Medically reviewed by Dr. Alexander Bonakdar, O.D.
Keratoconus Specialist · Illinois College of Optometry · Last reviewed March 2026
Keratoconus is a Spectrum
Keratoconus isn't "on or off." It is a progressive disease with distinct stages. Understanding where you fall on this spectrum is critical for creating a treatment plan.
Stage 1: Early (Forme Fruste)
Symptoms: Slight blurring, minor astigmatism. Often misdiagnosed as just "needing glasses."
Diagnosis: Can only be seen on a Corneal Topographer (mapping). Slit lamp exams usually miss this.
Treatment: Watchful waiting or Corneal Cross-Linking (CXL) to lock it in place.
Stage 2: Mild to Moderate
Symptoms: Ghosting images, halos at night. Glasses no longer provide crisp 20/20 vision.
Treatment: CXL is highly recommended. Soft specialty contacts or Hybrids (SynergEyes) are often used here.
Stage 3: Advanced
Symptoms: Significant distortion. The "cone" is visible to doctors. Glasses are useless. Hard contact lenses (RGP) pop out frequently.
Treatment: Scleral Lenses are the mandatory treatment here. They bridge over the severe cone, providing stability and vision.
Stage 4: Severe
Symptoms: Severe scarring at the apex of the cone. Extreme thinning (danger zone). Possible "Hydrops" (a break in the corneal layer causing sudden clouding).
Treatment: Scleral Lenses can still work for many, but this is the stage where Corneal Transplant becomes a valid discussion if scarring blocks vision.
About the Author
Dr. Alexander Bonakdar is a specialist in complex contact lens fitting for keratoconus. With over 20 years of experience, he is a trusted referral source for CHOC and UCI Medical Center.
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