Keratoconus Treatment

Keratoconus is a progressive eye disease which affects the shape of the cornea. As the condition progresses, the cornea thins and begins to bulge into a cone-like shape, causing blurred and distorted vision.

Keratoconus treatment stops this thinning and bulging. Treatment options vary by stage, as we discuss in detail further below.

How we treat keratoconus at each stage

There are three stages of keratoconus: early/ moderate, intermediate and advanced. In this section, we’ll cover the signs and symptoms of each stage and treatment options.

Stage 1

In the early stages, you may have no symptoms. During stage 1, we may recommend glasses or contact lenses to counter short-sightedness and astigmatism. Your contact lenses may be soft or hard.

Stage 2

The changes in the shape of your cornea become apparent in this stage. We may also notice corneal thinning.

We would often use cross-linking to prevent keratoconus from progressing further. This may be combined with laser treatment (called laser refractive cross-linking) to improve the quality of vision and reduce or regularise your astigmatism. Suitability for this treatment depends on your scans and the health of your eyes.

Stage 3

Stage 3 is the most advanced. You will likely have substantial corneal thinning and scarring at this stage. We may use corneal ring segments and corneal transplants (penetrating keratoplasty) to treat the keratoconus. Though, this is rarely needed since the introduction of cross-linking.

What is cross-linking?

During the procedure, we remove the surface layer of the cornea. Mr Ayoub prefers using a laser (PTK) to remove this surface layer as it has been shown to improve the procedure’s outcome.

We then soak the cornea in riboflavin (vitamin B2) drops and shine UV light on the cornea to activate the riboflavin. Together, these stiffen the cornea and allow fibres in the cornea to bond tighter (cross-link).

By increasing corneal rigidity, CXL stops the progressive thinning and bulge that develops in keratoconus and stabilises your vision.

At the end of the procedure, we place a contact lens on the eye, which we remove after 5-7 days. Your first follow-up appointment will be the day after your surgery. Watch our video – What is cross-linking for keratoconus? – to learn more about the procedure.

Difference between cross-linking & laser refractive cross-linking

The primary aim of both treatments is to stabilise keratoconus. However, there are some fundamental differences as explained below.

Cross-linking

Corneal cross-linking (also known as CXL or C3R) is a treatment that strengthens the cornea and stops keratoconus from getting worse. Though, standard CXL does not focus on improving your vision.

Laser refractive cross-linking

In a select group of patients who meet the strict treatment criteria, we combine the cross-linking process with laser resurfacing. During laser refractive CXL, we reshape the cornea to improve your vision.

It may result in a reduced prescription and better glasses/contact lens corrected vision. Patients with early keratoconus may find that their vision improves enough that they are much less dependent on glasses and contact lenses.

What are corneal transplants?

In rare keratoconus cases, a corneal transplant may be needed. During corneal transplantation, we replace your cornea with that of a healthy donor. We can replace individual layers of your cornea or the entire cornea. We refer to this as partial or full thickness.

Common types of corneal transplant include:

Deep Anterior Lamellar Keratoplasty (DALK) – replacing 90% of the front layer
Endothelial Keratoplasty (EK) – replacing the back layer only
Penetrating Keratoplasty (PK) – replacing the entire cornea

Learn more about the different types of cornea transplants on our cornea transplant surgery treatment page.

What are the benefits of keratoconus treatment?

Keratoconus treatment can quickly improve your vision and prevent further vision loss. Mr Tariq Ayoub discusses the numerous benefits of corneal cross-linking in our video below: What is the success rate of corneal cross-linking?

Additional benefits of cross-linking include:

Proves suitable for thin corneas*
Enhances contact lens tolerance
Avoids corneal transplant

*We cannot perform the procedure if your corneas are very thin. Our specialist will inform you of your circumstances.

Cross-linking and corneal transplantation are safe and effective procedures with high success rates. Though, corneal transplants have more significant risks, such as rejection of the donated cornea, glaucoma, and retinal detachment.

Book an appointment

After a thorough consultation and corneal scanning, our specialists can determine the stage of your condition and the treatment required. Mr Ayoub will explain which stage of keratoconus you have reached and how we can prevent the condition from worsening.

If you want private treatment for keratoconus, book an appointment with Mr Tariq Ayoub.

Contact Us.

FAQs

Yes, you’ll usually remain awake for corneal cross-linking.

The aim of corneal cross-linking (CXL) is to stabilize keratoconus. After treatment, you will still need to wear glasses or contact lenses for clear vision.

Your prescription could take 3-6 months to stabilise after keratoconus treatment. Though, this depends on the type of procedure you had. Our ophthalmologist will let you know when to come for a follow-up appointment where we can check for changes in your prescription.

The whole procedure takes approximately 30 minutes for each eye.

The procedure itself is generally pain-free as we use anaesthesia in the form of drops during the procedure to numb the eye. After the procedure, you will be prescribed painkillers for a few days to control any pain experienced.

Most people are ready to return to work and their day-to-day activities after one week. Your eyes may feel sore during this time, but we can prescribe you painkillers to control any pain experienced.

The recovery from cross-linking is often faster than corneal transplantation and a corneal transplant can require more time off work.

Avoid heavy lifting and strenuous activity for two weeks after the procedure. During your consultation, Mr Ayoub will discuss whether any other factors will affect your recovery.

We may ask you to remove hard contact lenses for a few weeks before the procedure. Roughly a month after cross-linking, you can start wearing contact lenses again. It may take at least twelve months after corneal transplantation. Though, you’ll need to confirm this with your ophthalmologist.

If your temporary contact lens falls out before your follow-up appointment, you can contact our clinic for advice. It’s usually no cause for concern, but you should continue to use eye drops provided by the eye specialist.

Don’t wear eye makeup for the two weeks after your procedure. Makeup removal can irritate the cornea while it heals. You may wish to wait two to three weeks after corneal transplantation.

Complications are rare, though you may experience some temporary side effects.

These include:

Infection
Eye pain
Swelling
Blurred or hazy vision
Damage to the cornea

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“Mr. Ayoub was quick to identify the problem which multiple doctors had not done successfully. Mr. Ayoub suggested treatment that improved inconvenient and uncomfortable symptoms within days. Months of dealing
with the day to day inconveniences of this condition could have been much less if I had seen Mr. Ayoub sooner. Mr. Ayoub was polite, helpful and happy to answer any questions.”