Keratoconus at a glance
Keratoconus is a progressive thinning and bulging of the cornea, most often diagnosed before the age of 40. Left untreated, it leads to irregular astigmatism and, in advanced stages, to the need for a transplant. We treat it in stages: first we halt the disease (crosslinking, over 95% success rate), then we improve the optics – with laser, ICL lenses or biological CAIRS rings, for which we offer the only structured treatment pathway for patients from Warsaw and Krakow.
The keratoconus treatment ladder – from stabilisation to reconstruction
| Stage | When | Price |
|---|---|---|
| 1. Crosslinking (CXL) | progressing keratoconus – halting the disease (>95% success rate) | PLN 3,600 per eye |
| 2. CXL + PTK (Athens protocol) | stabilisation + laser smoothing of the cornea in a single procedure | PLN 8,700 per eye |
| 3. ICL lenses | stable keratoconus – correcting the error without touching the cornea | PLN 11,000 per eye |
| 4. CAIRS (biological rings) | advanced keratoconus – an alternative to transplantation | PLN 16,000 per eye |
| Scleral lenses (non-surgical) | vision rehabilitation with rigid lenses – provided in Krakow | individual fitting |
Keratoconus – diagnosis and treatment that stops the disease: cross-linking, CAIRS, ICL in Warsaw and Krakow
Warsaw · Krakow · Vienna · Zurich
Keratoconus is a progressive thinning and bulging of the cornea that distorts the image and, over time, makes good spectacle correction impossible. Today the disease can be halted in most cases and vision improved without a transplant. SwissLaser offers the complete pathway: MS-39 tomography, cross-linking (also with laser), biological CAIRS rings, ICL lenses and the fitting of rigid lenses. Treatment is led by Dr. Victor Derhartunian, who has performed cross-linking since 2007.
Keratoconus at a glance
- What it is: a non-inflammatory corneal disease in which weakened tissue thins and bulges into a cone. Result: increasing irregular astigmatism, blur and ghosting. It affects about 1 in 375 people (recent population studies), most often appearing between the ages of 12 and 25.
- How we diagnose it: MS-39 corneal tomography with epithelial mapping and Anterion biometry. This examination detects keratoconus years before visual acuity drops and tells us whether the disease is progressing. Assessment: 400 PLN, Warsaw and Krakow.
- How we treat it: in stages, always with the least invasive method that is sufficient. Cross-linking (CXL) halts 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 refractive error once the cornea is stable (11,000 PLN). Rigid and scleral lenses are fitted non-surgically.
- When to act: as soon as tomography confirms progression. In teenagers and young adults the disease advances fastest, so in this group we do not wait for vision to deteriorate. Stable keratoconus is monitored: check-ups every 6–12 months.
- Where: Warsaw, ul. Kolejowa 1, and Krakow, ul. Kluczborska 15/U3. The same surgeon, the same prices, patients from all of Poland and abroad; English-speaking care.
What happens to the cornea in keratoconus
A healthy cornea is a regular dome about 520–560 micrometres thick at the centre. Its stiffness comes from collagen fibres joined by cross-links. In keratoconus there are too few of these links: the tissue loses stiffness, thins (often below 450 micrometres) and bulges forward under intraocular pressure, usually in the lower part of the cornea. The image reaches the retina distorted, producing irregular astigmatism that glasses cannot fully correct.
The disease is painless and causes no inflammation. The first changes are visible only on corneal tomography, usually first in the epithelial map, because the epithelium smooths over irregularities of the stroma and masks the disease. That is why keratoconus is often recognised late, after several pairs of glasses that “don’t work”.
Stages of keratoconus
In practice we use the Amsler-Krumeich classification (curvature, corneal thickness, refraction) and the newer Belin ABCD scale, which grades the anterior and posterior corneal surfaces, thickness and visual acuity separately. This simplified guide helps you understand your own result.
| Stage | Curvature (Kmax) | Corneal thickness | What the patient notices | Typical treatment |
|---|---|---|---|---|
| I – early | below 48 D | above 500 µm | frequent prescription changes, slight blur, worse night vision | observation or cross-linking if progressing |
| II – moderate | 48–53 D | 400–500 µm | glasses no longer give full sharpness, ghosting, halos | cross-linking, often with laser; rigid lenses |
| III – advanced | 53–55 D | 300–400 µm | marked distortion, only rigid or scleral lenses tolerated | CAIRS, CXL in the sub400 protocol, scleral lenses |
| IV – severe | above 55 D, scarring | below 300 µm | severe loss of vision despite lenses | CAIRS or corneal transplant (DALK) |
The stage is a starting point, not a verdict. The choice of method depends above all on whether the disease is progressing and how much corneal tissue remains. More on the scales in classification and correction of keratoconus.
