Keratoconus is a progressive eye condition in which the cornea — the clear front surface of the eye — gradually thins and bulges outward into an irregular cone shape. This distorts the way light enters the eye, causing blurry, distorted vision that standard glasses often cannot fully correct. Keratoconus most commonly begins in the teenage years or early adulthood and may progress through the 20s and 30s before stabilizing. It affects both eyes in most patients, though usually unevenly.

What are the early signs of keratoconus?

Early signs of keratoconus include increasingly blurry or distorted vision, a prescription that keeps changing (especially with growing astigmatism), difficulty seeing clearly at night, halos or streaking around lights, and contact lenses that no longer fit properly or provide adequate vision. Because these symptoms are common to other refractive conditions, keratoconus is often missed without specific corneal topography imaging. If your prescription has changed more than once in a year, ask your eye doctor about corneal mapping.

Is keratoconus hereditary?

Yes — keratoconus has a genetic component and runs in families. If a parent or sibling has keratoconus, your risk is elevated compared to the general population. However, most people with keratoconus have no family history of the condition. Other associated factors include chronic eye rubbing, allergies, and certain connective tissue disorders. People with a family history of keratoconus should have corneal topography performed as part of their routine eye exams.

Can keratoconus be cured?

There is currently no cure for keratoconus — meaning no treatment reverses the corneal shape changes that have already occurred. However, corneal cross-linking (CXL) is an FDA-approved procedure that effectively halts progression in the majority of patients, preventing further worsening. For vision correction, specialty contact lenses such as scleral lenses provide excellent functional acuity for most patients. In advanced cases with scarring or contact lens intolerance, corneal transplant surgery can restore vision. With appropriate management, most keratoconus patients achieve good functional vision throughout their lives.

What is the difference between keratoconus and astigmatism?

Regular astigmatism is a common refractive error caused by a cornea that is slightly football-shaped rather than round — it is symmetrical and stable, and corrects well with glasses or standard contact lenses. Keratoconus is a progressive disease in which the cornea thins and distorts into an irregular cone shape — it is asymmetrical, worsens over time, and typically cannot be adequately corrected with standard glasses or soft lenses. Irregular astigmatism that is progressive, asymmetric, or not correcting well with glasses is a significant warning sign for keratoconus.

Does corneal cross-linking hurt?

Corneal cross-linking is performed under topical anesthesia (numbing eye drops), so the procedure itself is not painful. After the procedure, patients typically experience discomfort, light sensitivity, and tearing for several days as the corneal surface heals. Most patients describe this recovery period as similar to having a minor corneal abrasion. Vision may be blurry for several weeks after CXL as the cornea heals and stabilizes. Pain medication is prescribed for the first few days post-procedure.

Can I drive with keratoconus?

Many patients with keratoconus can continue to drive, particularly when their vision is well-corrected with specialty contact lenses. However, night driving is often the most challenging, as halos and glare around headlights are common symptoms — especially in moderate to advanced keratoconus. Whether driving is safe depends on the individual's visual acuity with best correction. Your eye doctor can advise you specifically based on your current visual function and prescription.

Where can I find a keratoconus specialist in Northern New Jersey?

Affiliated Eye Surgeons has corneal specialists at three locations in Northern New Jersey: Morristown, West Orange, and Denville. Our Denville office, which was formerly Hade Eye Care, has a long-established reputation for keratoconus management and scleral lens fitting in Morris County. Dr. Sanjai Jalaj, MD is a fellowship-trained corneal and refractive surgeon who performs corneal cross-linking, specialty lens fittings, and corneal transplant surgery including DMEK, DALK, and PKP. To schedule a keratoconus evaluation, call our Denville office at (973) 586-2188 or Morristown at (973) 984-5005.

