Laser Eye Surgery Keratoconus: Treatment Possibilities and Limitations

If you’ve been diagnosed with keratoconus, you might feel overwhelmed by your symptoms and wonder what treatment options are available to you. This progressive condition, which affects the shape and structure of the cornea, can lead to blurry or distorted vision, sensitivity to light, and frequent changes in your glasses prescription. Understanding your treatment options is an essential step towards managing the condition.

With so many treatment options available—ranging from non-surgical solutions to advanced procedures like corneal cross-linking (CXL)—it can be difficult to know where to start. You might also be curious about the latest treatments, the cost of corrective surgery, or whether procedures like LASIK or PRK are suitable for you. If you are in South Australia and considering these treatments, we offer laser eye surgery in Adelaide.

In this article, we’ll explore the best treatment options for keratoconus, explain why certain types of laser eye surgery may or may not be suitable, and provide guidance on how to protect and improve your vision. By understanding your options, you’ll feel more confident about taking the next step towards clearer sight. For more information on laser eye surgery’s limitations and what you can expect to achieve for different situations, take a look at our article What are the limits of vision correction?

Understanding Keratoconus and Its Impact on Vision

Keratoconus is a progressive eye condition that affects the shape and structure of the cornea—the clear, dome-shaped surface at the front of the eye. In a healthy eye, the cornea is smooth and evenly curved, allowing light to focus clearly on the retina. However, with keratoconus, the cornea gradually becomes thinner and bulges outward into a cone-like shape.

This irregular shape prevents light from focusing properly, leading to blurred or distorted vision. The condition often begins in the teenage years or early adulthood and can worsen over time. In more advanced stages, the cornea may scar, causing further vision problems.

How Does Keratoconus Affect the Cornea and Vision?

As the cornea weakens and thins, its distorted shape leads to several vision problems, including:

Blurred or Distorted Vision: The misshapen cornea causes light to scatter, leading to visual distortion.
Increased Light Sensitivity: Many people with keratoconus experience discomfort in bright light or glare at night.
Frequent Prescription Changes: Glasses and contact lenses often need to be updated regularly as vision worsens.
Ghosting or Double Vision: Overlapping images, especially when looking at lights, are common.

In its early stages, keratoconus might be manageable with glasses or soft contact lenses. As it progresses, more specialised treatments are often needed to stabilise the cornea and improve vision.

For those newly diagnosed - or for loved ones seeking to better understand this condition - it’s reassuring to know that there are many effective treatment options available today, ranging from non-surgical solutions to advanced surgical procedures designed to slow progression and improve vision.

Can You Have Laser Eye Surgery with Keratoconus?

Many people diagnosed with keratoconus wonder if laser eye surgery could help correct their vision. With so many advanced procedures available, it’s natural to ask whether treatments like LASIK or PRK are safe and effective options. However, the answer isn’t always straightforward and depends on the severity of the condition and the specific type of surgery being considered.

Why LASIK Is Not Suitable for Keratoconus Patients

LASIK (Laser-Assisted In Situ Keratomileusis) is one of the most popular laser eye surgeries for correcting refractive errors like nearsightedness, farsightedness, and astigmatism. However, it is not recommended for patients with keratoconus¹.

During LASIK, a thin flap is created in the cornea and lifted to allow the laser to reshape the underlying tissue. Because keratoconus causes the cornea to thin and weaken, creating this flap can further destabilise the cornea, increasing the risk of serious complications, such as:

Corneal Ectasia: A worsening of corneal thinning that can lead to vision loss².
Irregular Healing: Poor healing due to the cornea’s weak structure³.

For this reason, LASIK is not a safe or effective option for treating keratoconus.

Best Surgical Treatments for Keratoconus: Latest Advances and Options (2025)

Advancements in eye care have expanded the range of effective surgical treatments for keratoconus, offering new hope for patients looking to stabilise their vision and improve their quality of life. Understanding the latest procedures can help you make informed decisions about your treatment options.

What Is the Best Surgery for Keratoconus?

The most effective surgery for keratoconus depends on the stage and severity of the condition. The goal is to halt the progression of corneal thinning while also improving vision.

Can You Get PRK with Keratoconus?

PRK (Photorefractive Keratectomy) is another type of laser eye surgery that reshapes the cornea without creating a flap. Because PRK removes only the outer layer of the cornea, it may seem like a safer option for people with keratoconus. However, PRK is generally not recommended for patients with moderate to severe keratoconus due to the risk of further thinning and destabilisation of the cornea⁴.

In very mild cases or after the cornea has been stabilised with corneal cross-linking (CXL), PRK might be considered to improve vision⁵. However, caution is still advised as this approach requires careful evaluation by a specialist and is not suitable for everyone.

