Keratoconus – diagnosis and treatment that stops the disease: crosslinking, CAIRS, ICL in Warsaw and Krakow

Warsaw · Krakow · Vienna · Zurich

Keratoconus is a progressive thinning and bulging of the cornea, which distorts vision and eventually makes good correction with glasses impossible. Today, in most cases, the disease can be stopped and vision improved without a transplant. At SwissLaser, we offer a complete pathway: MS-39 tomography, crosslinking (also with laser), biological CAIRS rings, ICL lenses, and fitting of rigid contact lenses. Treatment is led by Dr. Victor Derhartunian, who has been performing crosslinking since 2007.

Keratoconus in brief

What it is: a non-inflammatory corneal disease in which weakened tissue thins and bulges into a cone shape. Effect: increasing irregular astigmatism, blurred and double vision. Affects about 1 in 375 people (newer population studies), most often manifesting between 12 and 25 years of age.
How we diagnose: MS-39 corneal tomography with epithelial map and Anterion biometry. This examination detects keratoconus years before visual acuity deteriorates and determines whether the disease is progressing. Qualification cost: 400 PLN, Warsaw and Krakow.
How we treat: in stages, always with the least invasive method that suffices. Crosslinking (CXL) stops progression (3,600 PLN per eye), CXL with laser smooths the cornea (8,700 PLN), CAIRS rings reconstruct advanced keratoconus (16,000 PLN), ICL lenses correct the defect in stable keratoconus (11,000 PLN). Rigid and scleral lenses are fitted non-surgically.
When to act: when tomography confirms progression. In teenagers and young adults, the disease progresses fastest, so in this group, we do not wait for vision to worsen. Stable keratoconus is observed: follow-up every 6–12 months.
Where: Warsaw, ul. Kolejowa 1 and Krakow, ul. Kluczborska 15/U3 · Crosslinking in Krakow. The same surgeon, the same prices, patients from all over Poland.

SwissLaser in numbers: crosslinking since 2007, method learned from Prof. Theo Seiler in Zurich · over 25,000 refractive procedures by the chief surgeon · MS-39 and Anterion tomography · one team in Warsaw, Krakow, Vienna, and Zurich · Google: 4,8 (Warsaw) and 5,0 (Krakow)

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Preliminary qualification

Keratoconus — shortest answers

Can keratoconus be cured? There is no cure that reverses keratoconus, but the disease can be permanently stopped with crosslinking, and vision can be improved with lenses, CAIRS rings, or an ICL lens.
Does keratoconus lead to blindness? No. Even in advanced stages, the cornea remains transparent outside of scars, and vision can be rehabilitated with scleral lenses, CAIRS, or, as a last resort, a transplant. Untreated keratoconus leads to very poor vision, not blindness.
How much does keratoconus treatment cost? Qualification with tomography 400 PLN. Crosslinking 3,600 PLN per eye, crosslinking with laser 8,700 PLN, CAIRS rings 16,000 PLN, ICL lens 11,000 PLN per eye. Two follow-up appointments in the first month are included in the procedure price, installments possible. Full price list for keratoconus treatment.
How fast does keratoconus progress? It varies greatly. In teenagers, the curvature can increase by several diopters within a year, while in thirty-year-olds, changes can be minimal. Therefore, we compare tomographies at 3–6 month intervals instead of guessing. After 40.
Is keratoconus treatment reimbursed by the NFZ (National Health Fund)? Crosslinking has been included in the NFZ benefits package since September 2023, but only in selected hospitals and with waiting times ranging from several weeks to several months, which can be risky for progressive keratoconus.

What happens to the cornea in keratoconus

A healthy cornea has the shape of a regular dome and a thickness of about 520–560 micrometers in the center. Its rigidity is ensured by collagen fibers connected by cross-links. In keratoconus, there are too few of these links: the tissue loses rigidity, thins (often below 450 micrometers), and under the influence of intraocular pressure, bulges forward, usually in the lower part of the cornea. The image reaching the retina is distorted: irregular astigmatism develops, which glasses cannot fully correct.

The disease is painless and does not cause inflammation. The first changes are visible only in corneal tomography, most often first in the epithelial map, which smooths stromal irregularities and masks the disease. Therefore, keratoconus is often diagnosed late, after several changes of glasses that “don’t work.”

Diagram: normal cornea and keratoconus – thinning and conical bulging of the cornea distort the image on the retina (irregular astigmatism) — Normal cornea and keratoconus cornea: thinning and conical bulging distort the image on the retina. Graphic: SwissLaser.

Stages of keratoconus progression

In clinical practice, we use the Amsler-Krumeich classification (based on curvature, corneal thickness, and refractive error) and the newer Belin ABCD scale, which separately assesses the anterior and posterior corneal surfaces, its thickness, and visual acuity. Below is a simplified guide to help understand your test results.