What Is Keratoconus? A Complete Patient Guide

What is keratoconus?
Keratoconus is a progressive eye condition in which the cornea — the clear front surface of the eye — gradually thins and bulges outward into an irregular cone shape. This distorts the way light enters the eye, causing blurry, distorted vision that standard glasses often cannot fully correct. Keratoconus most commonly begins in the teenage years or early adulthood and may progress through the 20s and 30s before stabilizing. It affects both eyes in most patients, though usually unevenly.
What are the early signs of keratoconus?
Early signs of keratoconus include increasingly blurry or distorted vision, a prescription that keeps changing (especially with growing astigmatism), difficulty seeing clearly at night, halos or streaking around lights, and contact lenses that no longer fit properly or provide adequate vision. Because these symptoms are common to other refractive conditions, keratoconus is often missed without specific corneal topography imaging. If your prescription has changed more than once in a year, ask your eye doctor about corneal mapping.
Is keratoconus hereditary?
Yes — keratoconus has a genetic component and runs in families. If a parent or sibling has keratoconus, your risk is elevated compared to the general population. However, most people with keratoconus have no family history of the condition. Other associated factors include chronic eye rubbing, allergies, and certain connective tissue disorders. People with a family history of keratoconus should have corneal topography performed as part of their routine eye exams.
Can keratoconus be cured?
There is currently no cure for keratoconus — meaning no treatment reverses the corneal shape changes that have already occurred. However, corneal cross-linking (CXL) is an FDA-approved procedure that effectively halts progression in the majority of patients, preventing further worsening. For vision correction, specialty contact lenses such as scleral lenses provide excellent functional acuity for most patients. In advanced cases with scarring or contact lens intolerance, corneal transplant surgery can restore vision. With appropriate management, most keratoconus patients achieve good functional vision throughout their lives.
What is the difference between keratoconus and astigmatism?
Regular astigmatism is a common refractive error caused by a cornea that is slightly football-shaped rather than round — it is symmetrical and stable, and corrects well with glasses or standard contact lenses. Keratoconus is a progressive disease in which the cornea thins and distorts into an irregular cone shape — it is asymmetrical, worsens over time, and typically cannot be adequately corrected with standard glasses or soft lenses. Irregular astigmatism that is progressive, asymmetric, or not correcting well with glasses is a significant warning sign for keratoconus.
Does corneal cross-linking hurt?
Corneal cross-linking is performed under topical anesthesia (numbing eye drops), so the procedure itself is not painful. After the procedure, patients typically experience discomfort, light sensitivity, and tearing for several days as the corneal surface heals. Most patients describe this recovery period as similar to having a minor corneal abrasion. Vision may be blurry for several weeks after CXL as the cornea heals and stabilizes. Pain medication is prescribed for the first few days post-procedure.
Can I drive with keratoconus?
Many patients with keratoconus can continue to drive, particularly when their vision is well-corrected with specialty contact lenses. However, night driving is often the most challenging, as halos and glare around headlights are common symptoms — especially in moderate to advanced keratoconus. Whether driving is safe depends on the individual's visual acuity with best correction. Your eye doctor can advise you specifically based on your current visual function and prescription.
Where can I find a keratoconus specialist in Northern New Jersey?
Affiliated Eye Surgeons has corneal specialists at three locations in Northern New Jersey: Morristown, West Orange, and Denville. Our Denville office, which was formerly Hade Eye Care, has a long-established reputation for keratoconus management and scleral lens fitting in Morris County. Dr. Sanjai Jalaj, MD is a fellowship-trained corneal and refractive surgeon who performs corneal cross-linking, specialty lens fittings, and corneal transplant surgery including DMEK, DALK, and PKP. To schedule a keratoconus evaluation, call our Denville office at (973) 586-2188 or Morristown at (973) 984-5005.

If you've been told your glasses prescription keeps changing, or you've noticed that your vision seems blurry or distorted even with your lenses in, keratoconus may be the reason — and many people go years without an accurate diagnosis.

Keratoconus is one of the most common corneal conditions we see at Affiliated Eye Surgeons. It's also one of the most misunderstood. Patients often describe years of being given stronger and stronger glasses prescriptions, never quite achieving clear vision, before a corneal specialist finally identified the underlying problem.

The good news: keratoconus is very manageable when caught early. This guide walks through everything you need to know — what keratoconus is, how it progresses, what treatment looks like at each stage, and what to do if you think you or someone in your family may have it.

