The 4 Stages of Keratoconus: Where Do You Stand?

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.