Eye Specialists of Westchester

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Keratoconus is a degenerative eye disease. It occurs when the cornea – the clear, dome-shaped surface of the eye – thins out, gradually producing a cone-shaped bulge in the front of the eye. This cone-shaped cornea causes blurred vision and may cause increased sensitivity to light and glare. Keratoconus usually affects both eyes but may progress at different rates in each eye.

In the early stages of keratoconus, the vision problems caused by the distorted cornea can be corrected effectively with glasses or soft contact lenses. As keratoconus progresses, special rigid gas permeable contact lenses may be necessary. Advanced keratoconus may require surgery.


Keratoconus is estimated to occur in 1 out of every 2000 people. The causes of keratoconus are still unclear but there are some risk factors:

  • Wearing hard contact lenses that are not properly fit. The constant pressure or continual injury caused by wearing rigid contact lenses that are not fit appropriately can lead to keratoconus.
  • Family history.
  • Down syndrome.
  • Habitual rubbing of the eyes vigorously.


The signs and symptoms of keratoconus may change as the disease progresses. They include:

  • Blurred or distorted vision.
  • Increased sensitivity to bright light and glare.
  • Disturbed night vision.

Testing and Diagnosis

Dr. Scharf or Dr. Donev can diagnose keratoconus during a routine eye examnation, but further testing may be done to determine the exact shape of the cornea. Tests to diagnose keratoconus include:

  • Eye refraction – This is a standard vision test that measures your eyes to check for clear vision, astigmatism and other vision problems.
  • Slit-lamp examination – This test helps the doctor to determine the shape of the cornea.
  • Ketatometry – This test is used to measure the cornea’s curvature.
  • Corneal topography – This is a computerized scan that generates a topographical map of the cornea.


The treatment of keractoconus depends on its severity and rate of progression.
Mild or moderate keratoconus can be treated with corrective eyeglasses or contact lenses.

  • Glasses or soft contact lenses. Early keratoconus can be treated with glasses or soft contact lenses to correct blurry or distorted vision. But because the condition is progressive, most people find they frequently need to change the prescription of their lenses as the shape of the cornea changes.
  • Rigid gas permeable contact lenses. Hard contact lenses are often the next step in treating progressing keratoconus. Rigid lenses may feel uncomfortable at first, but many wearers grow accustomed to them.
  • Piggyback lenses. If you don’t like the feel of rigid lenses, your doctor may recommend piggybacking a hard contact lens on top of a soft one.
  • Hybrid lenses. Also for people who can’t tolerate hard contact lenses, these contacts have a rigid center with a softer ring around the outside for increased comfort.
  • Customized contact lenses. These rigid gas permeable lenses are custom created for each individual based on topographical measurements of the corneas.
  • Scleral contact lenses. These lenses are useful for irregular cornea changes, because they rest on the white part of the eye (sclera) and vault over the cornea, instead of resting on the cornea like traditional lenses.

Surgery may be necessary for advanced keratoconus or scarring of the cornea. Several surgeries are available, depending on the location of the bulging cone and severity of the disease.

Surgical Options:

  • Keratoplasty. A keratoplasty is a corneal transplant. This treatment is used for extreme thinning or corneal scarring. This surgery can be performed in a number of ways. Intralamellar keratoplasty is a partial-thickness transplant, in which only a section of the cornea’s surface is replaced. Penetrating keratoplasty is a full-cornea transplant, in which an entire portion of your cornea is replaced.

During a keratoplasty, a general anesthetic may be administered, or the eye may be numbed with a local anesthetic. The doctor removes the central portion of the cornea and replaces it with the donor cornea. It may require up to one year to achieve the best possible vision after keratoplasty. It is likely that eyeglasses or contact lenses will still be required after keratoplasty.


Most cases of keratoconus are not preventable. There are some steps you can take to be sure you do not cause it yourself:

  • Use care when rubbing your eyes. Do not rub your eyes vigorously as this may cause damage to the corneas in a way that can lead to keratoconus.
  • Follow instructions when wearing rigid contact lenses. If you wear hard contact lenses, be sure that they fit correctly and use them as directed to avoid damage to the eyes.