AFFILIATED EYE SURGEONS | CORNEAL CARE
Keratoconus Diagnosis & Treatment in Northern New Jersey
Specialized care for
keratoconus — from advanced diagnostics and custom scleral lens fittings to
corneal cross-linking — at
three convenient locations in Morris and Essex counties.
Specialized Keratoconus Care, Close to Home
Keratoconus is a complex, progressive corneal condition that requires specialized expertise — not just a general eye exam. At Affiliated Eye Surgeons, our corneal specialist Dr. Sanjai Jalaj has devoted his career to the diagnosis and management of keratoconus, bringing advanced diagnostic technology, custom specialty lens fitting, and corneal cross-linking to patients throughout Morris and Essex counties.
Whether you've just received a keratoconus diagnosis, are struggling to find
contact lenses that work, or are concerned about progression,
our team will give you a thorough evaluation and develop a personalized treatment plan built around your corneal shape, prescription, and lifestyle.
What Is Keratoconus?
Keratoconus (often abbreviated as KC) is a progressive eye condition in which the normally round, dome-shaped cornea — the clear front surface of the eye — gradually thins and begins to bulge outward into an irregular, cone-like shape. Because the cornea is responsible for focusing light onto the retina, this distortion causes light to scatter as it enters the eye, producing blurred, distorted, and often rapidly changing vision.
Keratoconus typically affects both eyes, though usually one eye is more severely affected than the other. It most commonly appears in the late teens and early 20s and may progress over the following one to two decades before stabilizing. It affects approximately 1 in 2,000 people in the general population, though it is more common in certain groups.
Common signs and symptoms of keratoconus include:
- Blurry or distorted vision that glasses cannot fully correct
- Frequent prescription changes in glasses or contact lenses
- Increased sensitivity to light and glare
- Seeing halos, ghosting, or streaking around lights — especially at night
- Difficulty driving after dark
- One eye noticeably worse than the other
- Contact lenses that feel uncomfortable or no longer stay in place
- A history of chronic eye rubbing
What Causes Keratoconus?
The exact cause of
keratoconus is not fully understood, but research points to a combination of genetic predisposition and environmental factors that weaken the structural integrity of the cornea.
Key risk factors include:
- Family history — having a parent or sibling with keratoconus significantly increases your risk. Approximately 10% of keratoconus patients have a first-degree relative with the condition.
- Chronic eye rubbing — this is the most important modifiable risk factor. Vigorous or frequent eye rubbing is strongly associated with keratoconus onset and progression. Patients diagnosed with keratoconus should stop rubbing their eyes entirely.
- Atopic conditions — allergies, eczema, and asthma are associated with higher keratoconus prevalence, likely because they cause eye itching and subsequent rubbing.
- Connective tissue disorders — conditions such as Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome carry elevated keratoconus risk.
- Poorly fitted contact lenses — prolonged wear of poorly fitted rigid lenses may contribute to corneal warping in susceptible individuals.
How Is Keratoconus Diagnosed?
Keratoconus is diagnosed through a comprehensive corneal evaluation — not a standard eye exam. At
Affiliated Eye Surgeons, we use advanced diagnostic technology to map the cornea in detail and identify even subtle early changes before significant vision impairment develops.
Diagnostic tools we use:
- Corneal topography — creates a detailed color-coded map of the cornea's front surface curvature. This is the primary screening tool for keratoconus and detects irregular patterns characteristic of the condition.
- Corneal tomography (Scheimpflug imaging) — provides a full three-dimensional map of both the front and back surfaces of the cornea, including precise thickness measurements at every point. This is essential for staging keratoconus severity and planning treatment.
- Pachymetry — measures corneal thickness, which is critical both for diagnosing keratoconus and for determining candidacy for corneal cross-linking.
- Wavefront analysis — identifies higher-order optical aberrations caused by the irregular corneal surface.
Keratoconus Treatment Options
There is no one-size-fits-all treatment for keratoconus. The right approach depends on the severity of the condition, the rate of progression, your age, and your vision goals. At Affiliated Eye Surgeons, we offer the full spectrum of keratoconus treatments — from
non-surgical vision correction to
surgical intervention for advanced cases.
Stage 1: Early Keratoconus — Glasses & Soft Contact Lenses
Stage 2: Specialty Contact Lenses — The Foundation of Keratoconus Vision Care
Stage 3: Corneal Cross-Linking (CXL) — Stopping Progression
Stage 4: Surgical Options for Advanced Keratoconus
In the earliest stages of keratoconus, when corneal distortion is mild, updated glasses or standard soft contact lenses may provide adequate vision correction. However, as the condition progresses and the corneal surface becomes more irregular, standard lenses quickly become insufficient.
