Keratoconus · Concord Eyecare, North Strathfield, Sydney
Keratoconus — what it means, and what happens next.
Just been told you have keratoconus, or that it’s changing? Here’s what it actually is, whether it is likely to get worse, and every option for treating it — the lenses we fit here, and the surgical side we arrange with a corneal surgeon.
Corneal mapping
to see whether your cornea is changing
Rigid & scleral lenses
fitted on site, including after a graft
Surgery arranged
we organise cross-linking with a corneal surgeon and stay involved
What is keratoconus?
The cornea thins and bulges — and glasses can only correct a regular shape.
A normal cornea
Evenly curved, so light lands in one place. A streetlight looks like a streetlight.
A cornea with keratoconus
Thinned and pushed out into a cone, usually low on the cornea. The same streetlight grows streaks, haloes and ghosts.
Simplified illustrations — not scans, not to scale, and not a real patient. The dashed line on the right shows where a normal cornea would sit. How much your own vision is affected depends on how far the cone has developed, and it is different for everyone.
Most people notice it as vision that keeps changing. You get new glasses, they help for a while, and then they don’t. Straight edges look bent or doubled. Lights at night grow tails and haloes. One eye is often worse than the other.
Keratoconus is also more common than it was once thought to be. An Australian study — the Raine Study in Perth — scanned 1,259 twenty-year-olds and found corneal changes consistent with keratoconus in about 1 in 84. That figure comes from imaging everyone rather than waiting for symptoms, so it picks up very early changes that would never otherwise have been diagnosed. The honest read: early keratoconus is common, and severe keratoconus is not.
We manage pellucid marginal degeneration along the same lines. It is a related thinning that sits lower on the cornea, and the approach — map it, watch it, correct it with the right lens — is the same.
Will I go blind from keratoconus?
Left unchecked it can take your sight. Watched and treated, most people keep it.
We would rather tell you that plainly than reassure you and have you skip your reviews. The full picture has three parts, and the first one is the reason for the other two.
Advanced keratoconus can reach the point where lenses no longer work and corneal grafting is the remaining option. That is not a theoretical end point — in one Belgian series, 75 eyes with severe keratoconus were all transplant candidates by the time they were seen. What that series also showed is how much can still be done at that stage, which is covered further down this page.
Keratoconus tends to be most active through the teens and twenties and to quieten after that. In the Australian randomised trial run in Melbourne, untreated eyes steepened by roughly 1.75 dioptres over three years — real change, and it adds up, but it is gradual and measurable long before it becomes a problem you can feel. Most people who are picked up and monitored keep good functional vision for life.
Very occasionally the inner layer of a thin cornea splits and fluid floods into it — this is called hydrops. Vision goes cloudy quite suddenly, often with pain and light sensitivity. It usually settles over weeks to months, but it needs to be looked at straight away rather than waited out.
Nearly everything that leads to the bad outcome is slow, silent and measurable. Cross-linking exists to stop the steepening, and it works best while there is still cornea worth protecting — so the useful question is not whether keratoconus can blind you, but whether yours is changing. That is a question a scan answers.
Call us the same day if: your vision goes cloudy or drops suddenly, your eye becomes painful and red, or you develop new sensitivity to light. These are not things to sit on over a weekend.
Keratoconus treatment options
Two different jobs: seeing well, and holding the cornea steady.
Job one
Seeing wellDone with lenses — glasses while they still keep up, then rigid or scleral contact lenses as the cone steepens. This is the half that changes your day.
Job two
Holding the cornea steadyDone with corneal cross-linking, a hospital procedure that stiffens the cornea’s internal bonds. This is the half aimed at stopping progression.
They work together rather than competing. Which of them you need — and in what order — depends on whether your cornea is changing, which is what the monitoring further down this page is for.
Glasses
Genuinely fine for early keratoconus, while the shape is still regular enough for a spectacle lens to correct. If glasses are working, there is no reason to change.
Soft toric contact lenses
An option in mild cases with regular-enough astigmatism. Limited once the cone steepens, because a soft lens drapes over an irregular surface rather than correcting it.
Corneal rigid gas permeable lenses
A small rigid lens that sits on the cornea and forms its own smooth front surface. Excellent optics. Comfort is the usual limitation, and the usual reason people move on.
Scleral lenses
A larger rigid lens that vaults right over the cone and rests on the white of the eye, with fluid held underneath. Comfortable and stable when smaller lenses have not worked out.
Referred
Corneal cross-linking (CXL)
The treatment aimed at stopping progression. Riboflavin drops plus controlled ultraviolet light stiffen the bonds inside the cornea. This is the one that matters most if your cornea is changing.
Referred
Intracorneal ring segments
Small implants placed within the cornea to flatten the cone. Considered in selected cases, usually where lens wear alone is not getting there.