Stage	Curvature (Kmax)	Corneal thickness	What the patient notices	Typical treatment
I – early	below 48 D	above 500 µm	frequent changes in correction, slight blurring, worse night vision	observation or crosslinking, if progression
II – moderate	48–53 D	400–500 µm	glasses do not provide full acuity, double vision, halos	crosslinking, often with laser; rigid contact lenses
III – advanced	53–55 D	300–400 µm	pronounced distortions, only rigid or scleral lenses tolerated	CAIRS, CXL in sub400 protocol, scleral lenses
IV – severe	above 55 D, scars	below 300 µm	significant reduction in acuity despite lenses	CAIRS or corneal transplant (DALK)

The stage is a starting point, not a verdict. The choice of method is primarily determined by whether the disease is progressing and how much corneal tissue remains. A detailed discussion of the scales can be found in the article keratoconus classification and correction.

Symptoms of keratoconus: when to examine the cornea

Symptoms develop slowly and can be mistaken for common myopia with astigmatism. These signs should prompt corneal tomography, especially in people under 30 years of age:

Frequent changes in correction: new glasses every few months, increasing astigmatism, different refractive error in both eyes.
Glasses “don’t work”: despite a correct prescription, the image remains blurred, letters have shadows or double (monocular diplopia).
Worse night vision: streaks and halos around lights, glare from headlights.
Light sensitivity and eye fatigue, frequent blinking, need to rub eyes.
Sudden blurring and pain in one eye (corneal edema, so-called hydrops) is a condition requiring an urgent visit.

Risk factors

Eye rubbing: the best-documented factor we can influence. Chronic eye rubbing mechanically weakens the cornea; for allergies, we treat the itching instead of “rubbing it away.”
Allergy and atopy: allergic conjunctivitis, atopic dermatitis, asthma.
Family history of keratoconus: about 10–15% of patients have a relative with the disease; siblings and children of affected individuals should undergo tomographic examination.
Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, sleep apnea increase the risk.
Age: first symptoms between 10 and 25 years of age; progression usually ceases after 35–40 years of age, when the cornea naturally stiffens.

More about early signs in the article keratoconus: don’t miss the first symptoms. If any of the points sound familiar, corneal tomography is the decisive examination, taking 20 minutes.

Diagnosis: corneal tomography decides everything

Keratoconus is not diagnosed “by eye” or solely based on worsening vision. The basis is imaging of both corneal surfaces and its thickness. In both clinics, we use two complementary devices:

MS-39 Tomograph (CSO)

Combines Placido disc topography with anterior segment OCT tomography. It maps the epithelium and corneal stroma separately, allowing it to detect keratoconus before visual acuity changes and objectively compare subsequent examinations on the ABCD scale.

Anterion (Heidelberg)

Optical biometry and high-resolution anterior segment OCT: corneal thickness at every point, anterior chamber depth, parameters needed for planning CAIRS and ICL lenses.

Progression assessment

We compare examinations at 3–6 month intervals. Progression is defined as, among other things, steepening of Kmax by more than 1 D per year, corneal thinning, or a change in the posterior surface. Progression is an indication for crosslinking, not merely the existence of keratoconus.

history and refraction examination with and without correction
MS-39 tomography with epithelial map and Anterion biometry
pachymetry (thinnest corneal point) and keratometry
slit-lamp examination: Vogt’s striae, Fleischer’s ring, scars
intraocular pressure measurement and fundus examination after pupil dilation
if keratoconus in the family: examination of siblings and children

The qualification examination takes approximately 60–90 minutes and costs 400 PLN. Before the visit, discontinue soft contact lenses for 7 days, rigid or scleral lenses for 3–4 weeks, as they distort the corneal map. More: corneal topography and keratoconus diagnosis step by step.

Keratoconus treatment ladder: from stopping the disease to better vision

Treatment has two distinct goals that should not be confused. The first is to stop the disease. The second is to improve vision. We always start with the least invasive method that suffices at a given stage, and only add subsequent ones if needed.

Observation or crosslinking

Icon: crosslinking – riboflavin and UVA light irradiation of the cornea

Stable keratoconus: control tomography every 6–12 months. Progressive keratoconus: crosslinking (CXL), which permanently stops the disease in over 90% of cases. The procedure takes about an hour, under topical anesthesia. 3,600 PLN per eye.

Crosslinking with laser

When the cornea is very irregular, we combine CXL with laser in one procedure: the Cretan protocol (CXL + PTK), Athenian protocol (CXL + topography-guided PRK), or Total Corneal Wavefront. It stops the disease and smooths the cornea. 8,700 PLN per eye.

CAIRS rings

Advanced keratoconus, intolerance to rigid contact lenses: segments of human corneal tissue implanted into a channel created by a femtosecond laser flatten the cone and improve corneal regularity. An alternative to transplant. 16,000 PLN per eye, procedure at our center in Vienna.

