Keratoconus & Cross-linking

At Nielsen Eye Center, our experienced ophthalmologists are dedicated to providing you with the most advanced methods of treatments available. If you have keratoconus, you can trust that our eye doctors can create a detailed treatment plan to preserve or improve your vision. 

What Is Keratoconus?

Keratoconus is an eye condition that affects the front surface of your eye, known as the cornea. Those with keratoconus have a more cone-shaped cornea than a spherical one.

Keratoconus causes the corneal tissue to thin and bulge forward, producing blurry and distorted vision. Most cases of keratoconus are diagnosed earlier in life, around adolescence or early adulthood.

However, you can develop keratoconus at any age. Experts do not currently know the cause of keratoconus, although various factors seem to play a role in the development. 

There is also evidence to suggest that keratoconus may be hereditary. This condition also tends to be associated with frequent eye rubbing, allergies, and certain connective tissue disorders. 

What Are The Symptoms of Keratoconus?

If you have keratoconus, it is likely to be diagnosed by your eye doctor during routine eye exams. However, there are some symptoms that are common with keratoconus:

  • Mildly blurred vision
  • Excessive rubbing of the eyes
  • Frequent headaches
  • Vision that cannot be corrected with glasses
  • Difficulty seeing at night

Those who have keratoconus may start off experiencing mild symptoms. However, keratoconus symptoms often worsen with time. 

Keratoconus is usually a bilateral condition, meaning if you have it in one eye, you will likely have it in the other. It is possible to have a more advanced stage of the condition in one eye compared to the other. 

In mild stages of the condition, eye doctors often use hard contact lenses to correct distorted or blurry vision. A common symptom of keratoconus in more advanced stages is that these contact lenses no longer work to correct vision.

In some cases, the contact lenses may be unable to fit properly on the eye due to the bulging in the cornea. Although keratoconus tends to progress slowly, it can develop rapidly in some people. 

In the advanced stages of the condition, scar tissue begins to develop on the cornea that often further blurs and distorts the vision.  

How Do Eye Doctors Test for Keratoconus?

If your eye doctor suspects that you may have keratoconus, they will perform a few tests to determine how advanced the condition is. These tests and measurements will also help your eye doctor determine which treatment plan is best for you.

Before you begin to notice symptoms, your eye doctor can often diagnose keratoconus during your routine eye exams. Early detection and treatment of keratoconus are vital for preserving your vision.

For this reason, it is essential that you visit your eye doctor for routine exams. To diagnose or detect keratoconus, your eye doctor will perform a thorough examination of your eyes, including looking at them under a microscope.

When examining your eyes under the microscope, your eye doctor will be able to see if there are certain irregularities in your cornea, such as bulging. Your eye doctor will also test your vision to see how your vision compares to previous visits. 

For further information about how advanced your keratoconus is, they may take additional images and measurements of your eyes. A pachymetry test is an integral part of diagnosing keratoconus and determining its level of progression.

The results of a pachymetry test tell your eye doctor the thickness of your cornea. Your eye doctor can take this measurement at various locations on your cornea.

However, your eye doctor will be particularly interested in how thin your cornea is at the peak of the bulge. The thinner your cornea is, the weaker and more fragile it is. 

In addition to pachymetry, your eye doctor will likely take an image of your cornea that forms a topographical map. This image will show your eye doctor the thinnest or weakest part of your cornea. 

Depending on the severity of your condition, eye doctors use various methods to treat keratoconus. In mild cases, your eye doctor may prescribe you contact lenses to offset the visual symptoms of the condition.

In more advanced cases, a corneal transplant may be required to restore vision. However, our experienced eye doctors at Nielsen Eye Center offer the new iLink corneal cross-linking procedure that can slow the progression of the condition. 

Use this helpful website to learn more about living with Keratoconus.

What Is iLink Corneal Cross-Linking?

In order to slow the weakening of the cornea in people who have keratoconus, eye doctors may recommend they have the iLink corneal cross-linking procedure. This procedure is performed by your eye doctor in-office and is outpatient, meaning you can go home the same day.

The iLink corneal cross-linking procedure is the only FDA-approved procedure for the treatment of progressive keratoconus. This safe and effective procedure can slow the progression of keratoconus and possibly prevent the need for a corneal transplant in the future.

During the iLink corneal cross-linking procedure, your eye doctor will apply specifically formulated riboflavin drops in a sequence to the surface of your eye. In combination with a unique UV light, these drops help strengthen the bonds in your cornea. 

The entire procedure takes about one hour. Your eye doctor will give you specific instructions to follow to ensure the best results and avoid complications.

It is crucial that you do not rub your eyes for a few days to weeks after the procedure. You may notice some discomfort or light sensitivity while your eyes heal. 

You will also need to return to see your eye doctor for regular follow-up visits to ensure that the procedure was successful. The iLink corneal cross-linking procedure does not aim to improve vision, however, it will likely inhibit it from worsening.

The goal of the iLink corneal cross-linking procedure is to strengthen your cornea and help avoid further surgical intervention, like a corneal transplant, in the future. 

Is iLink Corneal Cross-Linking Right For Me?

If you have keratoconus and are considering your treatment options, schedule an appointment with Dr. Moreira or Dr. Khanna, our experts on keratoconus diagnoses, treatment, and surgical procedures. The iLink corneal cross-linking procedure may not be suitable for everyone. Read our iLink brochure here.

To see if this procedure may be able to help improve your keratoconus symptoms or halt the progression of the condition, ask your eye doctor for your treatment options. The eye doctors at Nielsen Eye Center are committed to providing you with the most advanced and customized treatment methods available.

Are you interested in learning more about keratoconus or the iLink corneal cross-linking procedure? Schedule an appointment with Dr. Moreira and Dr. Khanna at Nielsen Eye Center in Boston, MA, today!

