Keratoconus Treatment & Management

Understanding Keratoconus

Keratoconus is a progressive eye disease that causes the cornea (the clear front surface of the eye) to thin and bulge outward into a cone-like shape. This abnormal shape prevents light from focusing properly on the retina, resulting in distorted vision. Typically your cornea is round and dome-shaped, but in keratoconus it becomes more cone-shaped, causing vision distortion as light is no longer focused correctly onto the retina.

Symptoms of keratoconus include:

Blurred or distorted vision
Increased sensitivity to light and glare
Difficulty driving at night
Eye redness or swelling
Frequent changes in eyeglass prescriptions
Inability to wear contact lenses comfortably

Keratoconus typically begins during puberty and progresses through the 30s and 40s, usually stopping around age 40. The rate of progression varies significantly from person to person, which is why early diagnosis and treatment are crucial for preserving vision. While it usually progresses slowly over a period of 10-20 years, it can sometimes advance rapidly, leading to corneal swelling and scarring.

At the Eyecare Center of Orange County, Dr. Bonakdar specializes in diagnosing and managing keratoconus with advanced techniques and personalized care plans.

Our Treatment Options

Scleral Lenses

Scleral lenses are large-diameter gas permeable contact lenses that vault over the entire corneal surface and rest on the sclera (the white part of the eye). These specialized lenses create a new optical surface to replace the irregular cornea, providing dramatically improved vision for keratoconus patients.

Benefits include:

Superior vision correction for irregular corneas
Comfortable all-day wear
Protection of the corneal surface
Reduced symptoms of dryness and irritation

Corneal Cross-Linking (CXL)

Corneal cross-linking is a minimally invasive procedure that strengthens the corneal tissue to halt the progression of keratoconus. The procedure uses riboflavin (vitamin B2) drops and controlled UV light to create new bonds between collagen fibers in the cornea, both stabilizing and strengthening it.

This FDA-approved treatment can actually stop your cornea from thinning and becoming more irregular. Studies show that corneal cross-linking can improve vision, stop the progression of keratoconus, and flatten the irregular shape of the cornea, with results remaining stable for at least a year after the procedure.

Unlike other treatments that only improve vision while keratoconus continues to progress, CXL addresses the underlying condition itself. It can also be combined with other treatments and may reduce the need for corneal transplants.

Intacs Corneal Implants

Intacs are tiny, clear inserts placed in the periphery of the cornea to reshape its surface. These micro-thin prescription inserts help flatten the cone-shaped cornea and improve vision in patients with keratoconus.

The procedure is quick (taking about 10 minutes) and minimally invasive. The implants can be exchanged or removed as needed through additional procedures, making this a reversible option. While Intacs won't stop the progression of keratoconus like corneal cross-linking, they can significantly improve vision and may delay or prevent the need for corneal transplant surgery.

Specialty Contact Lenses

In addition to scleral lenses, we offer other specialty contact lens options for keratoconus patients, including:

Hybrid lenses: These combine a rigid center with a soft skirt, providing the vision correction of a gas permeable lens with the comfort of a soft lens. They're often more comfortable than RGP lenses and less of a hassle than piggybacking.
Custom soft keratoconus lenses: Specially designed soft lenses that can work for mild cases of keratoconus.
Gas permeable (GP) lenses: These rigid lenses can "vault" over the cornea and provide better vision than soft lenses by changing the shape of your eye.
Piggyback lens systems: This involves wearing both a soft contact lens and a gas permeable lens—one on top of the other. The soft lens is placed in the eye first for comfort, and then the rigid lens is put on top for vision correction.

Corneal Transplant Co-Management

For advanced cases of keratoconus, a corneal transplant (also called penetrating keratoplasty or PKP) may be necessary. This surgical procedure involves removing the irregular corneal tissue and replacing it with healthy donor tissue.

While this is typically considered the last course of action after other options have been explored, Dr. Bonakdar works closely with top corneal surgeons to co-manage patients before and after transplant surgery, ensuring continuity of care and optimal outcomes. Even after a corneal transplant, patients often still need prescription eyeglasses or contact lenses for optimal vision correction.

