Keratoconus is an eye condition in which the cornea, the clear front surface of the eye, loses structural strength, thins, and bulges outward into an irregular, cone-like shape. The cornea’s collagen framework normally helps it maintain a smooth, rounded shape that focuses light accurately. With keratoconus, changes in that shape cause blurred vision, ghosting, glare, and other distortion. As the irregularity increases, glasses may no longer provide clear vision, and specialty contact lenses may be needed.
Keratoconus is thought to develop through a combination of genetic and environmental factors. A family history increases your risk, although many people with keratoconus have no known affected relatives. Allergic conditions, including eczema and allergic eye disease, are also associated with keratoconus. Frequent or forceful eye rubbing may contribute to its development and progression, making it important to manage itchy eyes and avoid rubbing them.
Whether you have recently been diagnosed or are struggling with your current glasses or contacts, we can assess your corneal health and discuss options for clearer, more comfortable vision.
What keratoconus does to your vision
The cornea is the clear front surface of your eye. It helps focus incoming light onto the retina. With keratoconus, the cornea becomes thinner and bulges outward, creating an irregular shape that prevents light from focusing evenly.
Keratoconus often begins during the teenage years or early adulthood. It usually affects both eyes, although one eye may be more affected than the other. The rate of change varies, which makes monitoring important even when your vision seems stable.
Common symptoms include:
- Blurred or distorted vision.
- Ghosting or overlapping images.
- Glare, halos, and sensitivity to light.
- Difficulty seeing clearly at night.
- Frequent changes in your glasses prescription.
- Eye strain associated with unclear vision.
Glasses and standard soft contact lenses may provide adequate correction in early keratoconus. As the cornea becomes more irregular, changing the prescription alone may not resolve the distortion.
The exact cause is not fully understood. Family history, eye rubbing, and allergic eye disease are associated with keratoconus. Avoiding eye rubbing and addressing persistent itching are useful parts of care.
Evaluating keratoconus and watching for changes
An evaluation considers both how well you see and the condition of your cornea. Dr. Sturm reviews your symptoms, prescription history, previous contact lens experience, and any prior treatment. Vision testing and examination of the cornea help identify what is limiting your sight, including irregularity or scarring.
At InSight EyeCare, we use Pentacam imaging to measure the front and back surfaces of the cornea and map its thickness. These measurements help assess the pattern of corneal thinning and irregularity. Comparing scans over time helps Dr. Sturm evaluate whether the condition is changing.
The findings guide two related decisions: which correction may improve your vision and whether changes in the cornea warrant evaluation for treatment to slow progression. Clearer vision with a new lens does not, by itself, establish that keratoconus is stable.
Improving vision with specialty contact lenses
Specialty contact lenses are a central part of keratoconus care when glasses no longer provide useful clarity. Unlike glasses, rigid lens designs create a more regular optical surface in front of the irregular cornea. This can reduce distortion that a glasses prescription cannot adequately address.
Dr. Sturm selects a lens design based on your corneal shape, vision needs, eye surface health, and ability to wear and handle the lenses.
Scleral lenses
Scleral lenses are larger gas permeable lenses that vault over the cornea and rest on the tissue over the white part of the eye. A reservoir of sterile filling solution remains between the lens and the cornea.
The rigid lens surface and fluid reservoir help compensate for corneal irregularity. For many people with keratoconus, this provides clearer vision than glasses or standard soft contacts. The larger design can also provide a stable fit, including for some patients who have struggled with smaller rigid lenses.
Scleral lenses require individual fitting. Dr. Sturm evaluates the clearance over the cornea, how the lens rests on the eye, and the vision it provides. Comfort and clarity depend on the fit, prescription, eye health, and proper daily care.
Learn more about scleral lenses.
Other specialty lens options
Scleral lenses are not the only option. Depending on your findings, Dr. Sturm may recommend:
- Corneal rigid gas permeable lenses: Smaller rigid lenses that rest on the cornea and use the tear layer beneath them to help correct an irregular optical surface.
- Hybrid lenses: Lenses with a rigid center for vision correction and a soft outer skirt to support fit and comfort.
- Custom soft lenses: Designs made with specialized parameters that may provide useful correction for selected patients with keratoconus.
The most suitable lens is the one that provides an appropriate balance of vision, fit, comfort, and eye health for your individual eyes. Read about our broader options on the specialty contact lenses page.
What to expect during specialty lens fitting
Fitting lenses for keratoconus involves evaluating how a lens performs on your eye, not simply selecting a prescription. Corneal measurements guide the initial design. Dr. Sturm then assesses the lens fit and measures your vision through it.
Adjustments may be needed to improve clarity, stability, or comfort. Follow-up visits allow us to check how the lenses perform with regular wear and whether the eye remains healthy beneath them. More irregular or scarred corneas can require additional fitting steps.
You will also need to learn the insertion, removal, cleaning, and disinfection methods appropriate for your lenses. Scleral lenses have additional filling requirements. These routines are part of successful wear, along with following your prescribed wearing schedule.
The amount of visual improvement varies. Specialty lenses can reduce distortion caused by corneal shape, but they cannot remove corneal scars or correct every source of reduced vision.
When corneal cross-linking or surgical evaluation may be needed
Specialty lenses correct vision, but they do not stop keratoconus from progressing.
Corneal cross-linking is a procedure intended to strengthen the cornea and slow or stop further progression. It may be considered when progression is identified, including before keratoconus becomes advanced. Its main purpose is to stabilize the cornea, rather than eliminate the need for glasses or contact lenses.
Dr. Sturm monitors for changes and refers appropriate patients for cross-linking evaluation. We also coordinate co-management and specialty lens care afterward. As the cornea heals and its shape changes, lens adjustments or refitting may be necessary.
Some patients with significant scarring, advanced disease, or inadequate vision despite specialty lenses need evaluation for other surgical options, including corneal transplantation. These decisions depend on the condition of the cornea and the vision achievable with nonsurgical correction.
Ongoing care for keratoconus
Long-term care includes monitoring the cornea as well as checking lens fit, vision, and eye surface health. Dr. Sturm recommends follow-up based on your findings, age, evidence of progression, and treatment history.
Let us know about increasing blur, reduced lens comfort, persistent redness, or difficulty wearing your lenses. Sudden loss of vision, new corneal cloudiness, or significant eye pain requires prompt evaluation.
If allergies make your eyes itch, we can discuss ways to manage the irritation and reduce the urge to rub them.
Questions about keratoconus care
Can I try specialty lenses if I could not tolerate contacts before?
Possibly. Difficulty with one lens design does not rule out every other option. A different size, shape, material, or fitting approach may improve the experience. Dr. Sturm will evaluate why previous lenses were uncomfortable or unsuccessful before recommending another design.
Does everyone with keratoconus need scleral lenses?
No. Some people obtain adequate vision with glasses, while others do well with corneal rigid, hybrid, or custom soft lenses. Scleral lenses are particularly useful when corneal irregularity limits vision or other lenses do not fit or feel comfortable.
Will I eventually need a corneal transplant?
A transplant is not inevitable. Many patients manage their vision with specialty lenses, with cross-linking considered when appropriate to address progression. Surgical evaluation becomes relevant when corneal damage or other limitations prevent adequate vision or successful lens wear.
Schedule a keratoconus evaluation in Cibolo
InSight EyeCare provides keratoconus evaluation and specialty contact lens care for patients in Cibolo, Schertz, and surrounding northeast San Antonio communities.
Book an exam with Dr. Sturm, or call (210) 659-3937 for more information.