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Keratoconus and Lasik

Kertaconus is a strong contraindication for Lasik, however Lasik, Intacs, and Cxl in combination may be used to help reduce some of the effects if keratoconus.

Illustration of eye with distinctive keratoconic bulge.  
Illustration of topography map of eye with distinctive keratoconic bulge.
Keratoconus creates an irregular cornea that is a contraindication for most refractive surgery, but can be treated with Intacs inserts and/or CxL CrossLinking.  

Keratoconus is a disease of the cornea that makes the cornea become weak and gradually bulge outward.


The exact cause of keratoconus is unknown. Many theories based on research and its association with other conditions attempt to identify a single cause, however, no one theory explains it all. Keratoconus tends to run in families, so a genetic link may be indicated. It is likely that keratoconus is caused by a combination of things including genetics, the environment, and the endocrine system.


Most often, the corneal bulging is in the lower half of the cornea and first presents as astigmatism, however not all astigmatism is due to keratoconus. The abnormal curvature of the cornea due to keratoconus changes the cornea's refractive error producing moderate to severe irregular astigmatism and blurriness of vision including monocular diplopia, or ghosting. As the condition advances, scarring of the central cornea may occur.


In mild or early stages of keratoconus (forme fruste keratoconus), eyeglasses may correct the astigmatic vision. Approximately half of keratoconus patients have no negative lifestyle effects. The cornea stabilizes after a few years without ever causing severe vision problems.

As keratoconus advances, rigid gas-permeable (RGP) contact lenses maybe the only non-surgical way to achieve clear vision. Contact lens fitting of a patient with keratoconus requires much care and frequent check-ups, because the condition can worsen.

If keratoconus progresses the cornea may become unstable and the patient may require Penetrating Keratoplasty (PKP). Currently, between 10-30 percent of keratoconus patients require PKP because of contact lens intolerance, poor results from other stabilization techniques, or because of scarring of the cornea that causes loss of vision. PKP is highly successful but requires a long healing period. After three years 90%-95% people with advanced keratoconus have success with corneal transplant.

Alternative treatments for keratoconus that may significantly reduce the probability of the need for PKP, improve visual ability, stabilize the cornea, and halt or slow the progression of keratoconus have recently become available.

Intacs, which were originally used for refractive purposes, have caused stabilization in keratoconus patients and may be a good choice to reduce the possibility of keratoconus advancement. Keratoconus is an indication for Intacs as a therapeutic treatment, which adds material to the cornea. For keratoconus patients who are also myopic (nearsighted, shortsighted), Intacs can also correct up to 3.00 diopters of myopia in a normal healthy eye, but can correct significantly more refractive error in a eye affected by keratoconus. Additionally, by making the cornea more regular, patients who had become contact lens intolerant may be able to again wear contacts after Intacs.

Used as a therapeutic treatment for keratoconus and corneas that have become unstable or weak due to ectasia, Corneal CrossLinking with Riboflavin (CxL) is a technique where the eye is flooded with a riboflavin solution and exposed to ultra high frequency light. CxL apparently causes the collagen fibrils to thicken, stiffen, and reattach to each other, making the cornea stronger and more stable. CxL is a new and noninvasive therapy that has been showing significant improvement for some patients with keratoconus.

Contraindication for Refractive Surgery

Keratoconus is a strong contraindication for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, or any refractive surgery technique that removes tissue, due to the high probability that these procedures may further weaken a cornea affected by keratoconus.

RLE and P-IOL are lens-based procedures that neither add nor subtract from the cornea, however advanced keratoconus may require other surgery that would be best performed before RLE or P-IOL.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

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Recent Keratoconus Medical Journal Articles...

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