Keratoconus Treatment Options, Causes and Symptoms

Keratoconus treatment is a journey for everyone diagnosed with the disease — and it really is a journey, because keratoconus is progressive. Each stage requires its own management. Early on, glasses are usually enough; over time, the patient may need rigid contact lenses; and in the more advanced stages, some patients eventually require a corneal transplant. Our aim in this article is to walk you through every option used to treat keratoconus and which one fits each stage. We recommend reading to the end.

Who Is the Keratoconus Patient?

A keratoconus patient is someone whose cornea becomes weaker and thinner and is no longer able to maintain its normal shape, gradually taking on a cone-like form. This causes general visual problems, and the condition is known as keratoconus.

Keratoconus typically appears in the late teenage years through the early twenties. Visual symptoms then worsen slowly over a 10- to 20-year period.

Causes of Keratoconus

The exact cause of keratoconus is still unknown, but about 1 in 10 patients with keratoconus has a family member with the same condition. The known risk factors include:

1- Genetic predisposition.

2- This may sound surprising, but eye rubbing — particularly in children — is one of the most important triggers of disease progression.

3- Connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.

4- Allergic eye disease.

Now that we understand the causes of keratoconus, let's move on to the treatment options and the symptoms.

Treatment Options for Keratoconus

As mentioned above, keratoconus is a progressive disease whose treatment depends on the stage reached. Here we walk through each stage and the appropriate management.

Stage 1 — Early Keratoconus

Mild corneal distortion with minimal or no impact on visual quality, and minimal or no progression.

Treatment at this stage

Glasses are usually enough to correct the myopia and astigmatism and provide adequate vision. Soft contact lenses — spherical or toric — can be a good option for general use or for sports activities.

Stage 2 — Moderate Keratoconus

Corneal changes are now noticeable. Distortion increases and vision drops even with glasses.

The treatment at this stage is rigid gas-permeable (RGP) contact lenses.

RGP lenses cover the irregular cornea with a smooth, rigid front surface, neutralising about 90% of the corneal distortion. The refractive power of the lens can also correct any associated myopia, hyperopia or astigmatism — producing better contrast, much less glare and ghosting, and clearer vision overall.

Stage 3 — Advanced Keratoconus

Significant corneal distortion is present, with moderate keratoconic changes and mild to moderate corneal scarring. Lens fitting is similar to moderate keratoconus, but the rigid gas-permeable lens design often needs to be adjusted, with steeper inner curvatures to maintain a proper fit. Larger, scleral or hybrid lenses can also be helpful for irregular corneas, since they vault over the cornea and improve stability and comfort.

Severe Keratoconus
Marked corneal distortion, significant scarring, and severe thinning. Vision is often poor even with rigid gas-permeable contact lenses, contact lens tolerance is reduced, and a successful rigid lens fit is usually very difficult to achieve.

Treatment of keratoconus at this stage: corneal transplantation, performed by a surgeon specialised and experienced in transplants for keratoconus.

What Are the Symptoms of Keratoconus, and When Do Patients Notice Them?

Keratoconus typically begins to appear in the late teens through the early twenties. Visual symptoms then worsen slowly over a 10- to 20-year period.

Keratoconus often affects both eyes,

and can result in significant differences in vision between the two. Symptoms vary between eyes and can change over time.

In the early stages, symptoms can include:

• Mild blurring of vision.

• Slight visual distortion, where straight lines appear bent or wavy.

• Increased sensitivity to light and glare.

• Eye redness or swelling.

In advanced stages, the picture changes — the patient may notice:

• Marked visual distortion even with glasses.
• Visible spots on the eye.
• Severe light sensitivity even when wearing rigid contact lenses.

The Best Doctor for Keratoconus Treatment in Egypt and the Arab World

Dr. Ahmed Shaarawy has been the first choice for hundreds of patients over the years for corneal transplantation and keratoconus management, for the following reasons:

• Dr. Shaarawy is a corneal surgery specialist, with a PhD and fellowship from the Devers Eye Institute, USA.

• He was the first surgeon to perform endothelial keratoplasty (S-DMEK) in Egypt and Iraq, and the first to discuss the technique in the Arab world.
• He has a wide and distinguished record of successful procedures across the Arab world, alongside an active research profile, having published novel approaches to corneal disease.