Keratoconus can gradually distort vision as the cornea becomes thinner, weaker, and more cone-shaped. At The Bochner Eye Institute, patients are evaluated by Dr. Raymond Stein, Dr. Fatimah Gilani, Dr. Nancy Tucker, Dr. Rebecca Stein, and Dr. Zale Mednick. Their combined experience supports detailed corneal imaging, careful monitoring, and individualized treatment planning for patients with mild, moderate, or advanced keratoconus.
The appropriate treatment depends on whether the condition is stable or progressing, how much the corneal shape has changed, and how well vision can be corrected with glasses or contact lenses. Some treatments are intended to improve visual clarity, while others focus on strengthening the cornea and reducing the risk of further progression.
What Is Keratoconus?
The cornea is the clear front surface of the eye. In keratoconus, the cornea becomes thin and weak, causing it to bulge forward into an irregular cone-like shape.
This change prevents light from focusing evenly inside the eye and may lead to irregular astigmatism, visual distortion, and difficulty achieving clear vision with glasses or soft contact lenses.
Keratoconus often begins during adolescence or early adulthood. It usually affects both eyes, although one eye may be more advanced than the other. Progression can be unpredictable and may occur more quickly during the late teens and twenties.
What Are the Symptoms of Keratoconus?
Symptoms vary according to the shape and severity of the cornea. Common signs include:
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Blurred or distorted vision
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Frequent prescription changes
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Increasing nearsightedness or astigmatism
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Glare, halos, or multiple images
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Increased light sensitivity
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Reduced night vision
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Poor vision despite updated glasses
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Difficulty tolerating soft contact lenses
As keratoconus progresses, the cornea may develop scarring or become too irregular for glasses or standard contact lenses to provide useful vision.
What Increases the Risk of Keratoconus?
The exact cause is not always known, but several factors may increase the risk of developing or worsening the condition:
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Frequent or forceful eye rubbing
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A family history of keratoconus
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Genetic predisposition
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Eye allergies
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Connective tissue disorders
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Certain systemic conditions, including Down syndrome
Patients with allergies should avoid rubbing their eyes and discuss ways to control itching or irritation. Repeated eye rubbing may place additional stress on an already weakened cornea.
How Is Keratoconus Diagnosed?
Detailed corneal imaging is used to confirm keratoconus, measure its severity, and monitor change over time.
Testing may include:
Corneal Tomography
Corneal tomography creates a three-dimensional map of the front and back surfaces of the cornea. It can identify early cone formation, irregular steepening,and thinning before obvious symptoms appear.
Corneal Tomography
Corneal tomography creates a three-dimensional map of the front and back surfaces of the cornea. It can identify early cone formation, irregular steepening,and thinning before obvious symptoms appear.
Wavefront Analysis
Wavefront testing evaluates how light travels through the eye and identifies optical distortions that may reduce visual quality.
Slit-Lamp Examination
The ophthalmologist examines the cornea for signs such as thinning, stress lines, or scarring.
Refraction and Visual Acuity Testing
Vision testing measures the prescription and determines how clearly the patient can see with glasses or other correction.
Together, these results show whether keratoconus is progressing and help determine which treatment options may be appropriate.
What Are the Main Goals of Keratoconus Treatment?
Keratoconus treatment may have two separate goals:
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Improving vision with glasses, contact lenses, or corneal reshaping
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Strengthening the cornea to slow or stop progression
A treatment that improves vision does not necessarily stabilize the disease. Contact lenses, for example, may provide clearer vision but do not prevent the cornea from thinning or becoming more irregular.
Corneal crosslinking is designed primarily to strengthen the cornea and reduce the risk of future progression. Some patients may also experience an improvement in corneal shape or visual quality, but this cannot be guaranteed.
Can Glasses or Contact Lenses Treat Keratoconus?
Glasses or soft contact lenses may provide useful vision during the early stages. As the cornea becomes more irregular, specialized contact lenses may be needed.
Options may include:
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Rigid gas-permeable lenses
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Scleral lenses
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Hybrid lenses
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Piggyback systems that place a rigid lens over a soft lens
These lenses create a smoother optical surface over the irregular cornea and may improve clarity. However, they do not strengthen the cornea or slow the progression of keratoconus.
Contact lens comfort and visual quality may become harder to maintain as the condition advances. Proper cleaning and handling are also important because poor lens hygiene can increase the risk of infection.
What Is Corneal Crosslinking?
Corneal crosslinking, or CXL, is a treatment designed to strengthen the cornea and reduce continued bulging and thinning.
The procedure uses riboflavin eye drops and controlled ultraviolet A light. When activated by the light, the riboflavin helps form additional bonds between collagen fibres within the cornea. These bonds act as structural anchors, increasing corneal strength.
Crosslinking is not a cure for keratoconus. Its main purpose is to stabilize the cornea, preserve its existing shape, and reduce the likelihood of further vision loss or a future corneal transplant.