Concerned about keratoconus? Our corneal specialists serve patients throughout Northern New Jersey from three locations — Morristown, West Orange, and Denville. Call (973) 984-5005 or request an evaluation online.

What Is Keratoconus?

Keratoconus (often abbreviated KC) is a progressive eye condition in which the cornea — the clear, dome-shaped front surface of the eye — gradually thins and loses its round shape, bulging outward into an irregular cone.

Under normal circumstances, the cornea has a smooth, symmetrical curve that bends (refracts) light precisely onto the retina, producing clear vision. In keratoconus, the structural integrity of the corneal tissue breaks down over time, causing it to distort. As the shape becomes increasingly irregular, light scatters as it enters the eye rather than focusing cleanly — resulting in blurry, distorted, and frequently shifting vision that glasses often cannot fully correct.

Keratoconus typically affects both eyes, though one eye is often more advanced than the other. It most commonly begins in adolescence or early adulthood — often in the teens or early twenties — and tends to progress through the 20s and 30s before stabilizing, usually around age 40.

What Causes Keratoconus?

The exact cause of keratoconus isn't fully understood, but research has identified several contributing factors:

Genetic Factors

Keratoconus runs in families. If a parent or sibling has keratoconus, your risk is meaningfully higher than the general population. Certain genetic syndromes — including Down syndrome and connective tissue disorders like Ehlers-Danlos syndrome and Marfan syndrome — are also associated with higher keratoconus rates.

Eye Rubbing

Chronic, vigorous eye rubbing is one of the strongest modifiable risk factors for both developing and accelerating keratoconus. Rubbing exerts mechanical stress on the corneal tissue and triggers the release of inflammatory enzymes that degrade the collagen fibers holding the cornea in shape. Patients with allergies — who often rub their eyes frequently — are at particular risk. If you have keratoconus, stopping eye rubbing is one of the most important things you can do.

Atopy and Allergies

Hay fever, eczema, and asthma are all associated with higher rates of keratoconus, likely in part because of the associated eye rubbing, but also potentially due to shared inflammatory mechanisms.

UV Exposure

Some research suggests that chronic ultraviolet light exposure may contribute to corneal thinning. Wearing UV-blocking sunglasses is generally recommended for patients with keratoconus.

Recognizing the Symptoms

Keratoconus symptoms are often subtle at first and easy to attribute to ordinary nearsightedness or astigmatism. As the condition progresses, they become harder to ignore. Typical signs include:

Blurry or distorted vision that fluctuates — even with up-to-date glasses or contact lenses
Frequent changes in glasses prescription, often with increasing astigmatism
Ghosting or double vision in one eye (monocular diplopia)
Increased sensitivity to light, especially at night
Halos, streaking, or starbursting around lights — particularly noticeable when driving at night
Difficulty reading or focusing on fine detail
One eye noticeably worse than the other
Contact lenses that no longer sit or feel right, or no longer provide adequate vision

A particularly telling pattern: patients who notice that their vision is better looking through a pinhole (a small opening), or who find that hard contact lenses improve their vision dramatically while soft lenses do not, should be evaluated for keratoconus.

How Keratoconus Is Diagnosed

A standard eye exam — even a thorough one — may not catch keratoconus, particularly in its early stages. Accurate diagnosis requires corneal topography or tomography: imaging technology that maps the shape, curvature, and thickness of the entire corneal surface in fine detail.

At Affiliated Eye Surgeons, we use advanced Scheimpflug imaging (corneal tomography) that captures both the front and back surfaces of the cornea, along with pachymetry measurements of corneal thickness across multiple points. This level of detail allows us to detect keratoconus at its earliest stages — often before patients notice significant visual symptoms — and to monitor progression accurately over time.

If you have a family history of keratoconus, or if you've been told you have irregular astigmatism or a prescription that keeps changing, ask specifically about corneal topography during your next eye exam.

Stages of Keratoconus

Keratoconus is typically classified into four stages based on corneal curvature and thickness measurements:

Stage 1 — Mild

Early corneal steepening and thinning, often with only subtle visual symptoms. Glasses or soft contact lenses may still provide reasonable correction. This is the ideal stage for corneal cross-linking if progression is confirmed.

