Oculase Articles

Is laser eye surgery suitable for keratoconus?

Mr Tariq Ayoub - 15 Sep 2022

In a healthy eye, the cornea is dome-shaped. However, in a person with keratoconus, the cornea thins, bulges, and forms a cone-like shape. It can occur in one or both eyes and often begins in a person’s teens or early 20s. You may experience blurred, distorted vision, and your vision may become more nearsighted.

In some cases, keratoconus is only detected during screening for laser refractive surgery, as it often presents with no symptoms. Although this means you cannot have laser eye surgery, we will discuss other treatment options to support your vision going forward.

Treatment options

Keratoconus treatment will depend on the stage of keratoconus. If you have stable keratoconus, we may use ICL implants to improve your vision.


  • Glasses and contact lenses
  • Corneal cross-linking
  • Refractive cross-linking
  • Corneal ring segments
  • Corneal transplants

Cross-linking increases rigidity in the cornea. It may help to slow or halt the progressive thinning and bulging associated with the disease.

Is laser eye surgery suitable for keratoconus?

We do not recommend laser eye surgery as a refractive procedure for patients with keratoconus. Keratoconus is a degenerative disease that causes thinning of the cornea. 

Laser refractive surgery procedures, such as LASIK, could weaken the cornea further by removing tissue from the already thinned cornea. This leads to unpredictable changes in the shape of the cornea and, consequently, loss of vision.

Refractive-CXL or CXL-plus, where we combine PRK laser eye surgery with cross-linking, is often used to improve the quality of vision. You would continue to need to wear contact lenses or glasses for good vision. But, night vision problems such as haloes, glare and starbursts often improve after the procedure.

Selected patients, who are stable after CXL-plus, can have implantable contact lens surgery to rid them of glasses or contact lenses. Keep reading to learn more about refractive CXL.

Refractive cross-linking

Laser refractive cross-linking combines laser resurfacing of the cornea with corneal cross-linking. Laser refractive CXL allows us to improve the shape of your cornea, sharpening your vision with glasses or contact lenses. Whereas standard CXL focuses on preventing the progression of keratoconus.

Who is suitable?

The initial thickness of your cornea will influence how much we can reshape your cornea. If you have a thin cornea, you may be more likely to experience complications during laser refractive CXL.

You may be unsuitable if you:

  • Are under 18
  • Are pregnant
  • Don’t meet the minimum corneal thickness of < 375 µm
  • Currently have an ocular surface disease, such as dry eye or blepharitis

Your eye specialist can evaluate whether they believe you are suitable for refractive cross-linking.

How to book keratoconus treatment

If you have keratoconus and are interested in discussing your treatment options, we recommend booking a consultation with our eye specialist.

We will thoroughly examine your eye and devise a personalised treatment plan. This may include cross-linking and laser-assisted cross-linking (CXL-plus) to stabilise your cornea and vision. Depending on the outcome of this procedure, it may be possible to have implantable contact lens surgery at a future date.

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About the author

Mr Tariq Ayoub
Mr Tariq Ayoub, Consultant Ophthalmologist

Mr Ayoub has been rated as one of the top eye surgeons in the UK. He is a Consultant Ophthalmic Surgeon with Imperial College Healthcare NHS Trust in London, one of the largest NHS trusts in England. He is also the Lead for the Emergency Department at Western Eye Hospital, as part of the Imperial College Trust.

Mr Ayoub completed his Ophthalmology training at the prestigious London School of Ophthalmology, namely at Moorfields Eye Hospital and Royal Free Hospital. During his career, he has received many prestigious awards from national and international organisations for his work in the field of ophthalmology.

His clinical interests include treatment for cataracts, vision correction, corneal disease, eye-lid disorders, trauma, and general ophthalmology. Mr Ayoub prides himself on the high quality of his work. With his extensive experience, he can holistically manage complex eye conditions to deliver the best care for his patients.

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