Your Guide to Keratoconus Treatment Options

Understanding Keratoconus

Keratoconus is a progressive condition in which the normally round, dome-shaped cornea gradually thins and bulges forward into a cone-like shape. This change in corneal thickness causes light to scatter as it enters the eye, leading to distorted vision. It often becomes apparent in the teenage years or early adulthood. Progression is generally more likely in younger people, but it can continue beyond age 30. There is no age at which everyone’s keratoconus becomes stable, so monitoring is based on your individual findings. ^{2, 9}

Common symptoms include:

• Blurred or distorted vision
• Increased light sensitivity
• Increased astigmatism
• Frequent prescription changes
• Glare or halos at night
• Eye irritation and sensitivity, and headaches

Read more about keratoconus symptoms and diagnosis.

Keratoconus treatment options at a glance

Monitoring your cornea

We closely monitor the shape and thickness of your cornea using corneal tomography. Your first scan gives us a starting point. At later visits, we look for meaningful changes in corneal shape and thickness alongside your vision and prescription. ¹

If your keratoconus is stable, we usually recommend a review every 6 to 12 months. Younger age and steeper corneas are associated with greater progression risk. Children, teenagers and anyone with suspected progression may need to return more regularly. ²

Eye rubbing has been linked with keratoconus. If your eyes itch, ask us about managing the irritation so you are less tempted to rub them. ⁸

Learn how we diagnose and monitor keratoconus.

Glasses and soft contact lenses

In the early stages of keratoconus, spectacles or soft contact lenses may provide adequate vision correction. Some specialised soft lenses also work well in selected keratoconus eyes. When the cornea is more irregular, an ordinary glasses prescription may not fully correct the distortion. ³

RGP, hybrid and scleral contact lenses

These lenses help you see more clearly. They do not themselves stop keratoconus from progressing, so monitoring continues while you wear them.

Corneal RGP lenses

A corneal RGP is a smaller lens that sits on the cornea. The rigid lens and the tears beneath it create a more regular focusing surface in front of an uneven cornea. ³ Read more about custom RGP lenses.

Hybrid lenses

Hybrid contact lenses combine a rigid gas-permeable centre with a soft outer skirt. They are one option when a smaller corneal RGP lens is difficult to tolerate. ³ Read more about hybrid contact lenses.

Scleral lenses

Scleral lenses vault over the cornea and rest on the sclera, the white part of the eye. They create a fluid reservoir (filled with saline) between the lens and the cornea.

FIG 4. SCLERAL LENS

Neither a corneal RGP nor a scleral lens is automatically the best choice for every eye. ³ See our comparison of keratoconus contact lens types.

What a scleral lens fitting involves

We use corneal topography and tomography to assess your cornea’s shape and thickness, and anterior-segment OCT to assess the clearance between the scleral lens and your eye. Diagnostic lenses are fitted to help design custom lenses tailored to your eyes, and you will be guided on how to use and care for them. Over several months, the lenses are reviewed and adjusted.

Your replacement schedule depends on the lens material and condition, prescription, fit and eye health. If your optometrist recommends an interval of around 18–24 months, lenses may still need replacing sooner if they become damaged or your needs change.

An initial scleral lens assessment costs approximately $300–$350, and a Medicare rebate may apply. Lenses start from $800 per lens, and a private health rebate may apply. See our scleral lens fitting and fees page for what is included and why the lens price varies.

Corneal cross-linking (CXL)

What is CXL?

Corneal cross-linking, often called CXL, aims to slow or stop further progression. It uses riboflavin (vitamin B2) drops and controlled ultraviolet A light to strengthen the cornea. ¹

Treatment success depends on the eye, technique and length of follow up. Continued monitoring is still needed afterwards, including checking for renewed progression. ¹

Some people experience improved vision after CXL, but that is not its main purpose and cannot be promised. Glasses or contact lenses are commonly still needed. ⁴

When is cross-linking considered?

If progression is suspected, we can refer you for an ophthalmologist’s assessment rather than waiting for your sight to become noticeably worse. Your ophthalmologist considers thickness, scarring, eye surface health and medical history alongside progression risk. ¹ Read more about corneal cross-linking for keratoconus.

How we support you before and after CXL

As optometrists, we do not perform the procedure. CXL is a surgical procedure performed by ophthalmologists in Australia.

Before

We monitor the shape and thickness of your cornea closely with corneal tomography and repeat your scans over time. If the cornea is changing, we refer you directly to an ophthalmologist and share your scans. We also advise on avoiding eye rubbing and managing allergy, and keep your vision corrected with glasses or contact lenses in the meantime.

The procedure

The ophthalmologist performs the surgical procedure.

