopping the progression of keratoconus. There are both FDA approved and “Off-Label” versions of CXL available, please ask what specific treatment is being recommended to you and benefits/risks associated with each form of treatment.
Corneal Collagen Cross-Linking (CXL)
How is Corneal Collagen Cross-Linking (CXL) Performed?
CXL is performed as an outpatient procedure. First, your eye doctor will instill anesthetic eye drops to help ensure comfort. Next, an eye speculum is used to help keep the eyes open during treatment and a series of vitamin B2 (riboflavin) drops are administered to the surface of the eye. An ultraviolet (UV) light is then applied to the eye, which causes the vitamin B2 to activate and thus form more collagen cross-linking.
How Does Corneal Collagen Cross-Linking (CXL) Work?
Ultraviolet light reacts at a molecular level with riboflavin on the surface of the cornea. Resulting bonds, or cross-links, make the cornea stronger. Studies have shown that collagen cross-linking has been extremely successful in slowing or stopping keratoconus and corneal ectasia. Many patients also have improved vision after undergoing treatment.
Corneal Collagen Cross-Linking Benefits
- Slows or Halts Progressive Keratoconus
- Zero Injections
- A Single One-Hour Treatment
- Zero Incisions & Stitches
Corneal Collagen Cross-Linking Candidacy
- 14 Years of Age or Older
- Adequate Corneal Thickness
- Ability to Leave Contact Lenses Out for Four Weeks Before and After Treatment
- Prior Diagnosis of Progressive Keratoconus or Corneal Ectasia
- Not Be Pregnant
Corneal Collagen Cross-Linking (CXL)
Soft and Rigid Contact Lenses
In the early stages, eyeglasses or soft contact lenses are usually the first step in helping with keratoconus induced myopia and astigmatism. As the disease progresses, most patients will graduate to rigid gas permeable (RGP) contact lenses. These lenses help smooth the irregular cone-shaped cornea, which helps improve vision. RGP contacts are somewhat difficult to fit, which is why it is important to see an eye doctor that has a lot of experience with these specialty fit contacts.
Intacs
Intacs are extremely thin semi-circular rings made out of a plastic-like material. These rings are inserted into the eye to help reinforce corneal strength and stability. Intacs can also help to correct for myopia and astigmatism caused by keratoconus.
Corneal Transplant
As corneal thinning caused from keratoconus progresses, RGP contacts and Intacs may no longer be a viable solution. When this happens, a corneal transplant is needed. A cornea transplant, also known as penetrating keratoplasty (PK) is necessary in 10-20% of patients diagnosed with keratoconus. During the corneal transplant procedure, the surgeon will remove the diseased cornea and replace it with a healthy donor cornea. This is often a highly successful procedure, however recovery time can take a year or sometimes longer.
Call Today
If you’ve been diagnosed with keratoconus, call LaserVue today to learn more about our treatment options for keratoconus.
Remember, the early detection of this disease is essential to stopping the progression. Keratoconus does not have have a cure, only treatments to stop progression.
1-800-527-3745
Corneal Collagen Cross-Linking (CXL) FAQs
How Long Does CXL Treatment Last?
Studies have shown that CXL can last a long time, and many doctors believe that CXL is permanent. In some cases however, CXL may require a second treatment.
Can CXL Prevent The Need For A Corneal Transplant?
Many studies have shown that cross-linking can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again.
Does Insurance Cover The CXL Treatment?
In some cases, Insurance may cover the cost of CXL treatment.
How safe is CXL?
Since CXL is a non-invasive procedure, it is very safe. Newer techniques don’t require removal of the epithelium layer and allow for much greater patient comfort. This technique also allows for a faster healing time and reduces the risk of complications.
Can CXL Be Performed On Anyone With Keratoconus?
During your consultation, the doctor will determine if cross-linking might be an appropriate treatment option for you.
Is Financing Available?
Keratoconus: Collagen Cross-Linking Doctors
Jay Bansal, MD
Your LASIK & Cataract Surgeon in Northern California
Stephanie Wangyu, MD
Ophthalmologist
Ready to SEE a Change?
Helping you to achieve your personal best vision is our mission at LaserVue Eye Center. Wondering where to start?
Please complete the fields on the right to schedule a free consultation and discuss your options with our eye doctors! You can also Call 1-800-527-3745 to speak with our staff.
Understanding Keratoconus: Stages and Progression
Keratoconus is a progressive corneal disease in which the cornea gradually thins and bulges forward into a cone-like shape, distorting vision in ways that glasses alone cannot fully correct. It most commonly emerges during the teenage years or early twenties and can progress for one to two decades before stabilizing. Understanding the stages of keratoconus is essential to choosing the right treatment at the right time.
