Keratoconus After LASIK: Is It Inevitably Progressive?

Since first observing post-LASIK keratoconus, commonly referred to as iatrogenic keratoconus, in 1997, I have gained extensive experience in managing these cases. My clinics were among the largest in Australia at the time, and I inherently managed many patients who required corneal rehabilitation before considering corneal transplantation.

One thing that has become clear to me is the uniqueness of each patient. Just like in non-LASIK keratoconus, some cases continue to progress while others remain stable. The overarching question remains: how should each case be handled?

Handling the Condition

The principle of choosing the most conservative approach first holds true, followed by vision correction measures such as glasses or custom contact lenses. For most patients, these methods provide adequate vision improvement.

Once vision is optimized, careful monitoring for any further progression is essential. Specialized optometrists specializing in keratoconus or ophthalmologists with cornea expertise use corneal scanning technology to track any changes. If progression is detected, collagen cross-linking is often recommended as a treatment option.

Collagen Cross-Linking

Collagen cross-linking is a highly effective method for stabilizing the cornea. In my experience, it has proven more satisfactory than other procedures like Intacs or kerarings, where vision rehabilitation can be more challenging. Collagen cross-linking alone often results in better visual outcomes, the ultimate goal of any treatment.

This positive outcome is further reinforced by the good news that in the past 20 years, iatrogenic keratoconus following LASIK has become less common due to advancements in screening techniques. This means that with the right care and monitoring, patients can manage their condition effectively and slow or halt progression.

Conclusion

While LASIK-associated keratoconus might seem like a daunting condition, it does not have to lead inevitably to worsening vision. By employing a conservative approach, including vision correction and close monitoring, along with innovative treatments like collagen cross-linking, patients can stabilize and even improve their cornea condition. Early intervention and regular follow-ups are crucial for successful management.