Keratoconus treatment in San Diego
A Patient’s Journey With Keratoconus
Written by Dr. Bruce Nguyen, OD
Evidence-based care for keratoconus, not guesswork
Note: This story is shared with our patient’s permission to raise awareness about keratoconus, a condition that is often misdiagnosed or overlooked.
Recently, a new patient visited our office and entered the exam room, saying her eyes were “just plain weird.” She even suggested that we skip the tests or ignore the instrument readings because, in her words, “they never make sense.”
Naturally, this caught my attention. She explained that since her teenage years, the prescriptions measured by machines and doctors never matched. Despite many eye exams, she had never been able to see the 20/20 line on the chart. “No one knows why I cannot see well,” she told me.
By the time she came to us, she was in her late twenties. She had accepted the idea that her eyes were simply unusual and only wanted a new pair of glasses during her routine annual exam.
However, her symptoms made me suspect undiagnosed keratoconus. I performed a corneal topography scan, which confirmed moderate keratoconus in both eyes. I showed her the 3D images of her cone-shaped corneas and gently explained:
“You have keratoconus in both eyes. This is most likely why you’ve struggled with your vision for so many years.”
To my surprise, her first reaction was laughter and relief. After years of unanswered questions, finally having a diagnosis brought comfort—even if the news was not what she expected. Once the relief settled, the real questions began.
OUR TESTIMONIALS
This an overdue review for Dr. Nguyen and his wonderful staff. Always very friendly, courteous and professional. I always try to get my exam yearly due to a lot of working on the computer and my eyes get quite a workout; Dr. Nguyen and his staff, David, are always so helpful and their recommendations are on spot. Definitely would recommends for friends and family members.
Dr. Bruce Nguyen and all of the staff at Clairemont Optometry are great at providing a very comprehensive eye exam in a friendly way. Dr. Bruce Nguyen is very helpful when explaining anything about your eye exam. The office is very nice, and they have lots of styles of frames to choose from if you're looking for glasses. I highly recommend them if you need your eyes checked and want to work with people who are very helpful and friendly.
Why Keratoconus Often Goes Undiagnosed (And What It Means for You)
Keratoconus is an eye disease that affects the cornea—the clear, dome-shaped window at the front of your eye. Normally, the cornea focuses light onto your retina to give you sharp vision.
Many patients are first told they have “astigmatism.” Simply put, astigmatism means the cornea isn’t perfectly round like a basketball—it’s shaped more like a football or an egg.
But with keratoconus, the problem is different:
The cornea becomes thinner and weaker over time
Vision becomes blurred and distorted
Patients often notice halos and glare, especially worse at night
How Common Is Keratoconus?
Older studies estimated it affects 1 in 500 to 1 in 2000 people
A 2020 study found the rate may be closer to 1.38 in 1000
That means keratoconus is more common than many people—and even some doctors—realize.
Why Early Diagnosis Matters
Keratoconus usually begins in the teenage years, but it’s often misdiagnosed as simple astigmatism for years. This delay means patients miss the chance for early treatment.
In our office, we screen every patient for keratoconus during their annual eye exam—because early detection makes all the difference.
Early detection of keratoconus opens the door to advanced treatments like corneal cross-linking, helping preserve clear vision for the future.
Keratoconus Runs in Families
Did you know keratoconus can actually run in families? Research shows that children of closely related parents—especially first cousins—face a much higher risk of developing the condition. One study even found a fourfold increase compared to children of unrelated parents.
The exact cause of keratoconus isn’t fully understood. But evidence clearly points to a genetic link, combined with environmental triggers like:
Frequent eye rubbing
Seasonal allergies or eczema
Systemic conditions such as Down syndrome or Ehlers-Danlos syndrome
What the Science Tells Us
If a family member has keratoconus, your own risk increases significantly.
Depending on the study, this risk ranges anywhere from 5% to 27%.
One study reported a 14% chance if a relative is affected.
That number climbs to 20% (1 in 5 chance) when it’s an immediate family member such as a parent, sibling, or child.
Why This Matters for You and Your Family
This is not just a statistic—it’s a wake-up call. If you’ve been diagnosed with keratoconus, your siblings and children may also be at risk, even if they see “perfectly fine.”
As an eye doctor, I always stress the importance of family screening. A simple exam can help detect keratoconus at an early stage, when treatments like FDA-approved corneal cross-linking work best.
Think about it this way: if there’s a 1 in 5 chance that someone you love could have keratoconus, isn’t it worth making sure?
Does Keratoconus Affect One Eye or Both?
A common question patients ask is: “Can keratoconus affect just one eye?”
The short answer: Almost never. Keratoconus is a progressive, bilateral eye disease, which means it nearly always affects both eyes, though one eye may be more advanced than the other.
Why Many Patients Think It’s Only One Eye
When vision is blurry, distorted, or full of glare in just one eye, it’s natural to assume the other eye is “perfectly fine.” Many patients are even told they have unilateral keratoconus (only one eye affected). But modern research shows that true unilateral keratoconus is extremely rare.
What Studies Reveal
A study of 164 patients found only 1.8% had keratoconus in one eye at first—but some later developed it in the other.
Another study quoted a 4% chance of having keratoconus in just one eye.
