For many people, blurry or distorted vision may seem like a routine change in their prescription. But for those with keratoconus, these symptoms can be signs of a progressive corneal disease that can significantly affect vision without appropriate treatment.
In recognition of World Keratoconus Day, Vance Thompson Vision is encouraging patients, parents, and eye care providers to recognize the signs of keratoconus and understand the importance of early detection and treatment.
Keratoconus is a condition in which the normally round, dome-shaped cornea progressively thins and develops a cone-like shape. This irregular shape can cause blurred or distorted vision and irregular astigmatism that may not be fully corrected with traditional glasses or contact lenses. Keratoconus often begins during the teenage years or early adulthood, although it can develop at other ages.
“Early detection is incredibly important with keratoconus because we now have treatments that can help stabilize the cornea before more vision is lost,” said Dr. Brandon Baartman, ophthalmologist at Vance Thompson Vision. “The goal is not simply to help someone see better today, but to protect the health and stability of the cornea for the future.”
Cross-Linking: An Important Tool for Protecting Vision
One of the most significant advances in keratoconus treatment is corneal collagen cross-linking (CXL). This minimally invasive procedure uses riboflavin, a form of vitamin B2, together with ultraviolet-A light to strengthen collagen fibers within the cornea.
Unlike glasses or contact lenses, which help correct vision affected by keratoconus, cross-linking is designed to slow or stop the underlying progression of the disease. Research reviewed by the American Academy of Ophthalmology has found that epithelium-off cross-linking significantly reduces keratoconus progression, with an acceptable safety profile.
A New Option: Epithelium-On Cross-Linking
Traditionally, corneal cross-linking has been performed using an epithelium-off (epi-off) technique. In this approach, the thin outer layer of the cornea, called the epithelium, is removed to allow riboflavin to penetrate the cornea before it is activated by ultraviolet-A light.
Today, patients may also have access to epithelium-on (epi-on) cross-linking, an advancement designed to leave the corneal epithelium intact during treatment. In October 2025, the U.S. Food and Drug Administration approved Epioxa HD and Epioxa for epithelium-on corneal collagen cross-linking to treat keratoconus in adults and patients ages 13 and older, when used with the O2n System and Boost Goggles.
“Having additional cross-linking options allows us to consider the individual patient and their corneal health when determining the most appropriate treatment,” said Dr. Caroline Wilson, ophthalmologist and cornea surgeon at Vance Thompson Vision. “The important thing is identifying progression and intervening when treatment can make a meaningful difference.”
Epi-on treatment offers potential benefits, including preserving the epithelium and reducing some of the discomfort and recovery associated with epithelial removal. But the two approaches are not interchangeable for every patient. Current evidence continues to support epithelium-off cross-linking as an effective treatment for progressive keratoconus, while newer epithelium-on technology is an important addition to the treatment landscape.
Know the Signs
Keratoconus can be easy to overlook, particularly in its early stages. Patients may notice:
Frequent changes in their glasses or contact lens prescriptions
Increasing or irregular astigmatism
Blurry or distorted vision
Difficulty achieving clear vision with glasses
Increased sensitivity to light or glare
A need for increasingly specialized contact lenses
Eye rubbing is also an important risk factor. Vance Thompson Vision recommends avoiding frequent or aggressive eye rubbing, particularly in children and young people who may be at increased risk of developing or progressing keratoconus.
“Sometimes patients have been told for years that they simply have a strong prescription or astigmatism,” said Dr. Michael Greenwood, ophthalmologist and cornea surgeon at Vance Thompson Vision. “A comprehensive eye examination by their primary eye care provider and corneal imaging can help determine whether there is an underlying corneal condition.”
Protecting Vision Starts With Early Detection
Although there is currently no cure for keratoconus, the condition can be managed, and treatment can help preserve vision. Depending on the individual patient, management may include observation and monitoring, specialty contact lenses, corneal cross-linking, corneal reshaping procedures, and, in advanced cases, corneal transplantation.
Vance Thompson Vision encourages anyone experiencing unexplained changes in vision, increasing astigmatism, or difficulty achieving clear vision with glasses or contacts to talk with their primary eye care provider.
To learn more about keratoconus and corneal cross-linking, visit vancethompsonvision.com or schedule a consultation with a Vance Thompson Vision cornea specialist.