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 many people they’re an excellent one. But they aren’t a treatment for the disease, and for a growing number of my patients they’re no longer the best way to see, either.
If you’ve been told that lenses are your only option, or lenses are the thing you’re struggling with, this post is for you.
What contact lenses do, and what they don’t
Keratoconus bulges the cornea into an irregular cone, and glasses can’t correct an irregular surface. A rigid or scleral contact lens fixes 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.
What the lens doesn’t do is change anything about the cornea underneath. The cone keeps steepening as long as the disease is active, the lens fit chases it, and the underlying problem is untouched.
The cost of living in lenses is also real, and the research is clear about it. Vision-related quality of life in keratoconus is substantially lower than in people with healthy eyes across nearly every measure, and a systematic review found that people wearing rigid corneal lenses fared worse than scleral lens wearers on overall quality of life, general vision and mental health. Even scleral lenses aren’t a complete answer: in one survey of keratoconus patients, two-thirds reported discomfort with them. Add the fitting appointments, the cost of replacing lenses, dry eye, allergy season, sport, swimming and the daily handling, and it’s easy to see why so many people quietly give up.
The four jobs, and which treatment does each
It helps to separate 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 regardless of how well your lenses work. And if lenses have become the problem rather than the solution, the third job is the one to ask 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 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. But cross-linking is designed to stop the disease, not to rebuild a cornea that has already bulged. That’s the next step.
CAIRS: reshaping it
CAIRS stands for corneal allogenic intrastromal ring segments. Arcs of donor corneal tissue are placed into channels cut in your cornea with a femtosecond laser, where they push the cone back toward a regular shape. The steepness drops, the irregular astigmatism that glasses can’t handle is reduced, and the surface a lens has to sit on becomes a far easier one.
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, and we now have data showing stability ten years after the procedure.
Three things make it the right tool for people who are struggling with lenses:
- It’s your own cornea, improved. Nothing is removed. Donor tissue is added to reinforce and reshape what you have, so the sutures, the year of recovery and the rejection risk of a transplant don’t apply.
- It’s donor tissue, not plastic. Synthetic ring segments have been implanted for decades, but plastic 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 set out the comparison with Intacs and Kerarings separately.
- It can be combined with cross-linking. In one session, the cornea is reshaped and then locked in place, so patients with progressing disease and poor vision get both jobs done with one recovery.
CAIRS is performed as a keratoplasty procedure with a Medicare item number, you’re asleep for it, and the recovery runs over a few weeks rather than the months a transplant takes.
What CAIRS doesn’t do
I’d rather you hear this from me than discover it afterwards. CAIRS reduces the steepness and irregularity of the cornea. It doesn’t remove every dioptre of prescription, and it isn’t a route to seeing perfectly with nothing. Most 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. The goal is a cornea that no longer needs a rigid lens to see well, and a lens fit, if one is still wanted, that’s stable and comfortable instead of a moving target.
Who should stay in lenses
If your keratoconus has been cross-linked and is stable, and your lenses are comfortable and give you good vision, there’s no reason to operate. Lenses aren’t a failure. CAIRS is for the people for whom lenses have stopped working: the ones who can’t tolerate them, can’t get a stable fit on a steep cone, are losing days to discomfort, or are young and facing decades of dependence on something that could be improved.
Finding out where you stand
One assessment answers it. Corneal tomography shows me the shape and thickness of your cornea, whether it’s still changing, and whether the cone is one that CAIRS can reshape. From there the plan is usually simple: cross-linking if it’s progressing, CAIRS if the vision or the lens situation warrants it, and both together where that’s the right call. 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.
