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Q&A on Keratoconus

Questions were answered by Burt Dubow, OD

Q: I have been diagnosed with the beginning stage of keratoconus and was prescribed rigid gas permeable lenses to treat the condition. However, I could not tolerate wearing these lenses. What are any other treatment options relating to this condition? — M.C., Wisconsin

A: Keratoconus is an eye condition where the clear front surface of the eye, the cornea, gets thin and bulges outward into a cone shape. This usually begins in the teens or early twenties and affects mostly males. And one eye is usually worse than the other eye. It is also oftentimes familial, so alert other family members to get their eyes checked.

As the cornea thins and bulges, it becomes distorted and even droopy, creating blurred vision that is not very correctable with glasses. Certain types of contact lenses can vault over the irregularly shaped cornea to help focus light properly. Rigid gas permeable lenses (also called RGP or GP lenses) are my first choice, and they usually can be prescribed successfully.

There are a number of gas permeable lens designs that can be tried before turning to other options. Before you give up on GP lenses, ask your practitioner if he or she can prescribe specially made rigid lenses such as the Rose K design for keratoconus. Also, large-diameter scleral contact lenses made of GP material might work better than standard RGP lenses.

If GP lenses simply will not work, hybrid contact lenses might be an option. These lenses have a GP central zone, surrounded by a skirt of soft lens material for added comfort, and special designs are available for keratoconus.

Soft lenses also are made for people with keratoconus, but these would be my last choice, because they are not rigid enough to help keep the cornea from bulging over time. But they can offer better vision than glasses.

Your eye care practitioner also can consider a contact lens fitting technique called piggybacking, which is an RGP lens fitted over a soft lens. This combination can make RGP lenses much more comfortable and give you excellent vision as well.

Please keep in mind that people with keratoconus usually have a harder time with contact lens comfort and vision — their eyes are not normal, their tears are not normal, etc. Give your practitioner plenty of time to get you up and running, and expect more frequent tune-ups than a regular patient. Most importantly, look at the good side... keratoconus is not a fatal disease and does not cause blindness. Hang in there! — Dr. Dubow

Q: My new eye doctor told me that I have keratoconus and recommended that I switch from soft contacts to rigid gas permeable contact lenses. What is keratoconus, and what should I do? — D.O., Missouri

A normal eye vs. an eye with a slight amount of keratoconus. The keratoconic cornea bulges slightly, for a more cone-shaped surface. (Artist's re-creation of keratometry images.)

A: Keratoconus is an eye condition where the cornea, the clear front surface of the eye, becomes thinner and starts to protrude, forming an irregular cone-like shape. This cone can grow larger and larger until it actually starts to droop due to gravity. This distortion on the front of the eye causes one's vision to be unclear. It is believed that keratoconus is a familial problem, so you should pass the word for others in your family to be on the alert.

Rigid gas permeable (RGP or GP) contact lenses are the standard of care for keratoconus because they provide a round and non-distorted front surface for the eye, improving vision, while hopefully slowing down the progression of the cone shape. There are many gas permeable lens designs that work very well for keratoconus, depending on the severity of the condition.

Other options include hybrid contact lenses and certain custom soft lenses. In some cases, wearing an RGP lens over a soft lens — this is called piggybacking — may be the best solution. — Dr. Dubow

Q: A doctor recently diagnosed me with keratoconus. He prescribed soft contact lenses, and my vision is back to 100 percent, but I was wondering if there are any other treatments for this condition. — Eric, Florida

A: Keratoconus is a condition where the front of the eye (cornea) bulges outward into a cone shape, distorting vision. It is very often hereditary.

Soft contact lenses would be my last choice because they are not rigid enough to keep the cornea from bulging. Standard rigid gas permeable (RGP) lenses may work for you, but other lens options are available if your keratoconus worsens, including large-diameter GP designs and hybrid contact lenses.

If contact lenses don't work, there are other new and interesting options available. Intacs corneal inserts received FDA approval for correction of nearsightedness and astigmatism in people with keratoconus. They are easily implanted in the peripheral cornea by an eye surgeon.

Intacs can flatten the cornea and reduce irregularities, helping people with keratoconus see much better.

Also, a surgical procedure called corneal crosslinking (CXL) can strengthen the connective tissue within the cornea, making the front of the eye harder and less flexible so it can maintain the proper shape for good vision.

Some people also may be candidates for a cornea transplant, where the center of the cornea is removed and a donor cornea is put in its place. Follow your eye doctor's advice — he or she will advise you of the best options to successfully manage your keratoconus. — Dr. Dubow

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[Page updated August 2011]