After

• Early healing: soreness, light sensitivity and blurred or fluctuating vision can occur after treatment. Recovery varies, so the surgeon’s advice takes priority over a general online timetable.
• Contact lens fitting: do not restart contact lens wear until your treating team says it is safe. Fitting depends on your ophthalmologist’s recommendation, but it is often around 6–12 weeks after your surgery.
• Longer term: your previous lenses may need adjustment because the cornea can change after CXL, and a later refit may be needed. You return to us for ongoing monitoring and vision correction.

Ring segments and CAIRS

Intracorneal ring segments are small implants an ophthalmologist places within the cornea to make its shape more regular. The aim is to improve vision or make contact lenses easier to wear in selected eyes. ¹ CAIRS (corneal allogenic intrastromal ring segments) uses segments made from donor corneal tissue instead of synthetic material. ⁷

These procedures reshape the cornea. They are not, on their own, a treatment to stop keratoconus progressing, and they may be combined with cross-linking. ⁷ Whether either is suitable needs a surgical assessment, and not every ophthalmologist offers every procedure. Vision Camberwell Optometrists does not perform them.

Corneal grafts and lenses afterwards

A corneal graft, also called a corneal transplant or keratoplasty, replaces damaged corneal tissue. It is performed by an ophthalmologist.

Early detection, corneal cross-linking and advances in contact lenses that allow more difficult corneas to be fitted have helped reduce the need for corneal transplantation for keratoconus. ^{5, 6}

After a graft, the healed surface can remain uneven. Specialised contact lenses can help correct this irregularity when glasses are not enough. See contact lenses after a corneal graft.

Who does what: your optometrist and your ophthalmologist

When an ophthalmologist’s opinion is needed, we refer you directly and send your scans. Referring practitioners can find details on our referral information page.

Vision Camberwell Optometrists provides ongoing monitoring and specialty contact lens care, and works with ophthalmologists when surgical assessment is needed. Find out more about keratoconus care at Vision Camberwell.

When should you seek an assessment?

Changes worth having checked include:

• Blurred or distorted vision, even with your current glasses.
• Ghosting or shadow images around text and objects.
• Increasing glare, halos or difficulty seeing clearly at night.
• Repeated changes in your glasses prescription, particularly astigmatism.

Let us know if keratoconus runs in your family, if you rub your eyes often, or if you have ongoing eye allergies. If you already have keratoconus and your vision changes, get in touch rather than waiting for your next appointment.

Common Patient Concerns

Do scleral lenses hurt?

A well-fitted lens should be comfortable to wear. Some initial lens awareness or handling difficulty can occur, but pain should not be ignored. Remove the lens and seek advice if you develop pain, increasing redness, light sensitivity or reduced vision. Sudden or severe symptoms need urgent assessment.

Will CXL cure my keratoconus?

No. The goal is to limit further change, not return the eye to an unaffected state. Ongoing monitoring remains essential.

Will I still need lenses after CXL?

Some people gain visual improvement, but glasses or contact lenses are commonly still needed.

Does Vision Camberwell perform the surgery?

No. We provide optometric assessment, referral, monitoring and specialty contact lens care. The ophthalmologist assesses surgical suitability, performs CXL and directs surgical recovery.

Can keratoconus be cured?

There is no cure, but keratoconus can be managed.

Final Thoughts

Keratoconus management relies on both accurate monitoring and timely, regular treatment. At Vision Camberwell Optometrists, our optometrists are known experts in keratoconus, use advanced imaging technology to track progression, provide customised scleral lens fittings, and co-manage surgical care closely with ophthalmologists. 

If you’re experiencing changing vision or have been diagnosed with keratoconus, our team is here to guide you through every stage of care. Contact us to discuss your vision today. 

Related reading

• Keratoconus symptoms and diagnosis
• Corneal cross-linking for keratoconus
• Contact lenses after a corneal graft
• Keratoconus contact lenses: which type is best for you?
• Understanding life with keratoconus

References

1. Deshmukh R, et al. Management of keratoconus: an updated review. Frontiers in Medicine. 2023;10:1212314.
2. Ferdi AC, et al. Keratoconus Natural Progression: A Systematic Review and Meta-analysis of 11 529 Eyes. Ophthalmology. 2019;126:935–945.
3. Lim L, Lim EWL. Current perspectives in the management of keratoconus with contact lenses. Eye. 2020;34:2175–2196.
4. Wittig-Silva C, et al. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology. 2014;121:812–821.
5. Godefrooij DA, et al. Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking. Acta Ophthalmologica. 2016;94:675–678.
6. Koppen C, et al. Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus. American Journal of Ophthalmology. 2018;185:43–47.
7. Jacob S, et al. Corneal Allogenic Intrastromal Ring Segments (CAIRS) Combined With Corneal Cross-linking for Keratoconus. Journal of Refractive Surgery. 2018;34:296–303.
8. Sahebjada S, et al. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2021;259(8):2057–2067.
9. Gokul A, et al. The natural history of corneal topographic progression of keratoconus after age 30 years in non-contact lens wearers. British Journal of Ophthalmology. 2017;101:839–844.