Can Laser Eye Surgery Work With Keratoconus?

Anyone that gets their eyes evaluated in a lasik consultation will receive a heap of testing on one tiny structure: the cornea. All this testing is to make the procedure as safe as possible; because through the process of correcting vision with laser eye surgery, the cornea becomes thinner. If the cornea becomes too thin, it can potentially weaken and lead to the development of keratoconus.

The quick answer is that laser eye surgery doesn’t work if you already have keratoconus. The laser eye surgery will weaken the cornea further and cause the keratoconus to become worse. But there is more to the story.

What if we strengthen the cornea with cornea cross-linking? Will then laser eye surgery work to correct vision? Well yes and no. Patients with keratoconus frequently have high prescriptions and irregular corneas. High prescriptions require a greater cornea thickness to be safe. Treating irregular corneas through topography-guided lasik also requires a good amount of cornea thickness. Keratoconus patients often have thinner corneas because their cone has stretched it thin. After cornea cross-linking, there is less concern that the eye will continue to get weaker with time; but not zero. Thus even after cross-linking, it may still be problematic to do a workable correction through a laser eye surgery such as PRK.

Treating keratoconus patients with laser eye surgery is still in exploration phase. Some clinicians have try treatments focused entirely on treating the higher-order aberrations through topography-guided lasik to allow for better vision with glasses or contact lenses. But until that becomes the norm, some form of hard contact lens remains the best way to correct vision with keratoconus.

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