Keratoconus is a rare eye condition that develops when the tissue within the cornea thins and weakens. It causes the cornea to bulge into a cone-like shape. This condition affects approximately 1 in 2,000 people. Those affected with keratoconus typically start experiencing symptoms as teenagers or young adults, and it may progress slowly over time.

"There are many different causes of keratoconus," says Brian Armstrong, MD, Nebraska Medicine ophthalmologist. "For some people, it runs in their family. For others, it can be due to a history of excessive eye rubbing from eye allergies and various other medical conditions. Sometimes it can be secondary to laser vision correction performed on a patient not properly screened."

Symptoms of keratoconus

Keratoconus causes vision to slowly worsen over time and is usually asymmetric (one eye affected more than the other). While it does not cause blindness, it makes people more dependent upon glasses and contact lenses. In advanced cases, vision can only be corrected with hard contact lenses or surgery.

Primary symptoms include:

1. Gradually decreasing vision in one or both eyes
2. Double vision when looking with just one eye
3. Objects both near and far look distorted and blurred, even when wearing corrective glasses or contacts 
4. Halo and glare around lights in high contrast situations, like streetlights, when driving at night

How is keratoconus diagnosed?

If you are experiencing changes in vision as described above, you should book an appointment to see your eye doctor. Your doctor will check your prescription and examine your eyes.

If the cornea shows signs of bulging, which is typical of keratoconus, your doctor may use several different instruments to measure the curvature of the eye. The primary method involves using a tomographer, which measures the shape and thickness of your cornea to create a three-dimensional "map" of your cornea. This process is painless, quick and does not touch the eye. 

"Early detection is important for monitoring purposes," Dr. Armstrong says. "If any progression is detected, treatment can reduce further vision loss.

"Additionally, if you have any risk of keratoconus, it is important not to proceed with laser vision correction surgery such as LASIK or SMILE, which can worsen the condition. We always screen for this condition before proceeding with laser vision correction."

How is keratoconus treated?

Treatment usually starts with new eyeglasses. New eyeglasses can usually make vision clear again in mild cases of keratoconus. Eventually, though, it may be necessary to use contact lenses. Sometimes, rigid contact lenses are needed. 

In cases where keratoconus progresses over time, corneal cross-linking is performed to strengthen the cornea, stop the thinning process, and stabilize the cornea. "This procedure can stop further vision loss, and in some cases, vision can gradually improve over time," says Dr. Armstrong.

What is corneal cross-linking?

Normal corneas have cross-links between the collagen fibers that keep them strong and able to retain their normal shape. With keratoconus and related disorders, the cornea is weak with too few cross-links or support beams. This weakening allows the cornea to bulge outwards. 

The cross-linking procedure adds cross-links or "cross beams" to the cornea. This makes the cornea more stable and helps it hold its shape and focus better. "At Truhlsen Eye Institute, we specialize in corneal cross-linking and multiple other procedures to help patients with keratoconus," says Dr. Armstrong.

What other treatments are available for keratoconus?

Corneal ring implantation is a surgery that involves implanting a small plastic ring into the middle layer of the cornea. It improves corneal shape and vision. This procedure can also help patients with keratoconus who have difficulty wearing contact lenses.  

Specialty contact lens fitting involves fitting keratoconus corneas with specialty contact lenses. Truhlsen Eye Institute has optometrists that specialize in this treatment methodology. 

EVO implantable Collamer lens placement is sometimes performed on stable adult keratoconus patients who can see well with eyeglasses. In this procedure, an intraocular lens is placed inside the eye to correct the prescription and eliminate the need for glasses or contact lenses.

Our specialists can perform corneal transplantation. "We specialize in an array of different corneal transplantation treatments, including some minimally invasive techniques that are performed at very few medical centers in the world," notes Dr. Armstrong.  

"We take the diagnosis and management of keratoconus very seriously at Truhlsen Eye Institute," says Dr. Armstrong. "We have established a one-stop shop for patients with keratoconus and are committed to helping you or your family members suffering from this condition."