Keratoconus Treatment Options
Non-Surgical Vision Correction
For many patients, managing keratoconus begins with corrective lenses. The right lens type depends on how far the disease has progressed and how irregular your corneal surface has become.
In the earliest stages of keratoconus, standard glasses or soft contact lenses may still provide acceptable vision. At this point, the corneal shape is only mildly irregular, and conventional lenses can compensate for it.
As keratoconus advances, the corneal surface becomes too irregular for soft lenses to follow, and vision correction with these options becomes less effective. Most patients eventually transition to specialty lenses designed specifically for irregular corneas.
Rigid gas-permeable (RGP) lenses are made from a firm material that holds its shape over the uneven corneal surface. This creates a smooth optical surface in front of the eye, correcting the distortion that soft lenses cannot fully address.
RGP lenses provide sharper vision than soft lenses for most keratoconus patients. Some people find that an adjustment period of a few weeks is needed to become comfortable with daily wear.
Scleral lenses are large-diameter gas-permeable lenses that vault completely over the cornea and rest on the sclera, the white of the eye. A fluid-filled space between the lens and the cornea corrects irregular astigmatism (uneven curvature) while keeping the eye surface hydrated and comfortable.
Scleral lenses are often the preferred specialty lens option for moderate to advanced keratoconus because they provide stable, consistent vision and are generally more comfortable than smaller RGP lenses.
Hybrid lenses combine a rigid gas-permeable center with a soft outer skirt, offering the optical clarity of an RGP lens with added wearing comfort. Custom scleral systems allow further personalization for patients with unusually shaped corneas.
Contact lenses of all types can delay the need for surgery in the vast majority of keratoconus patients. Our optometry team works closely with our cornea specialists to find the lens design that gives you the best combination of vision quality and daily comfort.
Treatments That Halt Progression
Corrective lenses improve how you see but do not slow down keratoconus. The treatments in this section address the underlying progression of the disease itself, helping to protect the vision you have.
Corneal cross-linking is the only proven treatment that stops keratoconus from getting worse. During the procedure, riboflavin (vitamin B2) eye drops are applied to the cornea and activated with ultraviolet-A light. This process strengthens the collagen fibers inside the cornea, making the tissue more resistant to further bulging.
Cross-linking halts progression in the overwhelming majority of treated eyes. No contact lens or other surgical treatment addresses the underlying weakening of the cornea the way cross-linking does.
Traditional cross-linking requires removing the thin outer layer of the cornea, called the epithelium, so that riboflavin can penetrate into the tissue. A newer approach, known as epi-on cross-linking, keeps the epithelium intact during treatment.
Epi-on cross-linking received FDA approval in 2025 and offers faster recovery and less post-procedure discomfort compared to the traditional method. Our cornea specialists can evaluate your corneal thickness and health to help determine which approach is the better fit for you.
Stopping eye rubbing is one of the most impactful steps you can take alongside any medical treatment. Rubbing the eyes weakens the collagen fibers within the cornea and can accelerate the progression of keratoconus.
If allergies cause itching that makes rubbing difficult to avoid, ask your specialist about antihistamine eye drops or cold compresses as safer alternatives. Managing the triggers that lead to rubbing works alongside medical treatment to protect the long-term health of your cornea.
Surgical Options for Keratoconus
When contact lenses no longer provide adequate vision, or when the cornea has thinned or scarred significantly, surgical treatment may be recommended. Several surgical options are available depending on the stage and characteristics of your keratoconus.
Ring segments are small, curved inserts placed inside the layers of the cornea to flatten the cone shape and reduce irregular astigmatism. They work best for moderate keratoconus and can improve how specialty contact lenses fit and function on your eye.
Ring segments do not stop progression on their own, so they are often combined with cross-linking. They are reversible and can be removed or exchanged if your needs change over time.
Corneal tissue addition keratoplasty, or CTAK, is a newer surgical approach that entered commercial use in 2024. A femtosecond laser is used to insert custom-shaped donor corneal tissue within your own cornea, flattening the cone from the inside.
Because CTAK preserves your own inner corneal layers, it carries a lower rejection risk than a full-thickness corneal transplant. Early outcomes have shown meaningful improvements in visual acuity for eligible patients, and our cornea specialists can assess whether you are a candidate.