Referred
Corneal graft (keratoplasty)
Replacing the cornea with donor tissue. Reserved for advanced disease where lenses can no longer give usable vision — and a long way from where most people ever get to.
Referred, same day
Anything sudden
Hydrops, a painful red eye, a sudden drop in vision. Seen here promptly and referred on if it needs a hospital, rather than added to a waiting list.
We don’t perform cross-linking — we refer for it, and we will organise that. In the Melbourne randomised trial, untreated eyes steepened by about 1.75 dioptres over three years and their vision slipped; cross-linked eyes flattened slightly, by about 1 dioptre, and their vision improved a little. Two eyes had minor complications and neither lost vision.
And one thing lenses cannot do. A scleral lens gives you clear, comfortable vision — often the best you have had in years. It does not stop the cone underneath from changing. In a study of 157 eyes followed for at least a year, about 15% lost some of their best lens-corrected vision as the keratoconus progressed beneath a well-fitting lens. That is exactly why we keep scanning your cornea whether or not you wear lenses.
Which contact lens is best for keratoconus?
Rigid lenses win on sharpness. Between them, it’s comfort that decides.
Average vision in glasses, then in scleral lenses, across published keratoconus studies — several lines on the chart. That gain is measured against spectacles, not against other contact lenses. Results vary between individuals.
Two findings are worth knowing, because they are often misrepresented — including by people selling lenses.
Corneal rigid lenses
A small rigid lens sitting directly on the cornea. Long-established, less expensive, and optically excellent.
Scleral lenses
A larger lens vaulting the cone entirely, resting on the white of the eye with fluid held underneath.
| What the research found | Corneal rigid | Scleral |
|---|---|---|
| Vision (randomised crossover trial) | No significant difference between the two | No significant difference between the two |
| Comfort (same trial) | Lower | Significantly better |
| Wearer preference | 53% | 47% |
| Comfort score, 422-person survey | 2.2 / 5 | 3.3 / 5 |
The trial that produced the near-even preference recruited people who were already wearing corneal lenses successfully, which stacks the deck in their favour — the authors said as much. Their conclusion was that the people who benefit from switching are the ones whose comfort is poor. That matches what we see: if you are taking a lens out by mid-afternoon, or you never got past the adaptation, a scleral is the honest next step.
And one finding that deserves more attention than it gets. In a Belgian series of 75 eyes with severe keratoconus — all of them corneal transplant candidates — scleral lenses were fitted to 51 eyes, and 40 of those 51 were still wearing them successfully at final follow-up, with the graft put off. Mean follow-up was about two and a half years, so “put off” is the honest word, not “avoided”.
How keratoconus progression is monitored
Progression is a change between scans — so the repeat scan is the test.
First visit
The steepest point sits just below centre.
Twelve months later
The same eye, steeper and tighter. That difference is what we are looking for.
Illustration only. These are simplified drawings to show what a comparison looks like — they are not a real patient’s scans, not a diagnosis, and not a treatment result. Your own maps will look different.
We use a corneal topographer — a Medmont — to build a map of your cornea’s surface, and a second scan that shows the cornea in cross-section where that helps. What we are watching is whether the steepest part of the cone is getting steeper over time.
One scan tells us the shape today. It cannot tell you whether that shape is stable, because keratoconic corneas vary a great deal between people — a measurement that would be alarming in one eye is simply another person’s baseline. The information is in the change, which is why we ask you back.
That is the treatment aimed at stopping it, and organising that referral is the whole point of the monitoring. We stay involved with the surgeon afterwards, so you are not carrying messages between two practices.
Stability is a finding, not a non-result. It is what lets us focus on the half that changes your day — getting you a lens that is comfortable and gives you sharp vision.
Keratoconus treatment cost
One price for the lens program. The surgical side isn’t ours to bill.
Scleral lens program · both eyes
$2,200
Lenses, fitting, and two years of reviews included
Lenses last about two years in normal wear. When yours are due for replacement, a new two-year cycle is $1,400 covering the lenses and the reviews in that period. If your prescription changes before then, we will quote before ordering anything.
Less than the scleral program, and quoted at your assessment once we know what your cornea needs.
Not ours to quote. Those costs sit with the surgeon and the hospital, and we will tell you who can give you the figure.
Contact lenses for keratoconus come out of your ordinary optical extras limit. There is no separate benefit for medically necessary lenses, so for most funds that is a few hundred dollars a year. We will give you an itemised receipt.
Keratoconus care in Sydney
We do the seeing-well half — and we say so when it’s the other half.