Find our iLink FAQs here.


About Intacs

Closeup of an Intac on a Finger

For those patients with severe keratoconus, whose vision is no longer correctable with contacts or glasses, there is a revolutionary procedure called Intacs. As keratoconus progresses, many patients find they can’t tolerate contact lenses and don’t achieve clear vision correction with glasses. Before Intacs, the only treatment for keratoconus was a very invasive corneal transplant. Intacs are designed to help strengthen and reshape the cornea, slow the progression of keratoconus, improve vision and help patients to tolerate contact lenses.

Intacs are two tiny pieces of clear polymer, which are inserted into the cornea to reshape the surface of the eye, counteracting the cone-shape developed in the cornea of keratoconus patients. Intacs are designed for long-term vision correction but can be removed and replaced at any time if the prescription changes.

The Procedure

The treatment is done on an outpatient basis, takes approximately 15 minutes and only requires eye drop anesthesia and a mild sedative. The doctor begins the surgery by using a laser to make a tunnel between the outer layers of the cornea. A customized thickness ring is then placed in the tunnel-like space, thereby flattening the cornea. The recovery time is minimal, with patients usually seeing improved vision over the next few weeks. Those with more severe keratoconus may require glasses or contacts after the surgery, but most patients achieve the noticeably clearer vision.

To find out if the Intacs is the right procedure for you, please contact the Nielsen Eye Center. Simply call 617-471-5665. We are proud to serve the Greater Boston communities of Quincy, Weymouth, and Norwell Massachusetts and beyond.

Frequently Asked Questions

Are you awake during cross linking?

You will take an oral medication to help relax your nerves and reduce anxiety about thirty minutes prior to the procedure. You will be awake but comfortable throughout the procedure with this and with the use of numbing medication for the eye.

Can keratoconus be cured permanently?

The goal with Keratoconus is to catch the condition at an earlier stage to prevent progression. Cross-Linking reduces the chance of further vision change related to Keratoconus significantly. tPatients are still monitored for progression after Cross-Linking, as very rarely a patient may still progress. There is no cure that exists which would take away the need for continued follow ups and monitoring.

Are you born with keratoconus?

Children with certain systemic conditions can be born with Keratoconus, though more often it is found and diagnosed in the teen years or twenties when patients have rapidly changing near sightedness and astigmatism.

Can you fly after corneal cross linking?

Generally, a patient will need to be seen within 1-3 days of their procedure to ensure proper healing and no infection. Though there is no physical reason that one cannot fly right after, the preference would be to plan travel after the first follow up visit.

Can you go blind if you have keratoconus?

In very advanced Keratoconus, patients may be blind. At those stages there are surgical options that can return vision such as a full thickness cornea transplant. This is why diagnosing Keratoconus early and receiving Cross-Linking is advantageous as it prevents patients from reaching that stage of the disease and requiring an invasive cornea transplant procedure.

Does cross linking improve vision?

Though some patients may feel their vision does improve, that is not the goal or intention of the procedure. The goal is to prevent progression and to “freeze” the vision where it is so that it does not further deteriorate.

How fast does keratoconus progress?

Every patient is different: some progress rapidly while some do not. This is why it is important to attend follow up appointments during which the physician is checking for several parameters of change.

How long does it take to recover from cross linking?

The first day or two after cross-linking we expect a patient to be light sensitive and their vision to be blurry. After a few days, generally the light sensitivity and irritation dissipates, but the blurriness can last until tfull healing takes place over 4-6 weeks (about 1 and a half months). This is why we wait about this long to do a patient’s second eye.

How successful is cross linking?

Cross-linking is very successful and patients very rarely need to have a second procedure done for progression.

Is corneal collagen cross linking painful?

With the numbing drops used for the procedure, it is very rare for a patient to feel pain. At most, for the first step of the procedure when the cornea is polished, a patient may feel a pressure-like sensation for about forty seconds.

What are the side effects of cross linking?

With any ophthalmic procedure and for Cross-Linking there is a risk of infection (very rare), permanent change in vision, or the need for additional procedures. All of these risks are rare. There are no expected long term side effects from the procedure as patients generally return to ttheir baseline vision once the eye has healed fully.

What causes keratoconus?

There are multiple associated conditions with Keratoconus, but no specific ones have been found to definitely cause Keratoconus.

When can I drive after corneal cross linking?

This depends on the state of the non-surgical eye and if the patient feels comfortable driving with one eye slightly more blurry than at baseline. No driving is recommended the day of the procedure.

Can I watch TV after cross linking?

Yes, though the day of the procedure it is recommended to rest the eyes as much as possible.

Does keratoconus get worse over time?

Not always. This depends on several patient characteristics such as age and severity of Keratoconus.

What is cross linking procedure?

It is a procedure that is done to halt progression of Keratoconus or ectasia after refractive surgery. If you are considering this procedure, it is important to verify the modality of treatment you are going to receive, who is doing the procedure, and where. At Nielsen Eye Center, we are proud to offer the only FDA approved version of Cross-Linking which will be performed by a tBoard Certified Ophthalmologist and team of trained personnel.

How do you prevent keratoconus?

Though there is no definitive way to prevent this condition, but it is best not to rub your eyes (specially with your fists) and to attend at least annual exams to be screened for Keratoconus.

Is keratoconus hereditary?

It can be but it is not always genetically linked.

Is Keratoconus is a disability?

It can be depending on the severity of the visual loss and impairment, but is not always.

Should I get corneal cross linking?

If you are concerned for Keratoconus or have a known history and qualify for Cross-Linking, then you absolutely should have it done. We recommend a consultation and then follow up visits as determined by one of our ophthalmologists who have experience in treating and diagnosing this condition.