Patients may still require glasses or contact lenses after treatment.
How Is Standard Corneal Crosslinking Performed?
Standard crosslinking is generally performed one eye at a time using anaesthetic eye drops.
The procedure usually involves:
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Removing the central surface layer of the cornea
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Applying riboflavin eye drops
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Exposing the cornea to controlled ultraviolet A light
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Placing a bandage contact lens over the eye
The bandage lens protects the cornea while the surface cells regenerate. It is removed after the cornea has healed sufficiently.
Temporary discomfort, light sensitivity, tearing, and blurry vision are common during the first several days. There is also a small risk of infection, haze, or delayed surface healing.
Who May Be a Candidate for Crosslinking?
CXL may be considered for patients with documented progression or a meaningful risk of future progression.
Candidates may include:
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Children, adolescents, and younger adults with keratoconus
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Adults whose imaging or prescription shows continued change
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Patients with increasing nearsightedness or astigmatism
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Patients whose best-corrected vision is declining
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Patients seeking to reduce the risk of a corneal transplant
Younger patients may benefit from earlier treatment because keratoconus can progress more quickly in this age group.
Very thin corneas or significant central scarring may limit candidacy. The cornea must meet minimum thickness requirements before ultraviolet light is applied. Specialized techniques may sometimes make treatment possible in thinner corneas, but eligibility must be determined through detailed testing.
What Is Bochner Precision CXL™?
Bochner Precision CXL™ is The Bochner Eye Institute’s excimer-assisted crosslinking technique. It was developed to strengthen the cornea while reducing the amount of surface tissue disturbed during treatment.
Instead of manually removing a broad central area of surface cells, the procedure uses an excimer laser to create a small, customized opening in the peripheral corneal surface. The central optical area is preserved.
This technique removes substantially fewer surface cells than standard crosslinking and is designed to provide a more comfortable and efficient healing process.
What Are the Benefits of Bochner Precision CXL™?
The smaller treatment area is intended to provide:
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Faster surface healing
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Less postoperative discomfort
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Lower risk of haze or infection
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Quicker return to daily activities
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Greater preservation of the central corneal surface
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Stabilization across mild, moderate, and advanced keratoconus
The main goal remains to strengthen and stabilize the cornea. Patients may still need glasses or contact lenses afterward.
Bochner Precision CXL™ is used as the institute’s preferred crosslinking approach for many keratoconus patients. Standard CXL remains available when a different treatment plan is considered more suitable.
How Does Bochner Precision CXL™ Differ From Standard CXL?
Both procedures use riboflavin and ultraviolet A light to strengthen corneal collagen. The main difference is how the corneal surface is prepared.
Standard CXL removes a larger central area of surface cells. This can lead to more discomfort, slower surface healing, and a longer period of blurry vision.
Bochner Precision CXL™ uses laser-guided removal of a much smaller peripheral area. Preserving the central surface is intended to reduce healing time and postoperative symptoms.
Both treatments primarily focus on strengthening the cornea rather than eliminating the need for glasses or contact lenses.
What Is Topography-Guided PRK With Crosslinking?
Topography-guided PRK with CXL combines corneal strengthening with a customized laser treatment designed to smooth some of the irregular shape caused by keratoconus.
Detailed corneal maps containing thousands of measurement points guide the excimer laser. The laser removes a carefully planned amount of tissue to reduce selected irregularities, and crosslinking is then performed to stabilize the cornea.
The goals are to:
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Improve corneal regularity
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Reduce optical distortion
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Enhance visual clarity with glasses or contact lenses
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Stabilize keratoconus
This procedure does not guarantee freedom from glasses. It may reduce dependence on rigid or scleral contact lenses in some patients, but corrective lenses may still be needed.
Who May Qualify for Topography-Guided PRK With CXL?
This option may be considered for selected patients with:
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Moderate keratoconus
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Reduced vision of approximately 20/30 or worse
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A corneal thickness of at least 430 microns
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Corneal irregularities that can be treated without removing too much tissue
Because a larger surface area is treated than with Bochner Precision CXL™, recovery is generally longer. Candidacy depends on detailed corneal imaging, thickness, prescription, and the amount of tissue required.
What Is Conductive Keratoplasty With Crosslinking?
Conductive keratoplasty, or CK, uses radiofrequency energy to shrink selected collagen fibres and flatten steep areas of the cornea.
At The Bochner Eye Institute, CK may be combined with Bochner Precision CXL™ for selected patients with advanced keratoconus. Crosslinking is performed first to strengthen the cornea, followed by CK to address steepness and irregular astigmatism.
The goals are to:
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Flatten the steepest part of the cone
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Reduce irregular astigmatism
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Improve best-corrected vision
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Decrease visual distortion
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Stabilize the cornea
This option may be considered for selected patients with advanced disease and vision of approximately 20/50 or worse. It is not appropriate for every cornea.
When Is a Corneal Transplant Needed?
