Are Contact Lenses the Only Treatment for Keratoconus?
The short answer is no. Contact lenses are the most common way to see with keratoconus, and for a lot of people they work very well. What they don’t do is treat the disease, and for a growing number of the patients I see, they’ve stopped being the best way to see, too.
If you’ve been told lenses are all there is, or the lenses themselves are what you’re struggling with, this one’s for you.
What a contact lens actually does
Keratoconus bulges the cornea into an irregular cone, and glasses can’t correct an irregular surface. A rigid or scleral contact lens gets around that by sitting over the cone and creating a smooth optical surface of its own. Vision through a well-fitted lens can be very good.
The lens doesn’t change anything about the cornea underneath it, though. While the disease is active the cone keeps steepening under the lens, so the fit has to keep chasing it, and nothing has been done about the cornea itself.
There’s also a cost to living in lenses, and the research is fairly clear on it. Vision-related quality of life in keratoconus is substantially lower than in people with healthy eyes on nearly every measure. A systematic review found that people in rigid corneal lenses did worse than scleral lens wearers on overall quality of life, general vision and mental health. And scleral lenses aren’t the complete answer either. In one survey of keratoconus patients, two-thirds said they had discomfort with them. Add the fitting appointments, the cost of replacing lenses, dry eye, allergy season, sport, swimming and the daily handling, and I understand why so many people quietly give up.
The four jobs, and which treatment does each
It helps to separate out what each treatment is actually for.
| Job | What does it |
|---|---|
| Correct the vision | Glasses, rigid or scleral contact lenses |
| Stop the disease | Corneal cross-linking |
| Reshape the cornea | CAIRS, and topography-guided laser in selected thicker corneas |
| Replace the cornea | Corneal transplant, for advanced disease with scarring |
Contact lenses only do the first job. If your keratoconus is progressing you need the second one done regardless of how well your lenses are working. And if the lenses have become the thing that’s making life hard, the third job is the one to ask me about.
Cross-linking: stopping it
Cross-linking uses riboflavin and ultraviolet light to stiffen the cornea so the cone stops advancing. It’s the only treatment that’s been proven to halt keratoconus, and it should come first for anyone whose cornea is still changing. With the topography-guided, epi-on technique I use, 60% of patients in my published series also saw better afterwards, which surprises people. But it’s designed to stop the disease, and it won’t rebuild a cornea that has already bulged. That’s a different job, and it’s what CAIRS is for.
CAIRS: reshaping it
CAIRS stands for corneal allogenic intrastromal ring segments. We take arcs of donor corneal tissue and place them into channels cut in your cornea with a femtosecond laser, and they push the cone back toward a more regular shape. The steepness drops, and so does the irregular astigmatism that glasses can’t deal with, and if you do still need a lens afterwards it has a much easier surface to sit on.
The procedure was first performed in 2015, and Dr David Gunn and I brought it to Australia. Brisbane has since become one of the busiest CAIRS centres anywhere, and the Brisbane nomogram we developed for sizing and placing the segments is now used by surgeons around the world. A 2025 systematic review and meta-analysis of the published series found that CAIRS significantly improves both uncorrected and corrected vision and the corneal shape, with low complication rates. We also now have data showing stability ten years after the procedure, which is reassuring.
I think there are three reasons it’s the right tool for people struggling with lenses.
- It’s your own cornea, reinforced. Nothing is removed. Donor tissue is added to strengthen and reshape what you already have, so the sutures, the year of recovery and the rejection risk that come with a transplant don’t apply here.
- It’s human donor tissue. Synthetic ring segments have been implanted for decades, but plastic sitting in a thin cornea can erode, extrude or thin the tissue over it, which is why they fell out of favour. Human corneal tissue integrates. I’ve written up the comparison with Intacs and Kerarings separately.
- It can be done together with cross-linking. In the one session the cornea is reshaped and then locked in place. For someone with progressing disease and poor vision, that’s both jobs done with a single recovery.
CAIRS is performed as a keratoplasty procedure and has a Medicare item number. You’re asleep for it, and the recovery runs over a few weeks, compared with the months a transplant takes.
What CAIRS doesn’t do
I’d rather you hear this from me now than find it out afterwards. CAIRS reduces the steepness and the irregularity of the cornea. It doesn’t take away every dioptre of your prescription, and it won’t get you to seeing perfectly with nothing in front of the eye. Most of my patients still use some correction afterwards, but of a different kind: glasses, or a soft lens, where before they depended on a rigid lens they couldn’t tolerate. What I’m aiming for is a cornea that doesn’t need a rigid lens to see well, and if you still want a lens, a fit that’s stable and comfortable rather than one that keeps needing to be redone.
Who should stay in lenses
If your keratoconus has been cross-linked and is stable, and your lenses are comfortable and giving you good vision, there’s no reason for me to operate, and I’ll tell you so, because staying in lenses isn’t a failure. CAIRS is for people whose lenses have stopped doing the job. Usually that’s someone who can’t tolerate them, or can’t get a stable fit on a steep cone, or is losing days to discomfort, or is young and looking at decades of relying on something that could be improved.
Finding out where you stand
One assessment sorts this out. Corneal tomography shows me the shape and thickness of your cornea, whether it’s still changing, and whether your particular cone is one that CAIRS can reshape. From there the plan is usually straightforward. If the cornea’s still changing you need cross-linking. Whether we add CAIRS depends on how you’re seeing and how the lens situation is going, and where both are needed they can be done together. There’s a broader tour of the options in keratoconus treatment beyond glasses and contacts, and the CAIRS page covers the procedure in detail.
Frequently Asked Questions
Are contact lenses the only treatment for keratoconus?
No. Contact lenses are the most common way to see with keratoconus, but they are a correction, not a treatment. They do nothing to the cornea itself. Cross-linking stops the disease progressing, CAIRS reshapes the cornea to reduce the irregularity that makes rigid lenses necessary, and a transplant replaces the cornea in the small number of eyes that need it.
Do contact lenses stop keratoconus getting worse?
No. A rigid or scleral lens sits on the cornea and creates a smooth optical surface over the cone, but the cone keeps changing underneath it. The only treatment proven to halt progression is corneal cross-linking. Anyone with progressing keratoconus needs that regardless of how well their lenses work.
What if I can't tolerate contact lenses?
You are not out of options, and you are not unusual. Discomfort, dry eye, allergy, an unstable fit on a steep cone and the sheer daily effort are the reasons many people give up on lenses. CAIRS reshapes the cornea so that it is regular enough for glasses or a simpler lens to work, which is exactly the situation it was designed for.
Will I still need contact lenses after CAIRS?
Often you will still need some correction, but of a different kind. CAIRS reduces the steepness and irregularity of the cornea rather than removing every dioptre of prescription, so many patients move from a rigid lens they could not tolerate to glasses or a soft lens they can. The aim is a cornea that no longer depends on a rigid lens to see.
Is CAIRS better than a corneal transplant?
For most eyes that are not yet at the transplant stage, yes, because it keeps your own cornea. CAIRS adds donor tissue to the cornea without removing it, there are no sutures to manage for a year, the recovery is measured in weeks rather than months, and the rejection risk of a full transplant does not apply. Transplantation remains the right answer for advanced disease with scarring.
Is CAIRS covered by Medicare?
Yes. CAIRS is performed as a keratoplasty procedure with a Medicare item number, which synthetic ring segments do not have. A gap may apply depending on your health fund, and patients without private cover are welcome; a detailed fee estimate is provided before anything is booked.