Symptoms of keratoconus: when the cornea should be examined
Symptoms build up slowly and are often mistaken for ordinary short-sightedness with astigmatism. These signs should prompt corneal tomography, especially in people under 30:
- Frequent prescription changes: new glasses every few months, rising astigmatism, different values in the two eyes.
- Glasses “don’t work”: despite a correct prescription the image stays blurred, letters have shadows or ghost images (in one eye).
- Worse night vision: streaks and halos around lights, glare from headlights.
- Light sensitivity and eye strain, frequent squinting, an urge to rub the eyes.
- Sudden blur and pain in one eye (corneal oedema, so-called hydrops) requires an urgent appointment.
Risk factors
- Eye rubbing: the best documented factor we can influence. Chronic rubbing mechanically weakens the cornea; in allergy we treat the itch instead of “rubbing it away”.
- Allergy and atopy: allergic conjunctivitis, atopic dermatitis, asthma.
- Keratoconus in the family: about 10–15% of patients have a relative with the disease; siblings and children should be examined by tomography.
- Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, sleep apnoea increase the risk.
- Age: first signs between 10 and 25; progression usually stops after 35–40 as the cornea stiffens naturally.
More on early signs in keratoconus: don’t miss the first symptoms. If any of these points sounds familiar, corneal tomography gives the answer in 20 minutes.
Diagnosis: corneal tomography decides everything
Keratoconus is not diagnosed “by eye” or from worsening vision alone. The basis is imaging of both corneal surfaces and of corneal thickness. In both clinics we use two complementary devices:
MS-39 tomograph (CSO)
Combines Placido topography with anterior segment OCT. Maps epithelium and stroma separately, so it detects keratoconus before visual acuity changes and allows objective comparison of consecutive examinations on the ABCD scale.
Anterion (Heidelberg)
High-resolution optical biometry and anterior segment OCT: corneal thickness at every point, anterior chamber depth, parameters needed to plan CAIRS and ICL lenses.
Progression assessment
We compare examinations 3–6 months apart. Progression means, among other things, Kmax steepening by more than 1 D per year, corneal thinning or a change in the posterior surface. Progression is the indication for cross-linking, not the mere presence of keratoconus.
- history and refraction with and without correction
- MS-39 tomography with epithelial map and Anterion biometry
- pachymetry (thinnest point) and keratometry
- slit-lamp examination: Vogt’s striae, Fleischer ring, scars
- pressure measurement and fundus examination after dilation
- with keratoconus in the family: examination of siblings and children
The assessment takes about 60–90 minutes and costs 400 PLN. Before the visit stop soft contact lenses for 7 days and rigid or scleral lenses for 3–4 weeks, because they distort the corneal map. More: corneal topography.
The keratoconus treatment ladder: from halting the disease to better vision
Treatment has two separate goals that must 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 is sufficient at the given stage and add further steps only when they are needed.
Observation or cross-linking
Stable keratoconus: control tomography every 6–12 months. Progressive keratoconus: cross-linking (CXL), which permanently halts the disease in over 90% of cases. About an hour, drop anaesthesia. 3,600 PLN per eye.
Cross-linking with laser
When the cornea is very irregular we combine CXL with laser in one procedure: the Cretan protocol (CXL + PTK), the Athens protocol (CXL + topography-guided PRK) or Total Corneal Wavefront. Halts the disease and smooths the cornea. 8,700 PLN per eye.
CAIRS rings
Advanced keratoconus, intolerance of rigid lenses: segments of human corneal tissue implanted into a femtosecond-laser channel flatten the cone and improve corneal regularity. An alternative to transplantation. 16,000 PLN per eye, procedure in our centre in Vienna.
ICL lenses or rigid lenses
Once the cornea is stable we correct the remaining refractive error with a phakic ICL lens (also toric, 11,000 PLN per eye) or non-surgically with rigid and scleral lenses, fitted in Krakow.
| Method | Goal | For whom | Price per eye | More |
|---|---|---|---|---|
| Cross-linking (CXL) | halt progression | progressive keratoconus, cornea from 400 µm (thinner: sub400 protocol) | 3,600 PLN | cross-linking |
| CXL + laser (Cretan, Athens, TCW) | halt progression and smooth the cornea | irregular cornea with thickness to spare | 8,700 PLN | laser variants |
| CAIRS rings | reshape the cornea, improve vision | advanced keratoconus, lens intolerance | 16,000 PLN | CAIRS |
| ICL lenses | correct the refractive error without touching the cornea | stable keratoconus after CXL, up to −18 D, astigmatism up to 6 D | 11,000 PLN | phakic lenses |
| Rigid and scleral lenses | visual rehabilitation without surgery | any stage when glasses are not enough | individual quote | treatment of keratoconus |
| Corneal transplant (DALK, PK) | replacement of a scarred cornea | central scars, extremely thin cornea | referral to a reference centre | keratoconus treatment options |
We do not perform corneal transplants and say so openly. Today fewer than 5% of keratoconus patients need one, and the aim of early treatment is precisely to avoid it.
