Keratoconus: Early Signs and How Scleral Lenses Help You See Again

At a glance: Keratoconus is a condition in which the cornea, the clear front window of the eye, thins and bulges forward into a cone. The cone bends light unevenly, causing blur, ghosting and glare that glasses often can't fully correct. Specialty lenses such as scleral lenses are one of the best ways to bring vision back into focus.

Many of my keratoconus patients are teens or young adults who have quietly struggled to see the board or drive at night.

Early signs

• A prescription that keeps changing. New glasses help for a while, then blur creeps back.
• Shifting astigmatism. The amount and direction change from one visit to the next.
• Ghosting. Letters have a faint shadow or second copy, even with one eye closed.
• Halos and streaks. Headlights smear or flare at night.

None of these means you have keratoconus. They mean it is time for an exam that looks at the shape of your cornea.

What causes it?

There is no single cause. It is likely a mix of genes and what happens to the eye over time. Hard, frequent eye rubbing is strongly linked to keratoconus getting worse. Allergies lead to rubbing, so the two often travel together. And because it can run in families, relatives of people with keratoconus should have their corneas checked.

How we find it

A standard vision test can't see the cone. Corneal topography makes a color map of the front of the cornea: cooler blues are flatter and warmer oranges and reds show steepening. A cone shows up as a steep, often lower, area. At Reimbold Eye Group we do topography on every patient every year, not only people with symptoms, because keratoconus can start quietly. Repeating the maps over time tells us whether it is stable or changing. Learn more on our keratoconus page.

Vision options, step by step

Glasses work well early on. Soft toric and custom soft lenses can help in milder cases. Rigid gas permeable lenses hold their shape so tears fill in the cone, giving sharp vision but sometimes less comfort. Hybrid lenses combine a rigid center with a soft skirt. And scleral lenses are where vision and comfort meet for many patients.

Why scleral lenses work so well

A scleral lens is a large rigid lens that vaults over the cornea without touching the cone and rests on the white of the eye. Saline fills the space underneath. The fluid fills in the cone's uneven shape, and the smooth front of the lens does the focusing, so ghosting and streaks often fade. Because nothing rubs on the tip of the cone, sclerals are often far more comfortable than small rigid lenses. Fitting takes a few visits plus a short learning curve for insertion and removal. See our specialty contacts page and insertion and removal guide.

Protecting the cornea

Lenses help you see, but they don't change the cornea. To protect it: stop rubbing your eyes (try a cool compress instead), treat itchy allergies, and if maps show the cone is progressing, talk with a corneal surgeon about corneal cross-linking. Cross-linking uses riboflavin (vitamin B2) drops and ultraviolet light to strengthen the cornea. It is FDA-approved, aims to slow or stop progression, and does not reverse the cone. We monitor your maps and refer you when it makes sense.

Call us the same day if a keratoconus eye suddenly becomes cloudy, painful, red or very light-sensitive. If you wear lenses and your eye hurts, take the lens out before you call.

Frequently asked questions

Can I get LASIK if I have keratoconus?

LASIK is generally not recommended for people with keratoconus because it thins the cornea further. Corneal mapping before vision surgery helps catch it.

Does keratoconus keep getting worse forever?

Not usually. It tends to progress most in the teens and twenties and often slows in adulthood. Regular maps show whether yours is changing.

Are scleral lenses safe?

Yes, when they are fitted well, cleaned properly and checked at regular follow-ups. If anything feels wrong, take the lens out and call us.

Should my children be checked if I have keratoconus?

Yes. It can run in families, and catching it early gives more options.

Visit Reimbold Eye Group in Alpharetta

If your prescription won't settle down or your vision is streaky even with new glasses, let's map your cornea. Book online or call 770-776-9000. We are at 4180 Old Milton Pkwy 1-D, Alpharetta, GA 30005, open Tuesday to Thursday 10 am to 6 pm, Friday 9 am to 5 pm and Saturday 9 am to 2 pm.