Some practitioners advocate “piggybacking” two different types of contact lenses on the same eye to better fit the gas permeable contact lens over the cone-shaped cornea. Some patients may find this a bit uncomfortable. The GP lens is fitted on top of the soft contact lens which sits on the eye. The approach is thought to increase patient comfort as the soft lens acts as a cushion under the rigid second lens, the GP lens.

Hybrid contact lenses are a relatively new design combining highly oxygen-permeable rigid center with a soft peripheral lens “skirt.” Manufacturers claim their hybrid contacts provide crisp optics of GP lenses alongside wear- comfort rivaling soft contact lenses. Hybrid lenses are available in a wide variety of parameters to provide optimal fit which conforms best to the irregular shape of a keratoconic eye.

These are gas permeable contact lenses which have a large diameter allowing the edge of the lenses to rest on the white part of the eye -the sclera. These lenses will also dome over the irregularly shaped cornea, allowing for a most comfortable fit. They will move less during eye blinks. Scleral lenses cover a larger portion of the sclera, whereas semi-scleral lenses cover a smaller white (eye) area.

 These are tiny plastic inserts which are surgically inserted just underneath the eye surface in the periphery of the cornea helping to reshape the cornea. The result, clearer vision. Intacs may be advised when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Studies show that Intacs can improve the spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two additional lines on a standard eye chart. The implants have the additional advantage of being removable and changeable. The surgical procedure takes 10 minutes. Intacs might delay but will not prevent the required corneal transplant, if keratoconus progresses.

This procedure, “CXL” for short, strengthens corneal tissue slowing or preventing the bulging of the eye surface. In turn this procedure can reduce the need to undergo a corneal transplant.

There are two types of corneal crosslinking: epithelium-off and epithelium-on. Epithelium-off crosslinking is where the outer portion of the cornea (epithelium) is removed to allow entry of riboflavin, a B vitamin, to the cornea. Once administered, the riboflavin is activated with UV light. With the epithelium-on method (transepithelial crosslinking), the corneal surface is left intact.

Neither procedure is FDA-approved. However, multiple clinical trials are currently underway. Although cross-linking may already be common in some countries — few doctors in the United States will perform the procedure until it is FDA-approved. For that reason, it’s also not covered by insurance. The procedure costs $2,500 per eye, not including the contacts or eye drops.

Some people with keratoconus cannot tolerate a rigid contact lens, or they are beyond the point of contact lenses or known therapies providing acceptable vision. The last resort remedy may be a corneal transplant, also called a penetrating keratoplasty (PK or PKP). Note that after successfully completing a cornea transplant, most keratoconic patients will still need glasses or contact lenses for clear vision.