Keratoconus

The specialized team of ophthalmologists at UT Southwestern Medical Center has expert training and years of experience in treating people with all types of eye conditions. We offer the latest diagnostic testing and treatment options for keratoconus, such as a minimally invasive procedure that can avoid the need for a cornea transplant.

What is Keratoconus?

Keratoconus is an eye disease that affects the cornea, the clear layer covering the front of the eye. The condition causes the middle of the cornea to become thin, bulge outward, and form a rounded cone shape. As keratoconus worsens, it causes vision problems.

Advanced, Minimally Invasive Treatment for Keratoconus

At UT Southwestern, we use a multidisciplinary approach to treat keratoconus, from specialty contact lenses to surgery when needed. Our skilled surgeons offer one of the latest treatment options for keratoconus – corneal collagen cross-linking. This minimally invasive, outpatient procedure can stop the progression of the disease and avoid the need for a cornea transplant. 

Causes of Keratoconus

The causes of keratoconus aren’t known, but research indicates that the tendency to develop the condition is likely congenital (present since birth). Keratoconus could result from a defect in collagen, the tissue that supports the cornea.

Eye rubbing can contribute to the development and progression of the disease.

Keratoconus Symptoms

This abnormal curvature of the cornea can cause symptoms such as:

• Double or blurred vision
• Nearsightedness and astigmatism
• Increased sensitivity to light
• Halos, glare, or poor night vision

Diagnosing Keratoconus

Early detection of keratoconus is key and allows patients to have the most treatment options. At UT Southwestern, our ophthalmologists begin with a comprehensive eye exam. We use these other tests to confirm a diagnosis and rule out other conditions:

• Corneal topography to map the cornea’s surface
• Slit-lamp exam to look at the structures at the front of the eye
• Pachymetry to measure the cornea’s thickness  

Treatment for Keratoconus

Keratoconus usually affects both eyes. At first, the condition is corrected with glasses or soft contact lenses. As the disease progresses, patients usually need specially fitted contact lenses to correct the distortion of the cornea and provide better vision. 

The lenses help with vision but do not slow the progress of keratoconus. Wearing sunglasses while outdoors can slow or stop the disease in some people.

Other patients are candidates for INTACS surgery, in which microthin polymer ring segments are placed under the outer edge of the cornea.

For people with advanced keratoconus, UT Southwestern offers two types of treatments: corneal collagen cross-linking and corneal transplant.

Corneal Collagen Cross-linking

Corneal collagen cross-linking – an FDA-approved treatment for keratoconus – is a minimally invasive outpatient procedure that uses vitamin B2 eye drops and ultraviolet light to stiffen and strengthen the cornea.

The procedure can prevent keratoconus from worsening, and in some cases, doctors can reshape the cornea using laser surgery. Corneal collagen cross-linking helps delay or prevent the need for corneal transplantation.

The procedure lasts about one hour and the patient is usually awake. The doctor will provide calming medication and numbing eye drops, and then gently and temporarily remove the thin layer on the surface of the cornea, called the epithelium. Eye drops will be placed in the patient’s eye for at least 30 minutes. After that, the cornea is exposed to ultraviolet light for another 30 minutes while additional eye drops are applied.

After the procedure, patients may experience some light sensitivity and have a foreign body sensation.

Corneal Transplant

In some patients, keratoconus is too advanced and cross-linking is no longer viable. In these cases, corneal transplantation may be an option, in which the patient’s unhealthy cornea is replaced with a healthy donor cornea. Corneal transplant is a highly successful surgical procedure and newer techniques allow for the transplantation of only one layer of the cornea when appropriate.