Dr. Aivars Tihonovs, plastic surgeon

Diagnosis and treatment of keratoconus

Keratoconus is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape. 

The disease is progressive and its causes are still being studied. There are various theories and some of them refer to metabolic disorders, inheritance and radiation emissions as possible causing factors. Usually the first symptoms appear for teenagers or for people aged from 20 - 30 years. Keratoconus occurs more often for men than for women, more often for people with myopia than with hyperopia and it affects both eyes. There are approximately two new cases of keratoconus disease per 100 00 people annually. 


  • Progressive vision deterioration
  • Pictures with shadows, caused by an astigmatism in progress;
  • Disorders of an vision in general;
  • Disorders of vision contrast at twilight and night;
  • Increased eye sensitivity to light;
  • Increased tear secretion;
  • Duplications;
  • Previously diagnosed astigmatism progresses and can change the axis.   


Precise diagnosis of keratoconus is possible only with the corneal topography. In our clinic we use computerized topography system Allegro Oculyzer where the corneal parameters get analyzed by the following criteria: 

  • Corneal thickness at the middle and at the thinnest point of the cornea;
  • Curvature radius of the corneal anterior and posterior at various points on the cornea;
  • Keratoconus index;
  • Index of surface variance (ISV)
  • Index of height asymmetry (IHA)
  • Astigmatism of the cornea (there is also a lens astigmatism)
  • Specific factors (Zernike)   

Treatment of keratoconus 

Vision correction with an eyeglasses and soft contact lenses does not provide a sufficient visual acuity which causes problems in everyday life – it complicates car driving and a person is unable to work in professions that require precision and accuracy. 

Keratoconus can be corrected at its initial stage with special keratoconus contact lenses which are gas permeable. Some time ago, a progressive keratoconus led to a corneal transplantation or even a corneal perforation. Now keratoconus can be stopped by a surgical method – collagen crosslinking (Corneal Cross Linking or CCL) whose aim is to increase the mechanical strength of the cornea. 

The crosslinking treatment method is offered also by Dr. Lukins’ Eye Clinic.

At the beginning of the procedure the corneal epithelium gets removed by a laser (Trans-Epithelial Surface Treatment), afterwards proceeding with an UV-A ray lightning on the cornea which lasts about 30 minutes. At the end of the procedure therapeutic contact lenses are applied. In the postoperative period a patient has to use an anti-inflammatory drops. 

It is possible to use this method only when the cornea is not thinner than 400 micrometers, otherwise there is a potential risk of corneal endothelium damage. The sooner crosslinking method is used the better the results will be.

The procedure should be performed for patients only over 18 years of age but there can be exceptions also if the keratoconus progresses very rapidly. 

The visual acuity may even get worse in the first month but later it improves, reaching the maximum effect approximately 6 months after the procedure. After crosslinking it is possible to use hard contact lenses to improve the vision but only when the period of stabilization will have passed.

If the progressive keratoconus has affected both eyes, the next procedure usually follows after three months.


Additional information about keratoconus, its symptoms and treatment you can receive when consulting with your doctor.


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