Diagnosis and treatment

How is keratoconus diagnosed?

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.

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

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.

Corneal cross-linking

Corneal cross-linking (also known as CXL and C3R) is a treatment that can prevent keratoconus from worsening. It uses ultraviolet light and vitamin B2 (riboflavin) drops to stiffen (and strengthen) the cornea to prevent further steepening and thinning in the future. It is effective in over 90% of patients. Moorfields offers the latest ‘accelerated CXL’ treatments which take approximately 20 minutes to perform. In general, CXL does not improve vision; the aim is to stop your vision getting worse.

Usually by your late 30s, the cornea naturally stiffens and CXL is generally not required. Below this age, the cornea is more flexible and disease progression (and worsening vision) are more likely to occur.

Laser refractive corneal cross-linking

Laser treatments can be combined with CXL to flatten and smooth the surface of the cornea. Laser refractive CXL may be suitable for you if your vision has already deteriorated. The aim of the treatment is to improve the focusing of the cornea, with sharper vision in either spectacles or soft contact lenses. The laser treatment typically takes 30 seconds at the start of the cross-linking treatment as a single, combined procedure.

Corneal rings

Intracorneal stromal ring implants (ICRS) are placed in a laser-formed channel within the cornea. Depending on the severity of the keratoconus, one or two rings are implanted with the aim of improving the overall shape of the cornea (reducing astigmatism and irregularity). Corneal ring implants can be combined with, or precede, corneal cross-linking.

Phakic intra-ocular lens implant

Implantable contact lenses may be suitable in some keratoconus patients to improve your vision without relying on spectacles or soft contact lenses. Lens implants are generally not effective in correcting vision if you use rigid gas permeable contact lenses (RGP). Depending on the prescription, you may benefit from lens implants in one or both eyes to balance the vision in your two eyes.

How much does keratoconus treatment cost?

Initial consultation

From £300

This includes an initial consultation and a visual acuity assessment.

If further outpatient tests and investigations are required, they will be charged at an additional rate. Your consultant will discuss this with you at your consultation.

Treatment

The cost of onward treatment will be provided after initial consultation,  based on your personalised treatment plan.

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0800 328 3421

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