Keratoconus can feel confusing — the symptoms develop gradually, the diagnosis often comes late, and the treatment options are not always explained clearly. This FAQ answers the most common questions we hear from patients across Michigan, written by the team at Michigan Contact Lens in Southfield. If you don’t see your question here, schedule a consultation with Dr. Shira Kresch.
Awareness: Understanding Keratoconus
What is keratoconus?
Keratoconus is a progressive eye condition where the cornea — the clear front surface of the eye — gradually thins and bulges outward into a cone-like shape. This irregular shape distorts how light enters the eye, causing blurry or distorted vision that standard glasses and soft contact lenses often cannot fully correct. Keratoconus typically begins during the teenage years or early twenties and can progress over decades. Early detection and specialized care can preserve vision and slow progression.
What are the early signs of keratoconus?
Early signs include increasing nearsightedness, frequent prescription changes (often every few months), blurry or distorted vision that doesn’t fully improve with glasses, sensitivity to light and glare, halos around lights at night, and ghosting or double vision in one eye. Many patients also experience eye strain or headaches from straining to see. Because these symptoms develop gradually, keratoconus is often misdiagnosed as ordinary astigmatism. If your prescription changes faster than expected, ask your eye doctor about corneal topography.
Who gets keratoconus?
Keratoconus most often appears in people aged 10 to 25 and can progress until around age 40. Risk factors include a family history of keratoconus, chronic eye rubbing, allergies that cause itchy eyes, and certain genetic conditions including Down syndrome, Ehlers-Danlos syndrome, and Marfan syndrome. People with poorly managed allergies who rub their eyes frequently are at notably higher risk. Keratoconus affects all ethnicities and both sexes, though some studies suggest higher rates in certain populations.
Diagnosis: Understanding Your Eyes
How is keratoconus diagnosed?
Keratoconus is diagnosed through a combination of vision testing and specialized imaging. The most important test is corneal topography, which creates a detailed map of the cornea’s surface curvature. Other tools include pachymetry (measuring corneal thickness), slit-lamp examination, and in some cases, corneal tomography for a 3D view of corneal structure. A routine eye exam alone may not catch early keratoconus, which is why patients with progressive vision changes should ask specifically for these advanced diagnostic tests at a specialty practice.
Will keratoconus get worse over time?
Keratoconus is typically progressive, especially during the teenage years and twenties. The rate of progression varies — some patients experience rapid changes over months, while others remain relatively stable for years. Progression usually slows or stops by age 35 to 40 as the cornea becomes more rigid with age. However, “stable” doesn’t mean “untreatable.” Even stable keratoconus benefits from specialty contact lens fitting to achieve clear, comfortable vision. Treatments like corneal cross-linking can also halt progression in actively worsening cases.
Is keratoconus the same as astigmatism?
No, though they are often confused. Astigmatism is a refractive error caused by a cornea that is slightly oval-shaped instead of round — it’s stable, common, and easily corrected with glasses or standard contact lenses. Keratoconus is a progressive disease in which the cornea structurally weakens and develops an irregular cone shape. Keratoconus produces what’s called “irregular astigmatism,” which standard glasses cannot fully correct. If you have astigmatism that is getting noticeably worse over time, or vision that remains blurry even with a current prescription, you should be evaluated for keratoconus.
Treatment: Restoring Clear Vision
What are the treatment options for keratoconus?
Treatment depends on the stage of keratoconus. Early stages may be managed with glasses or soft contact lenses. As keratoconus progresses, specialty contact lenses become the standard of care — including rigid gas permeable (RGP) lenses, hybrid lenses, and most commonly, scleral lenses. Corneal cross-linking (CXL) is a procedure that strengthens corneal tissue and can halt progression. For advanced cases that cannot be corrected with lenses, surgical options like corneal transplantation may be considered. A specialty practice will tailor the approach to your specific corneal shape and progression pattern.
Can glasses or regular contacts correct keratoconus vision?
Glasses and standard soft contact lenses can correct vision in the earliest stages of keratoconus, but they become less effective as the cornea changes shape. The irregular cone shape of a keratoconic cornea creates distortions that flat glasses lenses simply cannot match. Soft contact lenses drape over the irregular cornea instead of correcting its shape. As keratoconus progresses, most patients need specialty lenses that vault over or reshape the cornea to provide clear vision. If glasses no longer give you sharp vision, you likely need a specialty lens evaluation.
What are scleral lenses and how do they help with keratoconus?
Scleral lenses are large-diameter rigid contact lenses that rest on the white of the eye (the sclera) and vault completely over the cornea. The space between the lens and the cornea is filled with preservative-free saline, creating a smooth optical surface that masks the cornea’s irregular shape. This produces dramatically clearer vision than glasses or soft lenses for most keratoconus patients. Scleral lenses are also exceptionally comfortable because they don’t touch the cornea. At Michigan Contact Lens, scleral lens fitting is one of Dr. Kresch’s specialties — see our keratoconus services overview for more.
Getting Help
When should I see a keratoconus specialist?
You should see a keratoconus specialist if: your vision is blurry or distorted even with a current prescription; your prescription has been changing rapidly over months; you’ve been diagnosed with astigmatism that is getting worse; you have a family history of keratoconus; or your current eye doctor doesn’t perform corneal topography or specialty contact lens fittings. The earlier keratoconus is identified and managed, the more options you have to preserve vision long-term. Michigan Contact Lens in Southfield specializes in keratoconus diagnosis, scleral lens fitting, and ongoing management. Your first specialty consultation is free — see what to expect at your first visit, and our Insurance & Payment Options page explains superbill reimbursement, HSA/FSA, and CareCredit.
Schedule a Keratoconus Consultation
Dr. Shira Kresch is one of Michigan’s leading keratoconus specialists, with dual OD/MS training from SUNY Optometry and fellowship recognition from the American Academy of Optometry (FAAO). She has fit scleral lenses for hundreds of keratoconus patients across the Detroit metro area.