Stage 1 — Mild Keratoconus
In the earliest stage, corneal topography reveals subtle steepening but vision can still be adequately corrected with glasses or standard soft contact lenses. Annual monitoring with corneal tomography (such as Pentacam) is critical because this is the optimal window to intervene with corneal crosslinking (CXL) before meaningful structural damage occurs.
Stage 2 — Moderate Keratoconus
Corneal irregularity becomes more pronounced. Standard contact lenses no longer provide clear vision, and specialty rigid gas-permeable (RGP) or scleral lenses are typically required. Corneal crosslinking is strongly recommended at this stage to arrest further progression. Most patients treated with CXL at Stage 2 maintain functional vision for decades with specialty lens wear.
Stage 3 — Advanced Keratoconus
Significant corneal thinning and steep curvature make contact lens fitting challenging. Large-diameter scleral lenses that vault over the irregular cornea become the primary visual rehabilitation tool. Intacs corneal ring segments may be implanted to flatten the cone and improve contact lens tolerance. Crosslinking remains beneficial even at this stage if the cornea retains sufficient thickness.
Stage 4 — Severe Keratoconus
In the most advanced cases, the cornea may develop scarring (Vogt’s striae, apical scarring) that impairs vision even with optimal contact lens fitting. When contact lenses can no longer provide functional vision, corneal transplantation — either deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) — may be necessary. With modern treatments, reaching this stage is increasingly uncommon.
Diagnosing Keratoconus at LaserVue Eye Center
Early diagnosis is the single most important factor in preserving long-term vision in keratoconus patients. LaserVue Eye Center uses state-of-the-art corneal imaging technology to detect keratoconus — including subclinical (pre-keratoconus) cases that standard slit-lamp exams can miss entirely.
Corneal Topography
A computerized map of the front surface of the cornea that reveals irregular steepening patterns characteristic of keratoconus. Topography is the frontline screening tool in our comprehensive eye exam and is routinely performed on every patient being evaluated for laser vision correction.
Scheimpflug Corneal Tomography (Pentacam)
Unlike topography, which maps only the front corneal surface, the Pentacam captures both the anterior and posterior corneal surfaces, as well as full-thickness pachymetry maps (corneal thickness across the entire cornea). This allows detection of keratoconus suspects — patients who appear normal on topography but show posterior ectasia or focal thinning that places them at elevated risk.
Corneal Optical Coherence Tomography (OCT)
High-resolution OCT imaging provides cross-sectional views of the corneal layers, allowing our surgeons to assess structural integrity, identify the thinnest point of the cornea, and plan crosslinking or surgical intervention with precision.
When to Get Screened
We recommend keratoconus screening for any patient with: a family history of keratoconus; frequent prescription changes; blurred or distorted vision that glasses don’t fully correct; a history of eye rubbing; or a previous abnormal eye exam finding. Screening is also a standard part of our pre-LASIK evaluation — protecting patients from undergoing laser correction on a cornea that may be compromised.
Keratoconus Treatment Options at LaserVue
The goal of keratoconus treatment is twofold: halt progression with corneal crosslinking, and optimize vision through the best available optical or surgical means. The right treatment plan depends on the stage of disease, corneal thickness, and the patient’s visual demands.
Corneal Crosslinking (CXL)
FDA-approved corneal crosslinking is the only proven treatment to stop keratoconus from getting worse. The procedure uses ultraviolet-A light combined with riboflavin (vitamin B2) eye drops to create new bonds within the corneal collagen fibers, significantly increasing corneal strength and rigidity. CXL does not restore vision that has already been lost — its purpose is to prevent further deterioration. Most patients stabilize within 12 months of CXL, and many show measurable improvement in corneal shape over time.
Specialty Contact Lenses
For the majority of keratoconus patients, specialty contact lenses provide the best achievable corrected vision without surgery. Options include rigid gas-permeable (RGP) lenses for mild-to-moderate cases, scleral lenses (which vault over the irregular cornea and rest on the white of the eye) for moderate-to-advanced cases, and hybrid lenses that combine a rigid center with a soft skirt for improved comfort.
Intacs Corneal Ring Segments
Intacs are small, transparent plastic ring segments implanted in the peripheral cornea to flatten the cone and regularize the corneal shape. They are not a cure for keratoconus but can improve contact lens tolerance and, in some cases, reduce the best-corrected spectacle prescription. They are often used alongside crosslinking.