Specialty contact lenses are the cornerstone of vision correction for most keratoconus patients. Unlike glasses or soft lenses, rigid specialty lenses create a smooth, regular optical surface in front of the irregular cornea, dramatically improving visual clarity. Fitting specialty lenses for keratoconus requires significant expertise — it is not a routine contact lens fitting.
Specialty lens options we offer:
- Scleral lenses — large-diameter rigid gas-permeable lenses that vault completely over the irregular corneal surface and rest on the sclera (white of the eye). Because they don't touch the cornea at all, scleral lenses are highly comfortable and provide excellent optical quality. They are the preferred option for most keratoconus patients. Our team has extensive experience in scleral lens fitting for keratoconus, including complex and advanced cases.
- Rigid gas-permeable (RGP) corneal lenses — smaller rigid lenses that sit directly on the cornea. They provide excellent optics but may be less comfortable than sclerals for some patients, particularly those with more advanced corneal irregularity.
- Hybrid lenses — combine a rigid gas-permeable center (for optical clarity) with a soft skirt (for comfort). A good option for patients who want better comfort than a standard RGP but have not yet progressed to needing a scleral lens.
- Piggybacking — a soft lens worn beneath an RGP lens to improve comfort. Used in some cases where neither lens type alone provides adequate comfort or vision.
Corneal cross-linking is the only FDA-approved treatment proven to halt the progression of keratoconus. It does not reverse existing corneal distortion, but it prevents further deterioration — and for younger patients with progressive disease, it may preserve the vision they have today and reduce the likelihood of ever needing a corneal transplant.
How cross-linking works:
- Riboflavin (vitamin B2) eye drops are applied to the cornea over approximately 30 minutes, saturating the corneal tissue.
- Controlled ultraviolet-A (UV-A) light is then applied to the cornea, activating the riboflavin.
- This activates a photochemical reaction that creates new collagen cross-links within the corneal stroma — dramatically strengthening the cornea's structural integrity.
- The result is a stiffer, more stable cornea that is significantly more resistant to further ectatic progression.
Who is a candidate for cross-linking?
- Documented keratoconus progression — measurable change in corneal shape or thickness over time
- Corneas with sufficient thickness to safely undergo the procedure
- Younger patients (teens and 20s) where the condition is more likely to progress
- Patients who want to preserve vision and avoid future surgical intervention
For patients with advanced keratoconus — particularly those with significant corneal scarring or who can no longer achieve functional vision with specialty contact lenses — surgical options may be considered.
- Intacs corneal implants — small plastic ring segments surgically inserted into the cornea to flatten and regularize its shape. Intacs can improve the fit and effectiveness of contact lenses in some patients. They do not eliminate the need for specialty lenses but may make lens wear more effective or comfortable.
- Deep Anterior Lamellar Keratoplasty (DALK) — a partial-thickness corneal transplant that replaces the front layers of the cornea while preserving the patient's own inner layer (endothelium). DALK carries a lower rejection risk than full-thickness transplants and is the preferred surgical approach for most keratoconus patients who require transplantation.
- Penetrating Keratoplasty (PKP) — a full-thickness corneal transplant, reserved for the most advanced cases or those with corneal endothelial compromise. PKP has excellent long-term outcomes but requires a longer recovery and carries a higher risk of rejection than DALK.
Why Choose Affiliated Eye Surgeons for Keratoconus?
Dedicated Corneal Specialist — Dr. Sanjai Jalaj, MD
Dr. Sanjai Jalaj is a board-certified ophthalmologist with specialized fellowship training in corneal diseases and refractive surgery. Keratoconus diagnosis and management — including advanced scleral lens fitting and corneal cross-linking — has been a defining focus of his career.
Advanced Diagnostic Technology
Accurate keratoconus management begins with accurate measurement. We use Scheimpflug corneal tomography and topography to map the cornea in three dimensions, giving us the precise data needed to stage the condition, plan treatment, and monitor progression over time with serial measurements.
Scleral lens fitting for keratoconus is not a procedure that every eye care provider offers — it requires advanced training, specialized diagnostic equipment, and significant hands-on experience. Our team has fitted hundreds of scleral and specialty lenses for keratoconus patients, including those with advanced disease who were told elsewhere that nothing could be done to improve their vision.
We offer FDA-approved corneal cross-linking for patients with documented keratoconus progression. This is a critical intervention for younger patients whose condition is still evolving — stopping progression now preserves vision and avoids more invasive options later.
Full Surgical Spectrum for Advanced Cases
For the small percentage of patients who require surgical intervention, we offer Intacs, DALK, and PKP
corneal transplantation. Having this full surgical capability within the same practice means you never have to start over with a new provider if your condition progresses.
