Keratoconus - Symptoms, Causes, and Treatment Options

If you’ve been diagnosed with keratoconus, or suspect you might have it,  you’re probably dealing with vision that glasses and standard contacts can’t fully fix. You may be seeing halos around lights at night, ghosting, glare, or a general blur that no prescription seems to resolve. You are not imagining it, and you are not out of options.

Keratoconus is a progressive corneal condition, and managing it well requires a specialist — not a general eye care provider. At Keratoconus Specialists of Maryland in Baltimore, Dr. Benjamin Azman, OD, has dedicated his career almost exclusively to keratoconus. Many of his patients come after years of frustration with other providers, and leave with vision they didn’t think was possible.

“Dr. Azman is without a doubt the most knowledgeable doctor I have seen in the 37 years I have had Keratoconus, providing me with many more years of comfortable vision when others could not.” — Janet S., El Salvador

Keratoconus is a progressive eye condition in which the cornea, the clear, dome-shaped surface at the front of the eye, gradually thins and bulges outward into a cone shape. This irregular shape distorts the way light enters the eye, causing a range of visual problems that glasses and standard contact lenses cannot fully correct.

The condition typically begins in the teens or twenties and can affect one or both eyes. The rate of progression varies significantly; some patients experience rapid changes over months, while others remain relatively stable for years. Early diagnosis and regular monitoring are essential.

The most disruptive aspect of keratoconus is not simple blurring – it is the higher-order aberrations (HOAs) the irregular cornea creates. HOAs produce glare, halos around lights, ghosting, double vision, and a general visual quality that feels “off” even when the eye chart reading appears reasonable. These distortions are what bring most of our patients to us after standard treatments have failed.

Keratoconus symptoms often begin subtly and worsen over time. Common signs include:

• Blurred or distorted vision that cannot be fully corrected with glasses
• Glare, halos, and starbursts around lights — especially at night
• Ghosting or double vision in one eye
• Increased sensitivity to light
• Frequent changes in eyeglass or contact lens prescription
• Poor night vision
• Eye strain or headaches from visual effort

If you are experiencing these symptoms — especially if glasses or standard contacts are no longer providing adequate correction — a keratoconus evaluation is the right next step.

The exact cause of keratoconus is not fully understood, but research points to a combination of genetic, environmental, and biochemical factors. A weakness in the corneal collagen — the structural protein that gives the cornea its shape and strength — is believed to play a central role.

Known risk factors include:

• Family history — keratoconus has a genetic component and can run in families
• Chronic eye rubbing — repeated mechanical pressure weakens the corneal structure over time
• Atopic conditions — eczema, asthma, and allergies are associated with increased risk
• Down syndrome — keratoconus occurs at significantly higher rates in this population
• Connective tissue disorders — conditions such as Ehlers-Danlos syndrome
• Age — most commonly diagnosed between ages 10 and 30

Modern diagnostic technology has made it possible to detect keratoconus earlier and more precisely than ever before. At Keratoconus Specialists of Maryland, we use a full suite of advanced imaging tools to map the cornea and the entire optical system of the eye:

• Pentacam imaging — provides a detailed 3D map of the cornea’s shape, thickness, and curvature
• Corneal topography — maps the surface contour to identify irregularities
• Wavefront aberrometry — measures higher-order aberrations throughout the entire optical system
• Optical coherence tomography (OCT) — cross-sectional imaging of corneal layers
• Specular microscopy — examines the corneal endothelium for early signs of disease

Early diagnosis is critical. The sooner keratoconus is identified, the more options are available — including interventions to slow progression before significant corneal changes occur.

There is no single treatment for keratoconus — the right approach depends on the stage of the condition, the degree of visual distortion, and the patient’s individual goals. At Keratoconus Specialists of Maryland, every treatment plan is individualized based on detailed diagnostic data.

Treatment falls into two broad categories: vision correction (addressing how well you see) and disease management (addressing whether the condition is progressing).

For most keratoconus patients, specialty contact lenses are the most effective way to restore clear, functional vision. Unlike glasses or soft lenses, specialty lenses create a new, smooth optical surface over the irregular cornea — correcting not just basic focus, but the higher-order aberrations that cause glare, halos, and ghosting.

Scleral Lenses — Large-diameter lenses that vault over the cornea and rest on the sclera, creating a smooth optical surface. The fluid reservoir between lens and cornea also improves comfort and protects the corneal surface. Scleral lenses are the most commonly recommended lens type for moderate to advanced keratoconus.

Wavefront HOA-Correcting Scleral Lenses — Advanced scleral lenses designed using wavefront aberrometry data to correct the specific higher-order aberrations causing glare, halos, and ghosting. The right choice for patients who are still experiencing visual distortions with standard scleral lenses.

BostonSight PROSE Treatment — A highly individualized prosthetic lens fitted using OCT measurements down to the micron level. Used for complex cases where standard scleral lenses have not provided adequate vision or comfort.

EyePrintPro — An impression-based lens created from a physical mold of the eye’s surface. Designed for the most irregular or difficult-to-fit corneas, where even custom scleral lenses have not achieved a satisfactory result.

Corneal collagen cross-linking (CXL) is the primary treatment used to slow or halt the progression of keratoconus. It is a minimally invasive procedure performed by corneal surgeons in which riboflavin (vitamin B2) eye drops are applied to the cornea and then activated with ultraviolet A (UVA) light. This process strengthens the collagen bonds within the cornea, increasing its rigidity and stability.

CXL does not improve vision — it stabilizes the cornea to prevent further deterioration. Most patients who undergo CXL still require specialty contact lenses afterward to achieve their best visual correction.

At Keratoconus Specialists of Maryland, our on-site cornea specialist Dr. Richard Adler, MD, FACS — a fellowship graduate of the Johns Hopkins Wilmer Eye Institute — provides medical evaluation to assess corneal stability and determine whether CXL or other interventions may be appropriate. When surgical care is warranted, our team works with respected corneal surgeons to ensure a coordinated care plan.

Learn more: Corneal Cross-Linking for Keratoconus

Keratoconus is not a condition that responds well to general eye care. The diagnostic tools, lens design techniques, and clinical experience required to manage complex keratoconus cases are different from what a general optometry or ophthalmology practice uses day-to-day.

Keratoconus Specialists of Maryland is one of the few practices in the United States dedicated exclusively to keratoconus and complex corneal conditions. Founded by Dr. Irwin Azman in 1977, the practice has nearly five decades of focused experience. Dr. Benjamin Azman — the lead specialist — sees keratoconus patients almost exclusively, and is known among colleagues as a “doctor’s doctor”: optometrists and ophthalmologists throughout Maryland and the surrounding states refer their most complex keratoconus cases to him.

Patients travel from across Maryland, Virginia, Pennsylvania, Delaware, Washington DC, and from around the country and world to be seen at our Baltimore practice — many after being told nothing more could be done elsewhere.