Surgical Options for Keratoconus Patients

Keratoconus can be a very frustrating condition for those affected.  Luckily, advancements in scleral lens technology over the past decade has allowed the keratoconic patient clear and comfortable vision all day without the risk of corneal scarring like that seen with conventional corneal gas permeable lenses.  While surgery is always a last resort for any medical condition, it may still be necessary as an adjunct to scleral lenses.

It is important to remember that there is no surgery to “cure” keratoconus.  In other words, surgery does not free patients from the need for corrective lenses (and typically rigid contact lenses).  There are three surgeries available that serve a purpose certain individuals with keratoconus. ​​

Corneal Cross Linking

This breakthrough surgery has been a game-changer in keratoconus management since it was FDA approved in late 2017.  Corneal Collagen Cross Linking (CXL, C3R) is a procedure that stabilizes the corneal shape, preventing further progression of keratoconus or other corneal ectasias.  The procedure involves bathing the cornea in riboflavin and then exposing it to UV light.  This causes a reaction that increasing the cross-linking of collagen fibers in the cornea, therefore increasing corneal rigidity and preventing further steeping of the cornea.   It is important to note that this procedure does not get rid of the optical effects of keratoconus, instead it simply stops the progression in an effort to maintain best-corrected visual acuity and prevent corneal scarring or the need for corneal transplantation.  This procedure combined with scleral lens fitting has become an extremely effective management technique for those with keratoconus, pellucid marginal degeneration and post-refractive surgery ectasia.




Intrastromal Corneal Ring Segments

These corneal implants were initially developed to help stop the progression of keratoconus, but studies have since found that they are not effective in doing so.  They are still used by some specialists as a way to flatten the cone in hopes of making rigid contact lens fitting easier.  With the advent of cross-linking and scleral lenses, this procedure has been made largely obsolete.


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Corneal Transplant

A corneal transplant is a last-case scenario for any corneal disease.   Most transplant patients still need a rigid lens (like a scleral lens) in order to see adequately, and chronic steroids are typically needed to prevent rejection.  That said, if a cornea becomes too steep or too scarred to be functionally corrected with scleral lenses, a corneal transplant can be a great option to restore sight.