Three Convenient Locations
Keratoconus requires regular monitoring — corneal topography at scheduled intervals to track any progression. With offices in
Morristown,
West Orange, and
Denville, we make it easy to stay consistent with your follow-up care close to home.
Frequently Asked Questions
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-like shape. This distorts the way light enters the eye, causing blurry, distorted, and frequently changing vision. It most often develops in teenagers and young adults and typically affects both eyes, though usually one more severely than the other.
What causes keratoconus?
The exact cause of keratoconus is not fully understood, but it involves a combination of genetic and environmental factors. A family history of keratoconus is a significant risk factor. Chronic eye rubbing is the most important modifiable risk factor and is strongly associated with progression — patients are advised to stop rubbing their eyes entirely. Certain conditions including Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome are also associated with higher keratoconus risk. Atopic conditions such as allergies and eczema increase risk partly because they cause eye itching that leads to rubbing.
How is keratoconus diagnosed?
Keratoconus is diagnosed through a comprehensive corneal evaluation that includes corneal topography — a detailed mapping of the cornea's surface curvature — and corneal tomography, which measures the shape and thickness of the cornea in three dimensions. A standard eye exam or glasses prescription test cannot diagnose keratoconus. Patients frequently come to us after repeated prescription changes that haven't resolved their blurred vision. If that sounds familiar, a corneal topography scan is the appropriate next step.
Can keratoconus be treated without surgery?
Yes, in most cases. In the early stages, updated glasses or soft contact lenses may provide adequate vision correction. As the condition progresses, specialty contact lenses — including rigid gas-permeable (RGP) lenses, scleral lenses, and hybrid lenses — become the most effective non-surgical treatment. Corneal cross-linking is a minimally invasive procedure that halts progression without reshaping the cornea. The majority of keratoconus patients manage the condition successfully throughout their lives without ever needing a corneal transplant.
What are scleral lenses and why are they used for keratoconus?
Scleral lenses are large-diameter rigid gas-permeable contact lenses that vault completely over the irregular corneal surface and rest on the white of the eye (the sclera). Because they create a smooth, tear-filled optical surface in front of the cone-shaped cornea, scleral lenses can dramatically improve vision in keratoconus patients who cannot see adequately with glasses or standard contacts. They are comfortable to wear because they don't touch the cornea itself. Fitting scleral lenses for keratoconus requires specialized expertise — it is one of the core competencies of our team at Affiliated Eye Surgeons.
What is corneal cross-linking and is it right for me?
Corneal cross-linking (CXL) is an FDA-approved minimally invasive procedure that uses riboflavin (vitamin B2) eye drops combined with controlled UV light exposure to strengthen the collagen bonds within the cornea, halting or significantly slowing the progression of keratoconus. It is the only proven treatment to stop keratoconus from getting worse. CXL is most appropriate for patients with documented progression — meaning measurable change in corneal shape or thickness over time. It does not reverse existing distortion but prevents further deterioration and reduces the likelihood of needing a corneal transplant in the future.
Will I need a corneal transplant for keratoconus?
The majority of keratoconus patients do not need a corneal transplant. With modern treatments — particularly corneal cross-linking to halt progression and specialty contact lenses to restore functional vision — most patients manage keratoconus effectively without surgery. Corneal transplantation is reserved for advanced cases where the cornea is severely scarred or so irregular that specialty lenses can no longer provide adequate vision. Early diagnosis and timely treatment significantly reduce the likelihood of ever reaching that point.
Is keratoconus genetic — will my children have it?
Keratoconus does have a genetic component. First-degree relatives of someone with keratoconus have approximately 10 times higher risk of developing the condition compared to the general population. If you have keratoconus, we recommend that your children have corneal topography screening starting in their early teens. Early detection allows for earlier intervention with cross-linking, which can preserve vision before significant distortion develops.
Does keratoconus get worse over time?
Keratoconus is typically progressive, especially during the teens and 20s. Progression often slows and may stabilize naturally in the 30s and 40s. The rate varies significantly between individuals. Chronic eye rubbing accelerates progression and should be avoided entirely. Corneal cross-linking is the only proven treatment to halt progression and is most effective when performed before significant corneal thinning or scarring has occurred.
Why choose Affiliated Eye Surgeons for keratoconus treatment?
Affiliated Eye Surgeons offers specialized keratoconus care through Dr. Sanjai Jalaj, a corneal specialist with extensive training and experience in the diagnosis and management of keratoconus and other corneal conditions. Our practice offers the full spectrum of keratoconus treatments — from advanced corneal topography and tomography for diagnosis, to specialty scleral and RGP lens fitting, corneal cross-linking, and surgical options for advanced cases. Patients across Northern New Jersey trust us as their destination for complex corneal care.