Alternative Laser Procedures for Keratoconus

While LASIK and PRK are typically unsuitable for keratoconus, there are other laser-based treatments designed specifically to strengthen and stabilise the cornea:

Corneal Cross-Linking (CXL): This is the most effective treatment for halting the progression of keratoconus⁶. It involves applying vitamin B2 (riboflavin) drops to the cornea and activating them with UV light. This process strengthens the corneal fibres, preventing further thinning and bulging.
Topography-Guided PRK with CXL: In select cases, mild keratoconus can be treated with a combination of PRK and corneal cross-linking⁷. PRK reshapes the cornea to improve vision, while CXL stabilises the cornea to prevent further progression.
Intracorneal Ring Segments (ICRS): Small implants (such as Intacs) are placed in the cornea to flatten its shape and improve vision. This can be combined with CXL for better results⁸.

If you have keratoconus, it’s crucial to speak with an experienced eye surgeon to understand which treatments are safe and effective for your condition.

Corneal Cross-Linking (CXL): Strengthening the Cornea

Corneal Cross-Linking (CXL) is currently the most widely used and effective procedure for stabilising keratoconus⁹. It works by applying riboflavin (vitamin B2) drops to the eye, followed by controlled exposure to ultraviolet (UV) light. This process strengthens the corneal collagen fibres, helping to prevent further thinning and bulging.

CXL doesn’t improve vision directly but is essential for halting keratoconus progression. It can be combined with other procedures to enhance vision correction.

Implantable Collamer Lenses (ICL) for Vision Correction

For patients with keratoconus who are not suitable for LASIK or PRK, Implantable Collamer Lenses (ICLs) offer a safe and effective way to correct vision¹⁰. An ICL is placed behind the iris and in front of the eye's natural lens¹¹, improving focus without altering the cornea.

ICLs can be an excellent solution for patients with moderate to severe keratoconus who need vision correction but cannot undergo corneal reshaping procedures.

Combined Treatments: Cross-Linking with PRK

In certain cases of mild keratoconus, a combination of Corneal Cross-Linking (CXL) and Photorefractive Keratectomy (PRK) may be recommended. PRK gently reshapes the cornea to improve vision, while CXL strengthens the cornea to stop the disease from progressing.
This combined approach can offer both stabilisation and vision correction but requires careful screening by a specialist to ensure safety.

Non-Surgical Treatment Options for Keratoconus

Not all cases of keratoconus require surgery. In the early stages, many patients can manage their condition effectively with non-surgical treatments designed to improve vision and slow progression. These options offer relief and stability without the need for invasive procedures.

Keratoconus Treatment Without Surgery

For mild to moderate keratoconus, non-surgical treatments focus on correcting vision and supporting the cornea’s structure. These options can help patients maintain functional vision and comfort as the condition progresses:

Prescription Glasses: In the earliest stages, glasses can correct mild nearsightedness and astigmatism caused by keratoconus¹².
Soft Contact Lenses: Specialised soft lenses can provide clear vision for some patients in the early phases¹³. However, they may become less effective as the condition advances.

Specialty Contact Lenses (Scleral and Hybrid Lenses)

As keratoconus progresses, standard lenses may no longer provide clear or comfortable vision. Specialised contact lenses are often the next step:

Scleral Lenses: These large-diameter lenses rest on the white part of the eye (sclera) and vault over the irregular cornea, creating a smooth, moisture-rich surface for clearer vision. They are highly effective for moderate to advanced keratoconus.
Hybrid Lenses: These lenses combine a rigid gas-permeable centre for crisp vision with a soft outer skirt for comfort. Hybrid lenses are ideal for patients who need sharper vision but struggle with comfort in rigid lenses.

Both options offer significant improvement in vision and comfort by compensating for the cornea's irregular shape¹⁴.

Corneal Inserts (Intacs) for Vision Stabilisation

Intacs are small, curved implants placed within the cornea to flatten its shape and improve vision. While this is a minimally invasive procedure¹⁵, it is often considered a bridge between non-surgical and surgical treatments.

Intacs can:

Reduce Corneal Irregularity: Flatten the bulging cornea to improve how light enters the eye¹⁶.
Improve Contact Lens Fit: Make it easier to wear contact lenses by creating a more regular corneal shape¹⁷.
Delay the Need for Corneal Transplant: In some cases, Intacs can slow the progression of keratoconus and delay more invasive procedures, though it is not a suitable alternative to these procedures¹⁸.

Intacs are often combined with corneal cross-linking (CXL) for greater stability and improved vision outcomes.
For patients seeking alternatives to surgery, these non-surgical treatments can provide effective relief and maintain vision quality. At IVISION LASER, we will assess your condition and recommend the most suitable non-surgical options to help you manage keratoconus safely and comfortably.

Can LASIK Cause Keratoconus?

LASIK is considered a safe procedure with low complication rates¹⁹. However, for some people, concerns arise about whether LASIK could cause or worsen keratoconus—a condition where the cornea progressively thins and bulges into a cone shape. While LASIK does not directly cause keratoconus, it can lead to a similar condition known as corneal ectasia in rare cases.

Corneal ectasia is a rare but serious complication that can occur after LASIK. It involves progressive thinning and bulging of the cornea, resembling keratoconus. This condition typically arises when the cornea was already structurally weak or when too much corneal tissue was removed during surgery.