A small percentage of keratoconus patients, typically those with advanced thinning or significant scarring, eventually require a corneal transplant. Two main approaches are used depending on the depth of involvement.
- Deep anterior lamellar keratoplasty (DALK) replaces the front layers of the cornea while preserving your healthy inner layer, reducing rejection risk
- Penetrating keratoplasty (PK) replaces the full thickness of the cornea and is reserved for cases with deep scarring that extends to the inner layers
Keratoconus has among the best corneal transplant success rates of any corneal condition. Early intervention with cross-linking has significantly reduced the number of patients who ultimately require transplant surgery.
Treatment Guidance by Stage
The right treatment depends on where you are in the progression of keratoconus. Our specialists approach each stage with a plan designed to preserve the most vision while keeping future options open.
In early keratoconus, glasses or soft contact lenses may still provide clear vision while the corneal shape remains relatively regular. Regular corneal imaging, called topography, monitors the shape and thickness of your cornea over time.
If imaging shows progression, cross-linking can stabilize your cornea before additional vision is lost. The primary goal at this stage is early detection of change and timely intervention.
At the moderate stage, most patients benefit from RGP, scleral, or hybrid lenses for their daily vision needs. If progression is documented on imaging, your specialist should evaluate you for cross-linking.
Ring segments may improve lens comfort if corneal shape makes fitting difficult. Combining cross-linking with specialty lens fitting addresses both the progression of the disease and your daily vision correction at this stage.
Advanced keratoconus with significant thinning or scarring may require surgical intervention. Your specialist evaluates whether CTAK, DALK, or PK is the most appropriate choice based on the depth of scarring and your overall corneal condition.
Even in advanced cases, scleral lenses provide good vision for many patients and may delay or eliminate the need for surgery. Early cross-linking has meaningfully reduced the number of patients who reach this stage.
Frequently Asked Questions
These answers address the questions we hear most often about navigating keratoconus treatment decisions.
Treatment selection is based on a combination of factors including your corneal measurements, the rate of any documented progression, and how well your current lenses are meeting your vision needs. No single treatment is right for every patient or every stage. Our cornea specialists use detailed imaging and clinical evaluation to guide a step-by-step approach that starts with the least invasive option and preserves flexibility for the future.
Combining treatments is common and often the most effective approach. Cross-linking to halt progression is frequently paired with specialty contact lenses for vision correction. Ring segments may be combined with cross-linking to both stabilize the cornea and improve lens fit. Your specialist will sequence treatments in a way that makes sense for your specific corneal condition and timeline.
Lens intolerance is a real concern for some keratoconus patients, particularly with smaller RGP lenses. Scleral lenses are often more comfortable because they rest on the less sensitive white of the eye rather than on the cornea itself. If comfort remains a barrier after trying different lens designs, ring segments may reshape the cornea enough to make lens wear tolerable. When non-surgical options have been fully explored, CTAK or corneal transplant can restore functional vision without relying on lenses.
Yes, younger patients tend to experience faster progression than adults, which makes early monitoring and treatment especially important. Cross-linking is FDA-approved for patients 14 and older, and early treatment in this age group can prevent significant vision loss during critical developmental years. Children and teenagers with keratoconus should be monitored on a more frequent schedule, often every three to six months, so that progression can be caught and treated promptly.
Reach out to your specialist promptly if you notice sudden changes in your vision, increased blurriness that your contact lenses cannot correct, or any new eye pain or discomfort. These symptoms can signal a rapid change in corneal shape that warrants earlier evaluation than your next routine appointment. It is always safer to call and be reassured than to wait and allow a change to go undetected.
A second opinion from a fellowship-trained cornea specialist is a reasonable step, particularly before any surgical procedure. Different specialists may approach treatment sequencing differently based on their experience with keratoconus cases at various stages. When seeking a second opinion, look for a provider who offers corneal topography imaging, cross-linking, specialty contact lens fitting, and a full range of surgical options so that the recommendation reflects a complete picture of your available choices.
Speak With Our Keratoconus Specialists
Our cornea specialists at Rhode Island Eye Institute have the training, technology, and experience to guide you through every stage of keratoconus care, from your first specialty lens fitting to advanced surgical planning. We are proud to serve patients across Rhode Island and southeastern Massachusetts with subspecialty-level cornea care under one roof. If you have noticed changes in your vision or have questions about your current treatment plan, we welcome you to schedule a consultation with our team.