Category Archives for Keratoconus

What is Keratoconus?

Have you wondered What is Keratoconus?

The textbook definition of keratoconus is a bilateral progressive asymmetric non-infective non-inflammatory degeneration of the cornea. What that means is that keratoconus is a disease that over time affects both eyes (one more intensively than the other), that is not caused by an infection or inflammation of the eye, and leads to the decay of the cornea. But why care what happens to the cornea?

Reasons you need to be aware What is Keratoconus?

There are three main reasons why you should care. The first is that the cornea acts as the first layer of protection, like a castle wall, for your eye preventing physical (sand, dust, dirt), microbiological (bacteria, viruses), chemical (pool water, seawater), and radiation (UV light) hazards from reaching deeper parts of the eye.

The second reason is that it needs to withstand the natural pressures of the eye. The pressure is created by fluids that are constantly moving in deeper parts of the eye. Think about it like filling a balloon with jelly; as the jelly moves and shakes it causes the balloon to expand in order to prevent the jelly from stretching it too thin, and since the cornea’s first job is to defend if it gets stretched the strength of the barrier weakens as well.

The third reason is the cornea helps in letting you see the world around you. As the light enters your eye the cornea actually bends all the scattering light rays into a single dense ray that it directs through the pupil, effectively focusing the image you see about 75%. Now for example if the cornea is stretched or blocked by dirt that immediately reduces the ability of you being able to see a clear image.

Since keratoconus weakens the cornea over time it affects the ability of the eye to perform its job properly which is to let you see the world around you, and as the cornea weakens in its ability to do its three main jobs it leads to a rapid loss of vision: even to the point where glasses and contacts would not be able to help in correcting the vision.

So what does keratoconus actually do to the cornea? Essentially it breaks the bonds that hold the cornea together. Think about what termites do with wooden walls. They weaken the wall from the inside and create hollow spaces that reduces the structural integrity, the same basically happens with the cornea, and once it starts its rate of deterioration is uncertain. So while the cornea still appears to be intact from the outside the inside is straining to hold itself together: how does this affect the cornea in doing its job?

The stretching greatly reduces the cornea’s ability to defend the eye from external factors (that were previously mentioned). This leads to the eye becoming more prone to infections because the wall has lost its ability to resist the oncoming enemies since it is more like wood than stone. This also leads to the eye becoming more susceptible to scarring, from objects like contacts for example, because the corneas’ ability to heal when objects scratch/touch it is greatly decreased.

The main problem a cornea with keratoconus is the stretching it primarily undergoes because it does not have the strength to hold the pressure of the eye at its required level. This causes the cornea to bulge or expand forward, like our example about a balloon full of jelly, and then gravity pulls it down further which leads to the cornea becoming cone shaped because the pressure is trying to leave through the apex of the cornea.

After all of this the ability for the cornea to do its third job of focusing the light is greatly reduced because like a telescope everything has to line up properly for it send messages accurately to the brain.


Best Keratoconus Treatment

Best Keratoconus Treatment for your eyes has to be designed by a Keratoconus Surgeon, expert in surgical treatment of keratoconus eye disorders. Each eye is unique so the treatment plan is customized to your eyes and needs.

Information needed for Designing the Best Keratoconus Treatment

  1. Age
  2. Family History
  3. History of rubbing
  4. Progressive Keratoconus or Post lasik ectasia
  5. Duration of the disease
  6. Student or Employed
  7. Type of work
  8. Sports indulged in
  9. Lifestyle activities
  10. Medical Insurance coverage
  11. Finances available

Tests required for planning the Best Keratoconus Treatment

  1. Corneal pachymetry map
  2. Topography of the cornea
  3. Refraction of the eye

Treatment components for Best Keratoconus Treatment in Beverly Hills

  1. CXL or C3R
  2. Intacs
  3. Visian ICL
  4. PIE
  5. Toric Implants
  6. Combinations

We are always adding new keratoconus treatments to the options presented to you.

Best Keratoconus Treatment in Beverly Hills

Once Dr. Khanna the Los Angeles Keratoconus expert has all the ingredients he puts them in his magic cauldron. Out pops a personalized treatment plan suited for your needs. Lets go over some situations so you can understand the rationale involved in devising the treatment protocol.

A 18 year old high school junior is having trouble in school as her glasses prescription is changing frequently. She is apprehensive about getting and surviving in college. as he is also anxious about the upcoming program. Here we have to tackle two problems right away. Instant improvement of vision is required and than stabilization. In this scenario the best option would be to work on one eye at a time. Simultaneous Intacs and Cornea cross linking with riboflavin would meet her needs.

On the other extreme we may have a retired gentleman seeking bothered by declining vision. For keratoconus treatment in people above 50 years the plan would be different. Cross linking may take a back seat. PIE may be a first choice here.