EVO ICL for Stable Keratoconus
Patients with stabilized keratoconus (confirmed by serial topography over 12+ months) who wish to reduce their dependence on thick glasses or contact lenses may be candidates for EVO ICL implantable lenses. Because ICL does not remove corneal tissue, it avoids the risk of further weakening a structurally compromised cornea — making it far safer than LASIK in keratoconus patients.
Corneal Transplantation
Reserved for patients with severe keratoconus who cannot achieve functional vision with contact lenses, corneal transplantation replaces the diseased cornea with a healthy donor cornea. Modern techniques, including deep anterior lamellar keratoplasty (DALK), allow surgeons to replace only the affected layers while preserving the patient’s own healthy endothelium, reducing rejection risk and improving recovery.
Frequently Asked Questions About Keratoconus
Is keratoconus genetic?
Yes, keratoconus has a significant hereditary component. First-degree relatives of a keratoconus patient have approximately a 10–15% lifetime risk of developing the condition, compared to roughly 1-in-2,000 in the general population. Family screening is strongly recommended.
Can keratoconus be cured?
There is no cure that restores the cornea to its original shape. However, corneal crosslinking reliably halts progression in the vast majority of patients, and many individuals maintain excellent functional vision for life through a combination of CXL and specialty contact lenses.
Will I go blind from keratoconus?
Complete blindness from keratoconus is extremely rare. With modern treatments — crosslinking, specialty lenses, and corneal transplant when needed — the overwhelming majority of patients retain functional vision throughout their lives.
Does eye rubbing cause keratoconus?
Chronic vigorous eye rubbing is the most consistently identified environmental risk factor for keratoconus and is believed to accelerate progression in genetically susceptible individuals. All keratoconus patients are strongly advised to avoid eye rubbing entirely — allergic eye disease that triggers rubbing should be aggressively managed.
Can I have LASIK if I have keratoconus?
No. LASIK removes corneal tissue, which would further weaken an already structurally compromised cornea and can cause a serious complication called post-LASIK ectasia. Keratoconus is an absolute contraindication to LASIK. Our comprehensive pre-LASIK screening at LaserVue is specifically designed to identify keratoconus suspects and redirect them to safer alternatives.
How long does corneal crosslinking take?
The CXL procedure itself takes approximately 60–90 minutes per eye. Most patients return to work within one week, though mild light sensitivity and blurred vision during the healing phase are expected. Full stabilization of corneal topography is typically confirmed at the 12-month follow-up visit.
Is crosslinking painful?
The procedure is performed under topical anesthesia (numbing drops), so patients feel pressure but not sharp pain during treatment. Post-operatively, a therapeutic contact lens is placed on the eye for comfort, and most patients describe the first few days as similar to a mild corneal abrasion — managed effectively with prescribed pain medication.
How often should keratoconus be monitored?
Untreated or recently treated keratoconus requires topography monitoring every 3–6 months until stability is confirmed for at least two consecutive years, then annually thereafter. Children and teenagers with keratoconus should be monitored even more frequently given the faster rate of progression in younger patients.
Does insurance cover keratoconus treatment?
Corneal crosslinking is FDA-approved and is covered by most major insurance plans as a medically necessary procedure. Specialty contact lenses for keratoconus are also often covered, though coverage varies by plan. Our patient coordinators can verify your specific benefits and help maximize your coverage.
What is the difference between keratoconus and pellucid marginal degeneration (PMD)?
Both are forms of corneal ectasia, but they differ in location. Keratoconus typically affects the central or paracentral cornea, while PMD involves thinning in the inferior peripheral cornea. Both conditions can cause progressive irregular astigmatism and may be managed with similar treatment approaches, though the specific presentation on topography is distinct. Correct diagnosis by an experienced corneal specialist is essential.
Related Eye Care Services at LaserVue
Patients with keratoconus often have additional vision care needs. LaserVue offers comprehensive services to address them:
- EVO ICL Implantable Lenses — Stable keratoconus patients may be candidates for EVO ICL to reduce dependence on specialty contact lenses.
- PRK Laser Vision Correction — In selected mild keratoconus cases, PRK combined with corneal crosslinking may be considered.
- Dry Eye Treatment — Keratoconus and specialty contact lens wear often exacerbate dry eye symptoms — we treat both.
- Cataract Surgery — Patients with keratoconus require specialized planning for cataract surgery — our surgeons are experienced in these complex cases.
- LASIK Eye Surgery — While LASIK is not appropriate for keratoconus, our comprehensive screening ensures every patient is guided to the right procedure.
LaserVue Eye Center serves patients at our San Francisco and Santa Rosa locations. Schedule your consultation today.