Even in those rare cases, the “healthy” eye carries about a 50% risk of developing keratoconus within 16 years.
In other words, if you have keratoconus in one eye, there’s a very high chance the other eye will eventually be affected too.
Why This Matters for You
Early detection is critical. Catching keratoconus in both eyes early opens the door to treatments like corneal cross-linking, which can stop progression before vision loss becomes severe.
Regular monitoring saves vision. Even if your “good” eye seems fine, it should always be scanned during eye exams. Subtle signs of keratoconus can be detected before symptoms appear.
If you’ve been diagnosed with keratoconus in one eye, don’t assume the other is safe. In most cases, keratoconus eventually affects both eyes. Staying proactive with regular checkups gives you the best chance to protect your long-term vision.
Does Keratoconus Always Get Worse? Understanding Its Progression
Keratoconus is often considered a progressive eye disease, meaning it tends to worsen over time—especially in younger patients. Eye doctors usually assume keratoconus will continue to progress until proven otherwise through regular monitoring. That’s why early diagnosis and ongoing checkups are so important.
When Does Keratoconus Progress the Most?
Most patients are diagnosed with keratoconus in their teenage years (ages 15–18). Research shows the condition usually progresses for the next 15–20 years, often stabilizing naturally in the late 30s to early 40s. Interestingly, keratoconus is much less common in people over 50 because the cornea stiffens with age, which can naturally slow or stop progression.
Why Early Diagnosis Matters
As an optometrist, one of the most difficult parts of my job is telling parents that their child has keratoconus. Parents often feel shocked and worried, while children may not fully understand what’s happening. But catching the disease early is critical—because progression is most aggressive in younger eyes, and timely treatment can protect vision.
How Keratoconus Progression Can Be Stopped
Today, we have advanced treatments to control keratoconus:
Corneal cross-linking (CXL): Strengthens and stabilizes the cornea to stop further progression.
Scleral contact lenses: Provide clear, comfortable vision by creating a smooth optical surface.
Together, these treatments offer the best combination for keratoconus management—halting progression and restoring vision quality.
If you’ve been told you have keratoconus, especially at a young age, don’t wait until symptoms get worse. With early detection, corneal cross-linking, and specialty lenses, patients can protect their vision and maintain long-term eye health.
Corneal Cross-Linking (CXL): The FDA-Approved Solution for Keratoconus
“I can see light at the end of the tunnel, and it isn’t a train.” David Bowie
Corneal Cross-Linking (CXL) is the first FDA-approved treatment for keratoconus, offering real hope for patients. This minimally invasive procedure takes less than an hour and involves applying riboflavin (Vitamin B2) eye drops followed by controlled UV light exposure. The process strengthens the cornea by creating new collagen cross-links, which helps stop or slow keratoconus progression in over 90% of patients.
CXL is especially critical for younger patients and those with one “good eye” remaining, since early intervention can preserve vision before further damage occurs. In the U.S., the FDA-approved iLink® platform (by Glaukos) is currently the only authorized system, available for patients over 14 years old.
While the cost averages around $6,000 per eye without insurance, many providers offer coverage depending on your plan. Consulting a qualified eye care specialist ensures you receive evidence-based treatment, not guesswork, and helps protect your vision long term.
Ready to protect your vision? Book your appointment with us today and explore if corneal cross-linking (CXL) is the right treatment for you.
Conclusion
Keratoconus is a progressive eye condition that usually starts in the teenage years and stabilizes by the early forties. The best management combines corneal cross-linking (CXL) to stop progression and scleral contact lenses to restore vision.
Early detection and timely treatment are the keys to protecting long-term eye health. At our San Diego clinic, Dr. Bruce Nguyen specializes in keratoconus and myopia management, offering advanced, FDA-approved care tailored to each patient.
References
This article is supported by multiple peer-reviewed studies and clinical reviews. For example, Kennedy, Bourne, and Dyer (1986) published a 48-year clinical and epidemiologic study of keratoconus in the American Journal of Ophthalmology. Similarly, Hashemi et al. (2020) presented a systematic review and meta-analysis on the prevalence and risk factors for keratoconus in The Journal of Cornea and External Disease.
Other landmark studies include Holland et al. (1997), who analyzed the incidence and topographic features of unilateral keratoconus in Ophthalmology, and Olivares Jiménez et al. (1997), who investigated the age of onset and natural history of the condition in Optometry and Vision Science.
Genetic aspects have been discussed by Nowak and Gajecka (2011) in the Middle East African Journal of Ophthalmology, and Gordon-Shaag et al. (2015), who reviewed genetic and environmental factors in Biomedical Research International. Research by Lee and Hirst (1995) further confirmed the rarity of unilateral keratoconus, while Li et al. (2004) conducted a longitudinal study on normal eyes in unilateral cases, published in Ophthalmology.
More recent findings include Millodot et al. (2016) on the effects of aging on keratoconic corneas (Journal of Optometry), Hersh et al. (2017) reporting outcomes of a U.S. multicenter clinical trial of corneal collagen cross-linking (Ophthalmology), and Perez-Straziota et al. (2018), who reviewed pediatric keratoconus cross-linking in Cornea.
