INTACS or KeraRing

For patients who cannot use contact lenses and have a clear visual axis (no scarring), insertion of a ring (INTACS or KeraRing) into the cornea is an alternative treatment. These are transparent, crescent-shaped plastic rings inserted into the cornea. Intracorneal Rings are effective in mild to moderate keratoconus. A tunnel is created in the cornea, then 1 or 2 ring segments are inserted to flatten the cornea. The tunnel can be created mechanically or with laser. The procedure is done with anesthetic drops. Intracorneal Rings reduce the steepness caused by keratoconus. This is reversible; rings can be removed. Success follows the 'rule of 2': 2 lines reduction in astigmatism, 2 lines reduction in keratometry, 2 lines improvement in uncorrected and best-corrected visual acuity. Patients may still need glasses or contact lenses. Sometimes patients who couldn't wear lenses can wear them after this procedure. The 'rule of 2' is a success for doctors but may not be enough for patients. Ring treatment should be applied before keratoplasty or in patients who cannot wear hard lenses if keratoconus is not too advanced. Complications are rare, especially with femtosecond lasers.

Toric Phakic IOL implantation is another alternative for improving vision in patients with stable keratoconus and high myopia.