ICL lenses or rigid contact lenses

After corneal stabilization, the remaining refractive error is corrected with a phakic ICL lens (also toric, 11,000 PLN per eye) or non-surgically: with rigid and scleral lenses, which we fit in Krakow.

Method	Goal	For whom	Price per eye	More
Crosslinking (CXL)	stopping progression	progressive keratoconus, cornea from 400 µm (thinner: sub400 protocol)	3,600 PLN	crosslinking
CXL + laser (Cretan, Athenian, TCW)	stopping progression and smoothing the cornea	irregular cornea with sufficient thickness	8,700 PLN	laser variants
CAIRS rings	shape reconstruction, vision improvement	advanced keratoconus, lens intolerance	16,000 PLN	CAIRS
ICL lenses	refractive error correction without corneal intervention	stable keratoconus after CXL, refractive error up to -18 D, astigmatism up to 6 D	11,000 PLN	phakic lenses
Rigid and scleral lenses	vision rehabilitation without surgery	any stage of keratoconus when glasses are insufficient	individual valuation	rigid lenses
Corneal transplant (DALK, PK)	replacement of scarred cornea	central scars, extremely thin cornea	we refer to a reference center	when a transplant is not necessary

We do not perform corneal transplants and we are open about it. Today, less than 5% of keratoconus patients need it, and the goal of early treatment is precisely to prevent it.

When to treat: we operate on progression, not keratoconus itself

The most important decision in the entire treatment is the timing of the procedure. Crosslinking performed too early exposes a patient whose keratoconus would have stopped anyway to surgery. Performed too late, it perpetuates a state where vision is already poor, because CXL stops the disease but does not reverse the distortion. Therefore, we base the decision on comparing tomographies, not on a single examination.

Children and teenagers (from about 10 years of age): keratoconus progresses fastest in them and can be aggressive. With confirmed progression, we perform crosslinking without delay; in the youngest, the procedure takes place under general anesthesia at our center in Vienna, in Poland under topical anesthesia for cooperative teenagers.
Adults 20–35 years: the most common group. Two tomographies at 3–6 month intervals determine progression; with a clear result or very young age, one examination is sufficient.
After 40 years of age: progression is rare but does occur (pregnancy, eye rubbing, thyroid diseases). Stable keratoconus is observed, and we focus on improving vision: lenses, ICL, CAIRS.
Pregnancy and breastfeeding: hormonal changes can accelerate progression; the procedure is postponed until breastfeeding ends, but tomographic controls are more frequent.
After laser vision correction (ectasia): we treat it like keratoconus, crosslinking is the method of choice.

I have been performing cross-linking since 2007 and learned it from Prof. Theo Seiler, who created this method. The most important thing I learned from him was not the technique, but the indications: we operate on progression, not merely the existence of keratoconus. For a patient with stable keratoconus, the best decision might be a follow-up in six months, while for a sixteen-year-old with increasing curvature, the best decision is surgery next week.
Dr. med. Victor Derhartunian, FEBO, FWCRS, leading surgeon at SwissLaser

Am I a candidate for keratoconus treatment?

The final answer is provided by tomography. Below is an orientation on who typically qualifies for individual methods.

Green light

documented keratoconus progression: increasing curvature or corneal thinning between examinations
age 10–40 years, cornea without central scars
corneal thickness from 400 µm (thinner corneas are treated with the sub400 protocol)
advanced keratoconus with intolerance to rigid contact lenses: candidate for CAIRS
stable keratoconus after CXL with refractive error up to -18 D: candidate for ICL lenses

Yellow light – requires discussion

stable keratoconus without progression: usually observation, not surgery
pregnancy and breastfeeding: procedure after breastfeeding ends
severe dry eye syndrome, active allergic conjunctivitis: first treat the ocular surface
previous corneal hydrops or peripheral scars: examination determines

Red light – but there are alternatives

central, dense corneal scars or thickness below 300 µm: consider CAIRS or refer for transplant (DALK)
active inflammation or eye infection: first treatment, then qualification
lack of cooperation during the procedure in a young child: general anesthesia in Vienna

Want to check your chances before a visit? Fill out the preliminary online qualification: describe the results of previous examinations and attach corneal maps if you have them. We respond within one business day.

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Preliminary qualification

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Case study: advanced keratoconus treatment plan

Patient, 27 years old, stage III keratoconus in the right eye (Kmax 56 D, thinnest point 390 µm), intolerance to rigid contact lenses, 2 D progression within a year. Plan established based on MS-39 tomography:

Stage 1 – CAIRS in Vienna: donor tissue segments in a femtosecond laser-created channel flattened the cone by approximately 5 D and significantly improved corneal regularity; follow-ups in Krakow.
Stage 2 – crosslinking after 3 months: the sub400 protocol adapted to corneal thickness stabilized the new shape and stopped progression.
Stage 3 – refractive error correction after one year of stability: toric ICL lens corrected the remaining myopia and astigmatism; the patient sees 0.8 without glasses, previously 0.3 with glasses.