Symptoms of corneal ectasia include:

Blurred or distorted vision
Increasing nearsightedness or astigmatism
Light sensitivity and glare
Difficulty with night vision

Although similar to keratoconus, corneal ectasia develops after surgery and may progress more rapidly without treatment.

Risk Factors and Screening Before Laser Eye Surgery

To reduce the risk of corneal ectasia, comprehensive pre-operative screening is essential. Eye surgeons use advanced diagnostic tools to assess the thickness and shape of the cornea before recommending LASIK.

Key risk factors for developing corneal ectasia after LASIK include:

Thin Corneas: Patients with thinner-than-average corneas are more vulnerable to corneal instability after LASIK.
Irregular Corneal Shape: Abnormal corneal curvature or early signs of keratoconus increase the risk.
High Refractive Errors: Large corrections may require more tissue removal, weakening the cornea.
Family History of Keratoconus: Genetic factors can predispose individuals to corneal thinning.

If these risk factors are present, a reputable surgeon will recommend alternative treatments that are safer for your eye health. Procedures like PRK (Photorefractive Keratectomy) or corneal cross-linking (CXL) may be more suitable for strengthening the cornea and preventing complications.

Frequently Asked Questions About Keratoconus and Laser Eye Surgery

Can Keratoconus Be Cured Permanently?

Currently, there is no permanent cure for keratoconus, but treatments can effectively slow or halt its progression and significantly improve vision. Procedures like Corneal Cross-Linking (CXL) are designed to strengthen the cornea and prevent further thinning, helping to stabilise the condition.

For vision correction, options such as speciality contact lenses, Intracorneal Ring Segments (Intacs), and in advanced cases, corneal transplants, can provide long-term improvement. However, ongoing eye care and monitoring are essential to manage keratoconus effectively.

Is Laser Eye Surgery Safe for Keratoconus?

Traditional laser eye surgeries, such as LASIK, are not safe for patients with keratoconus due to the risk of worsening corneal thinning and developing corneal ectasia.

However, alternative treatments like Corneal Cross-Linking (CXL) and, in some cases, Topography-Guided PRK combined with CXL, can be safer options to help stabilise the cornea and improve vision. Every case is unique, so a thorough eye examination is critical to determine the safest and most effective treatment for each patient.

How Do I Know Which Treatment Is Right for Me?

Choosing the right treatment depends on the severity of your keratoconus, your overall eye health, and your vision goals. A comprehensive eye assessment is essential to evaluate the cornea's thickness, shape, and stability.

At IVISION LASER, we provide consultations to:

Assess the progression of your keratoconus.
Determine if you’re a candidate for procedures like Corneal Cross-Linking (CXL) or Intracorneal Ring Segments (Intacs).
Explore non-surgical options such as scleral contact lenses or hybrid lenses for vision correction.

Our team will guide you through all available options to help you make an informed decision for your vision health.

Conclusion

Managing keratoconus can feel overwhelming, but there are many effective treatment options available to stabilise the condition and improve vision. Whether you're in the early stages of keratoconus or facing more advanced symptoms, the right treatment depends on the severity of your condition and your individual vision goals.

For some, non-surgical treatments like speciality contact lenses may provide clear and comfortable vision, while others may benefit from advanced surgical procedures such as Corneal Cross-Linking (CXL), Intracorneal Ring Segments (Intacs), or a combination of treatments designed to both stabilise and correct vision.

The most important step is to work with a qualified eye care professional who can guide you towards the safest and most effective solution.

Book a Consultation with IVISION LASER

At IVISION LASER, we aim to support patients in managing their eye health through evidence-based care and advanced treatment options. Our qualified team conducts thorough eye assessments to provide tailored advice and discuss appropriate treatment plans.

Whether you are considering surgical or non-surgical options, our focus is on helping you make informed decisions that align with your needs and circumstances.

Contact us to arrange a consultation and learn more about how we can assist you in managing your vision and eye health.

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Hi, I’m Dr Aanchal Gupta, your laser and cataract surgeon in Adelaide

Over the past 10 years, I’ve had the joy of helping thousands of patients of all ages gain clear vision and freedom from glasses and contact lenses.

Laser eye surgery is a skill. Performing vision correction at a world-class standard hinges upon the expertise of your surgeon and their access to state-of-the-art tools.

I understand that getting eye surgery is a serious decision. Your eyes are unique and you should demand a custom solution tailored to your needs, lifestyle and goals. That’s why we offer a free appointment so we can meet and I can take the time to answer your questions and talk through any concerns you have.

I am passionate about helping patients transform their lives. I look forward to spending time with you at our gorgeous eye clinic in the heart of Adelaide to see whether you could gain exceptional vision without the need for glasses or contacts.

Dr Aanchal Gupta

MBBS, M.Med. (Ophth. Sci.), Grad. Dip. (Refract. Surg.), FRANZCO
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