The earliest signs and symptoms are progressive changes in one’s glasses prescription, as well as an overall deterioration in vision. Other symptoms may include: Distorted vision, where familiar objects look bent or wavy Frequent changes in eyeglass prescriptions Glare and halos around lights, which can make it difficult to drive at night Difficulty seeing at night Eye irritation and redness Headaches associated with eye pain Sudden and significant decrease in vision due to swelling Contact lenses that no longer fit properly and cause discomfort Keratoconus often affects both eyes. Each eye may be affected differently, and symptoms can change over time. Usually, it takes years to go from early stage keratoconus (the age of onset is the late teens to the early 20’s) to late stage keratoconus (into the mid 30’s). However, in some patients, the strain of a bulging cornea causes a tiny crack and sudden swelling to develop (corneal hydrops). As the crack gradually heals and is replaced by scar tissue, vision becomes even more distorted and blurry.

Keratoconus can be diagnosed with a routine eye exam and complete medical history. Dr. Logothetis may also conduct other diagnostic tests, such as: Computerized corneal mapping: This detailed photographic image shows the condition of the corneal surface and can measure the thickness of the cornea. Corneal topographic screening can provide early detection and better long-term outcomes, as newer treatments such as collagen cross-linking have optimal results when performed early in the course of the disease. This type of screening is the most accurate way to diagnose early keratoconus. Slit-lamp exam: Dr. Logothetis will shine a vertical beam of light on the surface of your eye and use a low-powered microscope to view the outer and middle layers of your cornea. Keratometry:. In this test, Dr. Logothetis focuses a circle of light on your cornea and measures the reflection, helping him determine the basic shape of your cornea. Eye refraction: Special equipment, such as a phoropter, is used to measure your eyes and check for vision problems. You may be asked to look through special lenses to ascertain which combination gives you the best vision. Sometimes hand-held equipment, such as a retinoscope, may be used to determine the refractive error in younger children.

Treatment depends on the stage of the disease and severity of symptoms. There are two approaches: one is focused on vision correction, and the other is focused on slowing the progression of the disease. To slow or halt progression, corneal cross-linking surgery may be indicated. This procedure, which was approved as a treatment for keratoconus by the FDA in 2016, “cross-links” new collagen fibers together to preserve the cornea’s strength and shape. The method used to correct vision depends on the severity of the condition. In the earliest stages, nearsightedness and astigmatism due to keratoconus can be treated with eyeglasses or contact lenses. As the disease progresses, and the cornea continues to thin and change shape, eyeglasses may no longer be adequate for vision correction. Hard (rigid, gas permeable) lenses are often the next step in maintaining good vision. These types of lenses can be made to fit your corneas, but can be uncomfortable at first and require a period of adjustment. Some people with late-stage keratoconus and severe symptoms require a corneal transplant. Even after a corneal transplant, glasses or contact lenses are typically necessary to provide clear vision.