Navigating the Controversies in the Treatment of Keratoconus

  • Adel Barbara
  • Paul R. Meredith
  • Ramez Barbara


Keratoconus significantly impacts upon the life of patients suffering from this frustrating disease. Quality of life is negatively affected at a young age, an age of learning and professional formation. The associated astigmatism, both regular and more significantly the irregular, reduces visual acuity and impairs the quality of vision.

Until two decades ago the only treatment options were rigid gas permeable contact lenses or penetrating keratoplasty. More recently deep anterior lamellar keratoplasty has been replacing penetrating keratoplasty as the treatment of choice in cases of very advanced and scarred keratoconic corneas. New innovations in contact lens design include soft contact lenses for keratoconus, hybrid lenses. Scleral-and semi-scleral contact lenses, enable more patients to wear contact lenses.

Early detection of keratoconus is enabled by the availability of various corneal topographies and tomographies. Collagen corneal cross-linking has proven to be effective in arresting keratoconus and has revolutionized the way we face keratoconus.

The cornea can be remolded by intrastromal corneal rings or photorefractive keratectomy, with or without combined collagen corneal cross-linking.

Phakic intraocular lenses, in particular toric lenses, are an additional means of improving visual acuity.

All the previously mentioned treatment approaches may be combined either simultaneously or sequentially.

Advancements in diagnosis and treatment has led to the emergence of keratoconus as a new subspecialty in ophthalmology. With so many new treatment modalities available and the potential to combine approaches it is easy for the clinician to become confused. This chapter will act as a guide in the ‘what’, ‘when’ and ‘how’ of the management of keratoconus.


Keratoconus Ectasia Post lasik Intrastromal rings ISCR Intacs Ferrara ring Keraring Barbara ring Collagen cross linking CXL Intraocular lens Penetrating keratoplasy PKP Deep anterior lamellar keratoplasty DALK Vernal kerato-conjunctivitis Eye rubbing Photorefractive keratectomy Phototherapeutic keratectomy PRK Astigmatism Myopia Proud nudule Hydrops 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Adel Barbara
    • 1
  • Paul R. Meredith
    • 2
  • Ramez Barbara
    • 2
  1. 1.Medical Director of IVISION, Refractive Surgery and Keratoconus Treatment CenterHaifaIsrael
  2. 2.Southampton Eye Unit, Southampton General HospitalSouthamptonUK

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