Treatments

Choosing the right options

Choosing the best treatment option for keratoconus is not easy because of the way the disease tends to evolve.

Unlike many diseases, keratoconus is unusual in that it is a progressive disease in young people and tends to stabilize by middle age. It also affects each eye differently.

Keratoconus is generally more aggressive when diagnosed in early adolescence, and can lead to significant vision loss in one or both eyes. A later age diagnosis is often associated with a milder form of keratoconus and more easily managed vision loss.

There are many different treatment options available for people diagnosed with keratoconus today. These range from spectacles in the earliest stages of the disease to corneal transplantation in the most severe cases. Corneal collagen crosslinking offers the hope of slowing or halting the progression of keratoconus - especially in less aggressive cases.

Which one you choose will obviously depend on your particular circumstances: younger patients facing the prospect of rapid progression are likely to consider crosslinking at an early stage while older patients with slow or no progression can often skip crosslinking and manage with spectacles and contact lenses.

So as you get older, less is generally more when it comes to treatments.

With so many treatment options available, most people with keratoconus should be able to manage vision loss caused by keratoconus and virtually none should expect to suffer significant, permanent loss of vision.

However there is no known cure for keratoconus or means of reversing damage done to the cornea by keratoconus.

It is important therefore to understand that all treatments for keratoconus aim to either slow or halt progression in the disease (corneal collagen crosslinking) or correct loss of vision already caused by keratoconus (contact lenses and surgery like corneal transplantation).

Deciding which option is best for you should always be done in conjunction with a keratoconus specialist after a full examination.

Non-surgical

These treatments are the most commonly recommended for people with keratoconus and generally offer the best, long term options for managing vision loss caused by keratoconus. They include spectacles and various types of contact lenses.

Most patients will experience an almost miraculous improvement in vision with correctly fitted rigid contact lenses.

Surgical

Surgery - apart from corneal collagen crosslinking for progressive keratoconus - is best avoided until absolutely necessary. All surgery comes with associated risks and side effects which can lead to permanent damage to the cornea.

Until recently, surgery for keratoconus was relatively rare, with only around 15% of patients ever requiring a corneal transplant.

These days, corneal collagen crosslinking is available for progressive keratoconus.

Other less common surgery such as intra-corneal rings (e.g. INTACS) and intraocular lenses is generally unnecessary if a patient can be properly fitted with contact lenses by a specialist contact lens fitter for keratoconus.

Unlike contact lenses, it is very difficult to predict the improvement in vision from surgery and the benefits often diminish over time. Further corrective surgery is therefore often required in the medium term.

Keratoconus Australia recommends that patients seek a second opinion from a corneal surgeon specialising in keratoconus before proceeding with surgery such as a corneal transplant or intracorneal ring segments such as INTACS. A keratoconus specialist is generally considered to be a surgeon performing at least 25 grafts a year.

Mental Health

In 2019, Keratoconus Australia approached Vision 2020 Australia to seek advice on resources for people suffering with mental health issues arising from newly-diagnosed vision impairment, such as the onset of keratoconus. We were told there were no vision-specific resources or treatment paths designed specifically for people in that situation. So we asked that Vision 2020 Australia to collaborate with us to create a resource base that could be used by people being diagnosed with keratoconus and also the wider population affected by vision loss.

The arrival of COVID-19 in 2020 had the dual impact of slowing efforts to create a mental health resource at the same time lockdowns prevented patients seeing their eye-carers in a timely fashion for diagnosis and treatment. Not surprisingly, the anxiety and stress created by COVID-19 and restricted access to timely eye care only exacerbated the issue of mental health amongst patients.

In June 2021, Vision 2020 Australia created a working party on improving mental health support for people with vision loss and nominated Gregory Harper, Vice president of Keratoconus Australia, as chair.

A growing number of organisations have joined the working party, which has made steady progress towards the development of vision-focused resources to support those suffering mental health issues from vision loss.

In September 2023, Vision 2020 Australia launched a new website called the Mental Wellbeing and Vision Loss Resource Guide which will form the foundation of future work in this space.

We urge all people with keratoconus and their families to consult this website for information on how to deal with mental health issues arising from vision loss. The guide includes information on different types of mental health problems, how to assist someone experiencing mental health issues, peer support groups and organisations working in the vision loss field, counselling and crisis assistance.