Most patients can be managed with glasses, specialized contact lenses, crosslinking, or combined procedures. However, a corneal transplant may be necessary when the cornea becomes extremely thin, steep, scarred, or irregular.
A transplant may be considered when:
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Vision cannot be corrected adequately with contact lenses
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Contact lenses can no longer be tolerated
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Central corneal scarring interferes with vision
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Other treatments cannot provide useful visual function
Approximately 10% to 20% of patients with keratoconus may eventually require a corneal transplant. Early diagnosis and stabilization are intended to reduce that risk.
Which Keratoconus Treatment Is Right for You?
A patient may be advised to consider:
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Glasses or contact lenses when the condition is stable, and vision remains correctable
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Bochner Precision CXL™ when the main priority is slowing or stopping progression
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Topography-guided PRK with CXL when stabilization and improved corneal regularity are both goals
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CK with CXL for selected advanced cones and severe irregularity
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Corneal transplantation when useful vision cannot be achieved with other treatments
Monitoring may also be recommended when keratoconus is mild and stable.
What Is Recovery Like After Keratoconus Treatment?
Recovery depends on the specific procedure.
After crosslinking, patients may experience:
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Blurry or fluctuating vision
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Light sensitivity
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Tearing
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Irritation or discomfort
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Temporary difficulty wearing contact lenses
Because a larger surface area is treated than with Bochner Precision CXL™, recovery is generally longer. Candidacy depends on detailed corneal imaging, thickness, prescription, and the amount of tissue required.
A bandage contact lens is usually worn until the surface heals. Antibiotic, anti-inflammatory, and lubricating eye drops may be prescribed.
Vision can initially be worse than before treatment and then gradually recover. Patients may need to wait before resuming contact lens wear or updating their glasses prescription.
Bochner Precision CXL™ is intended to provide a faster recovery than standard CXL. Topography-guided PRK with CXL generally involves a longer healing period because a larger area of the corneal surface is treated.
What Are the Possible Risks of Keratoconus Treatment?
No corneal procedure is risk-free. Potential concerns include:
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Infection
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Delayed surface healing
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Corneal haze
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Temporary discomfort
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Light sensitivity
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Blurred or fluctuating vision
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Changes in prescription
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Difficulty wearing contact lenses during recovery
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Incomplete stabilization
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The possible need for repeat treatment
Changes in corneal shape after treatment may require a new contact lens fitting or eyeglass prescription.
The strengthening effect may not be permanent in every case, and additional treatment may occasionally be considered if testing shows continued progression.
Frequently Asked Questions
No. Crosslinking strengthens the cornea and aims to slow or stop progression. It does not remove the condition or guarantee a normal corneal shape.
No. Vision is usually blurry during early healing and may temporarily be worse than before treatment.
The corneal surface gradually heals and smooths. Vision may continue changing over several weeks or months.
The main goal is stabilization, but some patients experience improved corneal shape or visual quality. Glasses or contact lenses may still be required.
Repeat treatment may be considered if imaging shows continued progression. This is uncommon and depends on corneal thickness, healing, and overall eye health.
Contact lenses are temporarily avoided while the corneal surface heals. The timing for returning to lens wear depends on the procedure and the surgeon’s instructions.
Changes in corneal shape may also require a new lens fitting.
Earlier treatment may preserve a more regular corneal shape before advanced thinning or scarring develops. This is particularly important for children, adolescents, and young adults whose keratoconus may progress more quickly.
The Bochner Eye Institute primarily uses Bochner Precision CXL™ for many patients due to its intended advantages in comfort and recovery. Standard crosslinking may still be offered when it is considered appropriate for the treatment plan.
Why Choose The Bochner Eye Institute for Keratoconus Treatment?
The Bochner Eye Institute has played an important role in bringing corneal crosslinking to patients in Canada and has treated thousands of eyes affected by keratoconus. Its corneal specialists use detailed tomography, wavefront analysis, corneal thickness measurements, and vision testing to evaluate disease severity and progression. Treatment may include specialized contact lenses, Bochner Precision CXL™, topography-guided PRK with crosslinking, or CK with crosslinking, depending on the cornea’s strength, shape, and thickness.
Patients with severe scarring or advanced distortion can also receive guidance about corneal transplantation when appropriate. Experience caring for patients from across North America supports an individualized approach focused on stabilizing the cornea, preserving vision, and improving visual quality whenever safely possible.
Protect Your Vision in Toronto and Scarborough, ON
Keratoconus can progress unpredictably, but timely diagnosis may help preserve corneal strength and visual function. The Bochner Eye Institute offers detailed testing and treatment options for patients with early, moderate, or advanced disease. To review which approach may be appropriate, schedule a consultation with The Bochner Eye Institute by calling (416) 960-2020.
Watch A Short Video On Keratoconus
In this short video, Dr. Raymond Stein discusses the cause, symptoms, variations, and treatment of keratoconus.