Diagnosis and treatment

How is keratoconus diagnosed?

Keratoconus is usually diagnosed in young people at puberty, late teens or early twenties. It is more common in non-Caucasians and affects up to 1 in 450 people (depending on ethnicity).

If you suspect you may have keratoconus, you can visit your ophthalmologist who will conduct an eye exam, as well as assessing your individual and family medical history. They may also conduct various tests, including eye refraction, a slit-lamp examination and computerised corneal mapping to give you a keratoconus diagnosis.

The eye doctor (ophthalmologist) or optometrist (ophthalmic optician) will examine your eyes with a microscope called a slit-lamp. You might also have a corneal topography scan. This is a quick, painless photo which checks the shape and thickness of your cornea in detail. 

Urgent referral is not required, as the various stages of keratoconus can take years to develop. As a result, your ophthalmologist may invite you back for multiple assessments in the years following your initial consultation. These visits will include vision and refraction tests, as well as corneal scans to monitor your condition. Your ophthalmologist will be able to advise if they believe you require further treatment.

Treatment for keratoconus

There is no cure for keratoconus and it cannot be treated with eye drops or medication.

In the early stages, spectacles or soft contact lenses may be used to correct vision. As the cornea becomes thinner and steeper, soft or rigid gas permeable (RGP) contact lenses are often required to correct vision more adequately. In very advanced cases, where contact lenses fail to improve vision, a corneal transplant may be needed. This type of intervention is rare however since the introduction of corneal cross-linking (CXL). CXL is a relatively new treatment that can stop the disease getting worse. It is effective in over 94% of patients with a single 30 minute outpatient procedure.

Early keratoconus clinic

Monitoring keratoconus

CXL is only suitable where the corneal shape is continuing to deteriorate. Once you are past your mid/late 30s, the cornea often naturally stiffens and CXL is generally not required. Below this age, the cornea is more flexible and disease progression (and worsening vision) is more likely to occur. During monitoring, if we detect any deterioration in your eyes we may recommend that you have CXL.

Changes caused by keratoconus can take many years to develop. For this reason we will invite you back for repeat assessments for up to 5 years from your initial visit.

This clinic is solely to diagnose keratoconus and to monitor the disease. It is important to stress that no extended eye examinations will be performed. We will not be checking your eyes for other problems (e.g. glaucoma, diabetes). This clinic is not a substitute for regular eye screening with your local optician or other eye healthcare providers.

Preparing for your visit

In order to obtain the most accurate scans, we ask that you remove your contact lenses prior to your appointment (2 weeks for hard lenses and 1 week for soft lenses). This is because contact lenses distort the corneal shape, which affects the accuracy of our scans. If you are unable to remove your lenses, please discuss this with the clinician at your appointment.

Please note that if you are unable to manage without your lenses, it is often not possible to accurately monitor your keratoconus using the above tests. CXL treatment may still be available and so long as the cornea is not too thin, may be offered based on the likelihood that your keratoconus will progress. Age is the most important factor in determining this risk: because of natural cross-linking as you get older, keratoconus usually stops getting worse mid/late 30s, so CXL is not normally required in this group of patients.

When you visit the clinic

Each time you attend this clinic, we will perform the same tests;

1. Vision test
2. Refraction (spectacle test)
3. Corneal scans

We will compare these results with those from your previous visits. If any of the results show deterioration, we will discuss with you whether CXL is required.