So the permutations and combinations are so many that it is best to seek an expert doc in the field of this degenerative disease.


Treatments for keratoconus

Treatments for keratoconus eye disorder have increased the benefits to patients. There are medical and surgical interventions available. Lets discuss new treatments for keratoconus.


  1. Glasses
  2. Soft contact lenses
  3. Toric contact lens
  4. Rigid gas permeable contacts
  5. Specialty contact lenses for keratoconus eyes – Rose K/Hybrid
  6. Scleral Contact Lens


  1. Cornea cross linking with riboflavin
  2. Intacs corneal ring segment
  3. Visian implantable collamer lens
  4. Toric implants
  5. Presbyopic Implants
  6. Laser vision correction for astigmatism
  7. Combinations
  8. DALK
  9. Laser corneal transplant

These new treatments for keratoconus have revolutionized the practice of keratoconus management. Twenty years ago keratoconus or bulging eyes sufferers had no option but to wear rigid contacts lens till they developed complications like hydros or scarring. At that time they waited for a corneal transplant.

In 2018 the paradigm has shifted. We want to avoid doing corneal transplant. We want to halt the progression of keratoconus eye disease. At the

Los Angeles Keratoconus surgeon can help guide you to the option best suited for your eyes. A pain free detailed corneal mapping and shape analysis done on state of the art machines helps make the determination.

New Treatment for Keratoconus eye disorder

Of note is this: of all the treatments listed the only one which can halt the progression of keratoconus eye disease is COLLAGEN CORNEAL CROSS LINKING.

The early a kid gets cxl intervention the better the chances to preserve best vision. But wait you have to be careful to get the correct type of cxl. The gold standard is epi off Dresden protocol  with 30 minutes riboflavin soak and ½ hour UVA irradiation. Don’t make compromises with your vision. Or your kids vision.

corneal collagen cross linking procedure combined with PTK and PRK

Corneal collagen cross linking procedure combined with PTK and PRK – Cretan protocol plus can improve refractive error (astigmatism). This is based on our experience and a study paper published in the Journal of Cataract and Refractive surgery from Crete, Greece By Dr. Grentzelos.

Corneal collagen cross linking as you may know was invented by Dr. Wollensack. It can halt the progression of Keratoconus. In US FDA has approved Avedro KXL/Photrexa system to prevent progression in post lasik ectasia and progressive keratoconus. The major drwaback has been that patients are still left with refractory error especially astigmatism. Hence vision is not optimal in these teens and young adults. Keratoconus surgeons had been hesitant to apply laser energy to the keratoconus cornea, for fear that tissue removal may further weaken the cornea.

This will also allow us do corneal collagen cross linking procedure combined with PTK and PRK – Cretan protocol plus can improve refractive error (astigmatism ) on patients of forme fruste keratoconus. Such people have been turned down for classification of cross linking/cxl)


Corneal collagen cross linking procedure combined with PTK and PRK can only be done for minor corrections where total corneal tissue ablated is less than 50 microns. And at least 350 microns should be left. Again, judicial judgment by an experienced laser and keratoconus surgeon is very important. We usually have restricted to treat astigmatism in the central 6 mm zone, especially when tissue ablated is away from the thinnest zone.


Vision can be improved. Combination allows rapid improvement of vision, avoiding contact lenses. There is no additional pain. If the two procedures are done separately there is discomfort and healing time for each. Another advantage of using the PTK mode for removal of epithelium is that it flattens the cone decreasing higher order aberrations.


As with any advance we have to be careful of potential side effects. PTK can weaken the thinnest bulging part of the cornea. This may destabilize the cornea.

Please consult with your keratoconus expert if this is a good choice for you.



Classification corneal cross linking procedure

Keratoconus Treatment Beverly Hills

Are you looking for Keratoconus Treatment Beverly Hills ?

We have learn in previous pages of this website on the keratoconus subject that c3R is helpful to halt Keratoconus. Cornea keratoconus treatment  with c3 R or cornea collagen crosslinking with Riboflavin can impede the progression of this vision devastating disease. Hence it can help one lead a more productive life.

On TV and online one may see numerous ads for various forms of cross linking. Remember to seek the best and FDA approved

Keratoconus Treatment Beverly Hills

In Beverly hills keratoconus treatment is performed at our center with FDA approved technology of Avedro. There are other machines which are not FDA approved like Peschke, Lightmed, and more. These can put your eyes at risk. Please ask your Beverly Hills keratoocnus treatment provider the machine they are employing. Make sure the UVA machine and the Riboflavin is FDA approved.

As of October 2017 Only KXL/Photrexa combination is FDA approved. Would you be a guniea pig in an experimental setting or would you rather have trusted and approved cxl treatment by a Avedro certified Keratoconus professional?

The choice is yours. You have one pair of eyes. Trust one name – Dr.Khanna

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