When to treat: we treat progression, not keratoconus itself
The most important decision in the whole treatment is the timing. Cross-linking done too early exposes a patient to a procedure whose keratoconus would have stopped anyway. Done too late, it fixes a state in which vision is already poor, because CXL halts the disease but does not undo the distortion. That is why we base the decision on comparing tomographies, not on a single examination.
- Children and teenagers (from about age 10): keratoconus progresses fastest and is often aggressive. With confirmed progression we perform cross-linking without delay; in the youngest under general anaesthesia in our Vienna centre, in Poland under drop anaesthesia in cooperative teenagers.
- Adults 20–35: the largest group. Two tomographies 3–6 months apart settle the question of progression; with an unequivocal result or very young age one examination is enough.
- After 40: progression is rare but does occur (pregnancy, eye rubbing, thyroid disease). Stable keratoconus is monitored and we focus on vision: lenses, ICL, CAIRS.
- Pregnancy and breastfeeding: hormonal changes can accelerate progression; we postpone the procedure until breastfeeding ends but check tomography more often.
- After laser vision correction (ectasia): treated like keratoconus, cross-linking is the method of choice.
I have performed cross-linking since 2007 and learned it from Prof. Theo Seiler, who created the method. The most important thing he taught me is not the technique but the indication: we treat progression, not the mere existence of keratoconus. For a patient with stable keratoconus the best decision is often a check-up in six months; for a sixteen-year-old with a steepening cornea the best decision is surgery next week.
Dr. Victor Derhartunian, FEBO, FWCRS, lead surgeon at SwissLaser
Am I a candidate for keratoconus treatment?
The final answer comes from tomography. As a guide, who usually qualifies for each method:
Green light
- documented progression: increasing curvature or thinning between examinations
- age 10–40, cornea without central scars
- corneal thickness from 400 µm (thinner corneas are treated with the sub400 protocol)
- advanced keratoconus with rigid-lens intolerance: candidate for CAIRS
- stable keratoconus after CXL with refractive error up to −18 D: candidate for ICL lenses
Amber light – needs discussion
- stable keratoconus without progression: usually observation, not surgery
- pregnancy and breastfeeding: procedure after weaning
- severe dry eye, allergic conjunctivitis in an active phase: treat the ocular surface first
- previous hydrops or peripheral scars: the examination decides
Red light – but there are alternatives
- central dense scars or thickness below 300 µm: we consider CAIRS or refer for transplantation (DALK)
- active inflammation or infection: treatment first, then assessment
- inability of a small child to cooperate during surgery: general anaesthesia in Vienna
Want to check your chances before the visit? Complete the online pre-qualification: describe previous findings and attach corneal maps if you have them. We reply within one working day.
Zapisz się na niezobowiązująca wizytę i konsultację, na której dowiesz się, jak możemy poprawić Twój wzrok.
A case from practice: treatment plan for advanced keratoconus
Patient, 27, stage III keratoconus in the right eye (Kmax 56 D, thinnest point 390 µm), intolerance of rigid lenses, progression of 2 D per year. The plan based on MS-39 tomography:
- Step 1 – CAIRS in Vienna: donor tissue segments in a femtosecond-laser channel flattened the cone by about 5 D and clearly improved corneal regularity; follow-ups in Krakow.
- Step 2 – cross-linking after 3 months: a sub400 protocol adapted to corneal thickness locked in the new shape and stopped progression.
- Step 3 – refractive correction after a year of stability: a 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 steps. Most people with early keratoconus finish treatment with cross-linking and good glasses or lenses.
Video: keratoconus – what it is and how we treat it
Dr. Victor Derhartunian explains in Polish (automatic subtitles on YouTube) what keratoconus is, what tomography looks like and how we choose the method. From the SwissLaser channel.
Why keratoconus patients choose SwissLaser
- Experience at the source of the method: Dr. Derhartunian has performed cross-linking since 2007, from the first years after CE certification, and learned it at the IROC clinic in Zurich from Prof. Theo Seiler, its inventor.
- The complete treatment ladder in one team: CXL, CXL with laser, CAIRS, ICL, rigid lenses. We never have to bend the diagnosis to fit the one method we happen to offer.
- Difficult corneas are routine: the sub400 protocol for corneas under 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 mapping and Anterion in both clinics; the same examination protocol in Warsaw, Krakow, Vienna and Zurich.
- Honest indications: stable keratoconus is monitored, not operated on. We also say plainly what cross-linking will not do: it does not improve visual acuity, it stops the disease.
