Blurred lines: Bringing Keratoconus into focus
Keratoconus Week takes place during the week of March 23-29, 2026. According to the
National Keratoconus Foundation, Keratoconus impacts a range between 1:400 to 1:200 people affected by this condition.
Dimitrios Karamichos, Ph.D., FARVO, Executive Director of NTERI and Vice President of Research and Graduate Studies at UNT Health Fort Worth, has focused on researching Keratoconus and corneal research. We sat down with Dr. Karamichos to learn more about Keratoconus and the treatment options currently in development for individuals living with this condition.
What exactly is keratoconus, and how does it affect a person’s vision over time?
Keratoconus is a human progressive eye condition in which the cornea—the clear, dome‑shaped surface at the front of the eye—gradually thins and bulges outward into a cone‑like shape. This condition changes the way light is focused onto the retina, resulting in significant vision impairment. Early on, people may notice mild blurring or increased sensitivity to light. As the condition advances, vision can become increasingly distorted, with ghosting and/or multiple images. In more advanced cases, ordinary glasses may no longer provide adequate correction, and daily visual tasks such as reading or driving can become challenging.
What are the early signs or symptoms that someone might have keratoconus, and when should they see an eye doctor?
Early keratoconus can be subtle. Common warning signs include frequent changes in eyeglass prescriptions, increasing astigmatism, blurred or distorted vision, and difficulty seeing clearly at night. Because these symptoms can overlap with more common vision problems, keratoconus is often missed in its earliest stages. Anyone experiencing rapid or unexplained changes in vision—especially teenagers or young adults—should see an eye care professional for a comprehensive eye exam. Early evaluation and diagnosis are important for disease management.
Who is most at risk for developing keratoconus? Are there genetic or environmental factors involved?
Keratoconus typically begins in adolescence or early adulthood, though it can appear later in life. Genetics plays a vital role but is not the only factor. People with a family history of keratoconus are at higher risk. Certain medical conditions, such as connective tissue disorders and Down syndrome, are also associated with increased risk. Environmental factors matter as well. Chronic eye rubbing—often linked to allergies or irritation—is a major modifiable risk factor and is believed to accelerate disease progression in susceptible individuals. Lastly, hormonal imbalances have emerged as a key player in managing the disease.
What promising new diagnostic tools or biomarkers are being developed to detect keratoconus?
Early detection is a major focus of current research. Advances in corneal imaging technologies, such as high‑resolution corneal topography and tomography, allow clinicians to detect subtle structural changes long before vision is noticeably affected. Researchers are also exploring biomechanical measurements that assess how stiff or elastic the cornea is, which may help identify keratoconus at a preclinical stage. In parallel, scientists are investigating molecular and tear‑based biomarkers that could one day be used to screen for disease risk or progression more precisely. Blood and salivary-based biomarkers are also being tested by researchers as we try to get a holistic view of this multifactorial disease.
How is research improving treatments beyond current options like corneal cross-linking or specialty contact lenses?
While corneal cross‑linking is now considered the standard approach for slowing or halting disease progression in eligible patients, ongoing research is focused on refining existing treatments and expanding therapeutic options. This is particularly important as clinical data show that some patients experience recurrence even after cross‑linking. New cross‑linking protocols are being developed to shorten recovery times and improve safety. Research is also underway to determine the frequency of crosslinks one can receive – currently, it is unknown whether multiple crosslinks are beneficial to the patient. Advances in specialty contact lenses—including scleral and hybrid designs—are improving comfort and visual outcomes for individuals with moderate to advanced keratoconus.
Are there any emerging technologies or therapies—such as regenerative medicine, gene therapy, or novel biomaterials—that could transform keratoconus care in the future?
Indeed – We have lots going on. Regenerative medicine strategies aim to strengthen or regenerate corneal tissue using bioengineered materials, bioprinted or cell‑based therapies. Gene‑focused research is strong and is helping us understand the molecular pathways that contribute to corneal weakening and keratoconus, ultimately driving targeted therapies. Novel biomaterials—including next‑generation intracorneal implants and bioresponsive “smart” materials—are designed and tested to provide more comfort, support, and fit with the native corneal tissue.
What areas of keratoconus research need the most attention or funding right now?
Earlier detection and prevention represent the greatest unmet needs. More research is needed to identify individuals at risk before vision is affected and to develop treatments that can intervene at the earliest stages. Long‑term studies comparing emerging therapies, especially in pediatric and adolescent patients, are also critical.
How can people with keratoconus protect their eye health and manage their condition day to day?
Regular follow‑up with an eye care specialist is vital. Avoiding eye rubbing, managing allergies, and following prescribed treatment plans can help slow progression. Advances in contact lens design and treatment options mean that many people with keratoconus can maintain good vision and quality of life. With continued research and innovation, the outlook for patients is steadily improving, offering hope for earlier diagnosis, better treatments, and more personalized care in the years ahead.
For more information on NTERI, please visit our website to learn more about eye health and Karamichos’ research.