Not every patient needs three stages. Most people with early keratoconus complete treatment with crosslinking and good glasses or contact lenses.

Video: keratoconus, what it is and how we treat it

Dr. Victor Derhartunian explains in Polish what keratoconus is, how tomography works, and how we choose the treatment method. Video from the SwissLaser channel.

Why patients with keratoconus choose SwissLaser

Experience at the source of the method: Dr. Derhartunian has been performing crosslinking since 2007, from the first years after CE certification, and learned the method at the IROC clinic in Zurich from Prof. Theo Seiler, its creator.
Full treatment ladder within one team: CXL, CXL with laser, CAIRS, ICL, rigid contact lenses. We don’t have to bend the diagnosis to fit one method we offer.
Challenging corneas are routine: sub400 protocol for corneas thinner than 400 µm, Total Corneal Wavefront laser planning, CAIRS as one of the few pathways in Central Europe.
Diagnostics that see more: MS-39 with epithelial map and Anterion in both clinics; the same examination protocol in Warsaw, Krakow, Vienna, and Zurich.
Honest indications: stable keratoconus is observed, not operated on. We also state clearly what crosslinking will not do: it will not improve visual acuity, it will stop the disease.

Our patients’ reviews

Google rating: Warsaw 4,8 (reviews: 258) · Krakow 5,0 (reviews: 171). All reviews, unselected and unedited, can be read directly on Google: Warsaw · Krakow.

Keratoconus – Frequently Asked Questions

Is keratoconus hereditary?

Partially. About 10–15% of patients have a relative with keratoconus, and the risk in siblings is several times higher than in the general population. The predisposition is inherited, and eye rubbing and allergy trigger it. We recommend corneal tomography for siblings and children of patients, for children from about 10 years of age.

Can I wear contact lenses with keratoconus?

Yes, this is the primary non-surgical correction method. Soft lenses are sufficient only in the early stage; later, rigid gas permeable, hybrid, or scleral lenses are needed, which “override” the irregular cornea. Lenses do not treat keratoconus or inhibit progression; crosslinking serves this purpose.

Will crosslinking improve my vision?

The goal of crosslinking is to stop the disease, not to improve visual acuity. In some patients, the cornea flattens by 1–2 D after the procedure and vision improves slightly, but this should not be expected. If you are interested in better vision, we discuss the laser variant, CAIRS, or an ICL lens.

Can laser vision correction be performed with keratoconus?

Classic LASIK is contraindicated because it further weakens the cornea. However, combining crosslinking with topography-guided laser (Athenian protocol) or PTK (Cretan protocol), which smooths the cornea without fully correcting the refractive error, is safe. Full correction of refractive error in stable keratoconus is provided by an ICL lens.

What is corneal hydrops?

Sudden corneal edema after rupture of its inner membrane (Descemet’s) in advanced keratoconus. It manifests as sudden blurring, pain, and tearing in one eye. Requires an urgent visit; we treat with drops and observation, edema subsides within weeks, sometimes leaving a scar.

Does keratoconus affect the ability to work or drive?

It depends on the visual acuity achieved with correction. Many patients after crosslinking and with well-fitted lenses meet driving requirements and work without restrictions. Disability certification applies only to severe, bilateral forms with significant vision reduction despite correction.

How to prepare for the qualification examination?

Discontinue soft lenses for 7 days, rigid and scleral lenses for 3–4 weeks. Bring previous corneal maps and glasses prescriptions; comparison with them is the most valuable information about progression. After pupil dilation, do not drive for several hours.

Do you treat keratoconus in children?

Yes. In children and teenagers, keratoconus progresses fastest, so we perform crosslinking immediately after confirming progression, in cooperative teenagers under topical anesthesia in Warsaw or Krakow, and in younger children under general anesthesia at our center in Vienna.

How does CAIRS differ from Intacs rings?

By material. Intacs and Keraring are segments made of PMMA plastic, which remain foreign bodies in the cornea and can shift or extrude. CAIRS are segments of human corneal tissue devoid of donor cells, which integrate with the cornea. We implant them into a channel created by a femtosecond laser at our center in Vienna; diagnosis and follow-ups take place in Poland.

Where do you treat keratoconus?

In Warsaw at ul. Kolejowa 1 and in Krakow at ul. Kluczborska 15/U3; tomography, crosslinking, laser variants, and ICL lenses in both clinics, scleral lens fitting in Krakow, CAIRS at our center in Vienna. We accept patients from all over Poland; travel details: keratoconus treatment Warsaw and keratoconus treatment Krakow.