Here at Concord Eyecare
Diagnosis, monitoring and lenses
Referred, and we’ll organise it
Anything surgical
We would rather be clear about that boundary up front than have you discover it halfway through. Plenty of keratoconus care involves two practitioners, and the handover between them is where things usually get dropped — so we hold on to that part rather than leaving it to you.
We assess each eye on its own and give you a straight answer — including when the answer is that something simpler has not been tried yet, or that the lens you are already wearing is the right one and does not need changing. Keratoconus is manageable, and most of managing it well is not rushing.
Keratoconus questions answered
The things people ask us first.
Who is experienced in keratoconus in Sydney?
Keratoconus is usually managed jointly — optometrists handle the diagnosis, the monitoring and the contact lenses, while ophthalmologists perform cross-linking and surgery. At Concord Eyecare we are experienced in fitting corneal rigid and scleral lenses for irregular corneas, and we refer for the surgical side.
If you have been diagnosed and do not know where to start, an assessment with corneal mapping is the sensible first step — it tells you both where your cornea is now and whether it is changing.
What should I avoid if I have keratoconus?
Rubbing your eyes is the one thing genuinely worth changing. People with keratoconus report rubbing their eyes far more often than people without it — several times more often across the available studies. What those studies cannot prove is which came first, because the trial that would settle it has never been run.
Even so, rubbing puts real mechanical force on a cornea that is already thinner than it should be, so stopping is worth doing. If your eyes itch, treat the itch rather than rubbing it — and tell us, because allergy and dry eye are both fixable.
At what age does keratoconus get worse?
It is usually most active through the teens and twenties, and tends to settle with age. In one large study the average age at diagnosis was about 28 — though that is when people were diagnosed, not when it started, and no reliable figure exists for when it actually begins.
Being young at diagnosis is the main reason we would want to monitor closely and talk about cross-linking early, while there is more still to protect.
Can keratoconus be cured?
No, and anyone telling you otherwise is overselling. But it is treatable, and that is a meaningful difference — cross-linking can stop it progressing, and lenses can restore sharp vision. Most people whose keratoconus is picked up and managed keep good vision for life. Left unwatched it is a different story, which is why the monitoring matters more than it sounds like it should.
Can I get laser eye surgery if I have keratoconus?
No. Standard laser vision correction works by removing corneal tissue, and a keratoconic cornea is already too thin — it would make things worse. Keratoconus is a specific exclusion for LASIK.
Cross-linking is the procedure that applies here instead, and it works the opposite way: it strengthens the cornea rather than thinning it.
Will glasses help my keratoconus?
Early on, yes — and while glasses are doing the job there is no reason to change. As the cone steepens they stop being able to keep up, because a spectacle lens can only correct a regular shape.
When new glasses stop making a real difference, that is the point to look at rigid or scleral lenses.
How much does keratoconus treatment cost in Australia?
It depends which half you mean. Contact lens management sits with us — our scleral lens program is $2,200 for both eyes, covering the lenses, the fitting and two years of reviews, and corneal rigid lenses are less than that.
Cross-linking is a surgical procedure billed by the surgeon and the hospital, so those costs sit outside our practice and we will point you to who can quote them.
Further reading
Where to go next.
References
- Chan E, Chong EW, Lingham G, et al. Prevalence of keratoconus based on Scheimpflug imaging: the Raine Study. Ophthalmology. 2021;128(4):515–521.
- Wittig-Silva C, Chan E, Islam FMA, Wu T, Whiting M, Snibson GR. A randomised, controlled trial of corneal collagen cross-linking in progressive keratoconus. Ophthalmology. 2014;121(4):812–821.
- Fuller DG, Wang Y. Safety and efficacy of scleral lenses for keratoconus. Optometry and Vision Science. 2020;97(9):741–748.
- Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs scleral rigid gas permeable contact lenses for keratoconus. Contact Lens and Anterior Eye. 2020;43(6):543–552.
- Shorter E, Schornack M, Harthan J, et al. Keratoconus patient satisfaction and care burden with corneal gas permeable and scleral lenses. Optometry and Vision Science. 2020;97(9):790–796.
- Koppen C, Kreps EO, Anthonissen L, et al. Scleral lenses reduce the need for corneal transplants in severe keratoconus. American Journal of Ophthalmology. 2018;185:43–47.
- Sahebjada S, Al-Mahrouqi HH, Moshegov S, et al. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2021;259(8):2057–2067.
Last updated August 2026
Book a keratoconus assessment
Not sure where your keratoconus is up to?
An assessment with corneal mapping tells you two things — how your cornea looks now, and whether it is changing. Both matter, and neither takes long. If it turns out nothing needs doing yet, we will tell you that too.
Book an assessment Or call (02) 8765 9600Concord Eyecare, North Strathfield — seeing patients from across Sydney. No referral needed. Appointments Monday to Saturday.