Keratoconus

Keratoconus is a progressive corneal condition in which the normally round cornea thins and weakens, protruding forward into an irregular, conical shape. This irregular steepening induces high irregular astigmatism and higher-order aberrations that cannot be adequately corrected with standard eyeglasses or mass-produced soft contacts. Keratoconus almost always affects both eyes—though often asymmetrically—and typically begins during puberty or early adulthood, progressing through the third and fourth decades of life.

There is currently no cure for keratoconus, but custom specialty contact lenses offer life-changing visual rehabilitation. The gold standard is a custom scleral lens, designed to vault entirely over the sensitive, cone-shaped cornea and rest gently on the sclera (the white of the eye). The space between the lens and cornea is filled with preservative-free saline, neutralizing surface irregularities and providing clear, stable 20/20-level vision without corneal friction. At Charlotte Contact Lens Institute, we utilize advanced Pentacam tomography collecting up to 240,000 elevation points to design custom free-form scleral, EyePrintPRO, and corneal GP lenses.

Yes, keratoconus is inherently a progressive disorder. It typically becomes apparent between the ages of 10 and 25 and often progresses steadily until approximately age 40, when natural corneal collagen stiffening (cross-linking) tends to stabilize the tissue. However, rate and severity of progression vary widely among individuals. Regular serial corneal tomography with our Pentacam AXL Wave is essential to track sub-micron changes in corneal thickness and curvature.

Corneal cross-linking (CXL) is an FDA-approved, minimally invasive procedure that uses riboflavin (vitamin B2) ophthalmic drops and ultraviolet-A (UV-A) light to stiffen and reinforce collagen cross-links within the corneal stroma, effectively halting keratoconus progression. While CXL stabilizes the cornea, it does not reshape it or eliminate existing irregularity—meaning patients almost always still require custom scleral contact lenses to achieve sharp, functional vision. Charlotte Contact Lens Institute performs comprehensive CXL candidacy evaluations and co-manages with leading corneal surgeons across the Carolinas.