Ongoing Monitoring & Management

Keratoconus requires lifelong management. We provide comprehensive monitoring using advanced technology like corneal topography and pachymetry to track changes in your cornea over time and adjust your treatment plan accordingly.

Scleral Lenses for Keratoconus

How Scleral Lenses Work

Scleral lenses are specially designed to vault over the cornea, creating a fluid-filled reservoir between the lens and the corneal surface. This design offers several advantages:

The fluid layer compensates for corneal irregularities, creating a smooth optical surface
The lens rests on the less sensitive sclera rather than the cornea, improving comfort
The fluid reservoir continuously bathes the cornea, providing relief for dry eye symptoms that often accompany keratoconus
The rigid material provides superior optics compared to soft lenses

The Scleral Lens Fitting Process

Fitting scleral lenses requires specialized expertise and technology. Our process includes:

Comprehensive corneal mapping using advanced topography
Custom lens design based on your unique corneal shape
Trial lens evaluation to assess fit and vision
Detailed training on insertion, removal, and care
Follow-up appointments to ensure optimal fit and comfort

Dr. Bonakdar is recognized as a leading scleral lens specialist, with extensive experience fitting even the most challenging keratoconus cases.

Benefits of Scleral Lenses

Dramatically improved vision quality
All-day comfort, even for patients who couldn't tolerate other contact lenses
Protection of the corneal surface from environmental irritants
Reduced progression of keratoconus in some cases
Avoidance or delay of corneal transplant surgery
Improved quality of life and ability to perform daily activities

Why Choose Us for Keratoconus Care?

Specialized Expertise

Dr. Bonakdar is a recognized specialist in keratoconus management with extensive experience treating even the most complex cases.

Advanced Technology

We utilize state-of-the-art diagnostic equipment including corneal topography, pachymetry, and anterior segment OCT to precisely monitor and manage your condition.

Personalized Approach

We develop customized treatment plans based on your specific corneal shape, vision needs, lifestyle, and disease progression.

Comprehensive Care

From diagnosis through ongoing management, we provide continuous care and support throughout your keratoconus journey.

"After being diagnosed with keratoconus, I was terrified about losing my vision. Dr. Bonakdar fitted me with scleral lenses that completely transformed my life. For the first time in years, I can see clearly without distortion or discomfort. His expertise and compassionate care have been invaluable."

- David R., Keratoconus Patient

Frequently Asked Questions

What causes keratoconus?

The exact cause of keratoconus is not fully understood, but it appears to involve a combination of genetic, environmental, and cellular factors. The American Academy of Ophthalmology reports that about 10 percent of people with keratoconus have a parent who has it too, suggesting a genetic component.

Risk factors include:

Family history of keratoconus
Excessive eye rubbing
Certain systemic conditions (like Down syndrome)
Inflammatory conditions like allergies and asthma
Connective tissue disorders

Can keratoconus be cured?

While there is no cure for keratoconus, treatments like corneal cross-linking can halt its progression, and specialty contact lenses can provide excellent vision correction. With proper management, most keratoconus patients can maintain good functional vision throughout their lives.

Are scleral lenses difficult to use?

Scleral lenses do have a learning curve, but most patients quickly become comfortable with insertion and removal. We provide comprehensive training and support to ensure you can manage your lenses confidently. The dramatic improvement in vision makes the adjustment period well worth it for most patients.

Is corneal cross-linking covered by insurance?

Many insurance companies now cover corneal cross-linking for progressive keratoconus since it received FDA approval. Coverage varies by provider and plan. Our staff will help you understand your coverage options and any available financing plans.

How often do I need to be monitored for keratoconus?

The frequency of monitoring depends on your age, disease progression, and treatment plan. Typically, patients with newly diagnosed or rapidly progressing keratoconus are seen every 3-6 months, while those with stable disease may be monitored annually. Dr. Bonakdar will recommend a personalized follow-up schedule based on your specific needs.

Our Impact by the Numbers (KERATOCONUS PAGE)

Take Control of Your Keratoconus

Schedule your consultation with Dr. Bonakdar and take the first step toward clearer vision and better quality of life.

Book a Consultation Call Us: 714-558-1182