Stage 2 — Moderate

More pronounced corneal irregularity. Standard soft contact lenses typically no longer provide adequate vision. Specialty contact lenses — scleral or RGP designs — become necessary to vault over the irregular corneal surface and provide a smooth optical front surface.

Stage 3 — Advanced

Significant corneal thinning and steep, irregular curvature. Vision correction requires specialty lenses. Corneal cross-linking is still possible at this stage in many cases, though the benefit of halting progression is weighed against the already significant structural change.

Stage 4 — Severe

Extreme thinning, very high corneal curvature, and in some cases corneal scarring from chronic stress on the tissue (called hydrops). Contact lens tolerance may be lost, and corneal transplant surgery is often the appropriate next step.

Treatment Options

The right treatment depends on the stage of keratoconus and whether it is still progressing. Here is a clear overview of what each option does — and when it applies.

Specialty Contact Lenses

For most patients with keratoconus, specialty contact lenses are the primary tool for achieving functional vision. Unlike soft lenses, which conform to the cornea's irregular shape, specialty lenses vault over or fit precisely to the irregular surface — providing a smooth, regular optical front surface for light to pass through.

Scleral lenses — large-diameter lenses that rest on the white of the eye (sclera) and completely vault the cornea, with a reservoir of saline solution between lens and cornea. Highly effective for moderate to advanced keratoconus. Excellent comfort. Our most commonly fitted specialty lens.
RGP (rigid gas-permeable) lenses — smaller hard lenses that sit directly on the cornea. Very effective optically; some patients find them less comfortable than sclerals but they remain an excellent option for many.
Hybrid lenses — a rigid center with a soft outer skirt. Combines the optics of a hard lens with improved comfort.
Piggyback systems — an RGP lens worn over a soft lens for improved comfort in sensitive corneas.

Corneal Cross-Linking (CXL)

Corneal cross-linking is the only FDA-approved treatment that stops keratoconus from getting worse. It does not reverse existing damage or reshape the cornea — it halts progression by strengthening the collagen bonds within the corneal tissue using riboflavin (vitamin B2) eye drops and controlled ultraviolet-A light.

CXL is most effective when performed early — before significant corneal thinning or distortion has occurred. This is why regular monitoring and early diagnosis matter so much. Most patients require no additional surgery after successful cross-linking and continue to manage their vision with specialty lenses.

Our corneal specialists perform CXL at all three Affiliated Eye Surgeons locations. Learn more on our Corneal Cross-Linking page.

Corneal Transplant Surgery

Reserved for advanced or end-stage keratoconus — typically when contact lens tolerance is lost, corneal scarring is present, or the cornea is too thin to safely cross-link. The most common procedure for keratoconus today is DALK (deep anterior lamellar keratoplasty), which replaces the front layers of the cornea while preserving the patient's own endothelium — resulting in faster recovery and lower rejection risk than traditional full-thickness transplant (PKP).

Dr. Jalaj performs DMEK, DALK, and PKP corneal transplants. Even after transplant, specialty contact lenses are often needed for optimal visual acuity.

Living with Keratoconus in Northern New Jersey

A keratoconus diagnosis can feel alarming, but the vast majority of patients live full, active lives with excellent functional vision — particularly when the condition is identified early and managed proactively.

At Affiliated Eye Surgeons, we've been managing keratoconus patients across Morris and Essex counties for many years. Our Denville office, which was formerly Hade Eye Care, has a particularly deep history in corneal specialty care and scleral lens fitting — and that expertise is now fully integrated into the Affiliated Eye Surgeons team across all three locations.

If you have a family history of keratoconus, have been told you have irregular astigmatism, or are finding that glasses or standard contact lenses no longer give you the vision you need, we encourage you to call us for a corneal evaluation.

Morristown: (973) 984-5005 — 95 Madison Avenue, Suite 400
West Orange: (973) 736-3322 — 405 Northfield Avenue, Suite 206
Denville: (973) 586-2188 — 1 Indian Road, Suite

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