Keratoconus

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment, diagnosis and management, with treatment planning based on severity, stability and your day-to-day visual needs.

Keratoconus is a condition where the cornea (the clear front “window” of the eye) becomes weaker and progressively thinner, causing it to bulge into a cone-like shape. This alters how light focuses in the eye and can lead to increasingly blurred or distorted vision.

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Stages of Keratoconus

Keratoconus is often described in broad stages:

• Early stage – mild changes, often increasing astigmatism and subtle blur
• Moderate stage – more noticeable distortion and reduced vision quality
• Advanced stage – significant irregular corneal shape and, in some cases, scarring that affects clarity

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Common Causes of Keratoconus

The exact cause is not always clear, but keratoconus is associated with a combination of factors, including:

• Genetic predisposition (it can run in families)
• Eye rubbing and long-term surface irritation
• Allergic eye disease (which may increase rubbing/irritation risk)

Your consultant will take a full history and assess any contributing factors that may be relevant to your care plan.

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Symptoms of Keratoconus

Symptoms can develop gradually and may include:

• Blurred or distorted vision (including “ghosting” or double images in one eye)
• Increasing short-sightedness (myopia) and worsening astigmatism
• Frequent prescription changes with glasses
• Glare and haloes, especially at night
• Light sensitivity
• Reduced clarity that is not fully corrected with standard spectacles in more advanced cases

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Diagnosis at Royal Buckinghamshire Hospital

Accurate diagnosis helps confirm keratoconus and determine whether it is stable or progressing. Assessment may include:

• Consultant-led eye examination and refraction (measuring your prescription)
• Corneal topography/tomography (specialist mapping of corneal shape)
• Corneal thickness measurements (pachymetry)
• Visual acuity testing and assessment of functional vision (e.g., driving/night glare)

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Treatment & Management

Treatment depends on how advanced the keratoconus is and whether it is progressing.

Management may include:

• Glasses or soft contact lenses in early disease
• Rigid gas permeable or scleral contact lenses to improve vision where spectacles are no longer sufficient
• Corneal cross-linking (CXL) if the condition is progressing, aimed at slowing or stopping progression (this is primarily a stabilising treatment rather than a vision-improving one)
• In selected cases, additional procedures may be considered (for example, when contact lens tolerance is poor or corneal shape is highly irregular)
• Corneal transplant is generally reserved for advanced cases where vision cannot be corrected adequately with lenses or where scarring is significant

Your consultant will discuss the most appropriate pathway based on your corneal measurements, rate of change, symptoms and lifestyle requirements.

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If you are experiencing symptoms of keratoconus or your prescription is changing frequently, contact Royal Buckinghamshire Hospital for expert assessment and advice. There is no need to be registered with The Royal Buckinghamshire Hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.