SwissLaser in numbers: cross-linking since 2007, trained by Prof. Theo Seiler in Zurich · over 25,000 refractive procedures by the lead surgeon · MS-39 and Anterion tomography · one team in Warsaw, Krakow, Vienna and Zurich · Google: 4.9 (Warsaw) and 5.0 (Krakow)
What our patients say
Keratoconus – frequently asked questions
Can keratoconus be cured?
There is no drug that reverses keratoconus, but the disease can be permanently halted with cross-linking, and vision improved with lenses, CAIRS rings or an ICL lens. Today fewer than 5% of patients need a corneal transplant, mainly those whose keratoconus was detected too late.
Does keratoconus lead to blindness?
No. Even in advanced stages the cornea stays clear outside 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?
Assessment with tomography 400 PLN. Cross-linking 3,600 PLN per eye, cross-linking with laser 8,700 PLN, CAIRS rings 16,000 PLN, ICL lens 11,000 PLN per eye. Two follow-ups in the first month are included, instalments available. Full price list.
How fast does keratoconus progress?
It varies greatly. In teenagers the curvature can increase by several dioptres a year; in people in their thirties the changes are often minimal. That is why we compare tomographies 3–6 months apart instead of guessing. After 40 the cornea stiffens naturally and progression usually stops.
Is keratoconus hereditary?
Partly. 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; eye rubbing and allergy trigger it. We recommend corneal tomography for siblings and children of patients, in children from about age 10.
Can I wear contact lenses with keratoconus?
Yes, this is the main non-surgical method of correction. Soft lenses are enough only in the early stage; later rigid gas-permeable, hybrid or scleral lenses are needed, which “overwrite” the irregular cornea. Lenses do not treat keratoconus or slow progression; that is what cross-linking is for.
Will cross-linking improve my vision?
The goal of cross-linking is to halt the disease, not to improve 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 better vision matters to you, we discuss the laser variant, CAIRS or an ICL lens.
Can I have laser vision correction with keratoconus?
Classic LASIK is contraindicated because it further weakens the cornea. What is safe is combining cross-linking with topography-guided laser (Athens protocol) or PTK (Cretan protocol), which smooths the cornea without correcting the full refractive error. Full correction with stable keratoconus is provided by an ICL lens.
What is corneal hydrops?
A sudden swelling of the cornea after a tear in its inner membrane (Descemet’s membrane) in advanced keratoconus. It presents as sudden blur, pain and watering of one eye. It requires an urgent visit; we treat with drops and observation, the swelling resolves within weeks and sometimes leaves a scar.
Does keratoconus affect work or driving?
It depends on the visual acuity achieved with correction. Many patients after cross-linking and with well-fitted lenses meet driving requirements and work without restrictions.
How do I prepare for the assessment?
Stop soft lenses for 7 days, rigid and scleral lenses for 3–4 weeks. Bring earlier corneal maps and spectacle prescriptions; comparing them is the most valuable information about progression. Do not drive for a few hours after pupil dilation.
Do you treat keratoconus in children?
Yes. In children and teenagers keratoconus progresses fastest, so we perform cross-linking right after progression is confirmed, in cooperative teenagers under drop anaesthesia in Warsaw or Krakow, in younger children under general anaesthesia in our centre in Vienna.
How does CAIRS differ from Intacs rings?
In the material. Intacs and Keraring are PMMA plastic segments that remain a foreign body in the cornea and can shift or extrude. CAIRS are segments of decellularised human corneal tissue that integrate with the cornea. We implant them into a femtosecond-laser channel in our centre in Vienna; diagnostics and follow-ups take place in Poland.
Where do you treat keratoconus?
Zapisz się na niezobowiązująca wizytę i konsultację, na której dowiesz się, jak możemy poprawić Twój wzrok.
Related topics and further reading
- Cross-linking (CXL): protocols, procedure, price
- CAIRS rings: biological corneal reconstruction
- Keratoconus treatment prices
- Phakic ICL lenses with stable keratoconus
- First symptoms of keratoconus
- Qualification for surgery
- Treatment of keratoconus
- Corneal scars
Medically reviewed by Dr. med. univ. (Vienna) Victor Derhartunian, FEBO, FWCRS, who has performed corneal cross-linking since 2007. Last updated: 6 September 2026.
Where we treat keratoconus
Tomography, cross-linking in every protocol, laser variants, ICL lenses and all follow-ups in both clinics; scleral lens fitting in Krakow; CAIRS implantation in our centre in Vienna. English-speaking care at every location.
SwissLaser Warsaw
ul. Kolejowa 1, 01-217 Warszawa · tel. +48 221 201 690
SwissLaser Krakow
ul. Kluczborska 15/U3, 31-271 Kraków · tel. +48 12 383 33 60
