Keratoconus: Understanding, Managing and Thriving book

For over three decades, my journey as an optometrist, professor, and scientist has been deeply intertwined with the lives of those affected by keratoconus. I have had the privilege of managing more than 5,000 keratoconus patients, spanning every age group and every stage of this complex condition — from the mild, early forms to the most advanced, vision-threatening cases.

This book is not just a compilation of clinical facts; it is a culmination of 36 years of lived experience, compassion, challenges, and triumphs. I’ve witnessed patients break down in despair, only to rise again with renewed hope after the right diagnosis and personalized care. I’ve seen the confusion on a teenager’s face when told their vision loss wasn’t fixable by glasses, and the joy when their world became clear again through a custom scleral lens. I’ve sat beside patients who had given up on their careers, relationships, and even their confidence — and helped them rebuild their lives.

Over the years, I’ve embraced not only non-surgical modalities like custom scleral lenses, high-order aberration correction, and impression lenses, but also surgical solutions such as CTAC, CAIRS, CXL, and IPCL when the condition demanded it. This book reflects that complete spectrum — from the first sign of blurred vision to advanced surgical rehabilitation.

I am immensely grateful to Dr. Quresh B. Maskati, the internationally acclaimed corneal surgeon, who has been an instrumental guide in my journey and has kindly agreed to contribute as a co-author of this book. He has operated on many of my patients with skill and dedication, helping them achieve remarkable outcomes. At times, when further expertise was needed, we have referred our patients to other renowned surgeons across India and the world, including Dr. Kasu Prasad Reddy  and internationally to experts such as Dr. Rajesh Khanna in California and Dr. Arun Gulani in Florida. Their contributions and surgical excellence have significantly expanded the scope of care available to our patients.

I could become an expert in scleral lens fitting because of the mentorship and knowledge shared by legends like Ken Pullum (UK), Dr. Donald Ezekiel (Australia), and Dr. Perry Rosenthal (USA). Their pioneering work and generous guidance shaped my understanding of the optical, anatomical, and emotional aspects of managing keratoconus with advanced contact lens technologies.

My intent in writing "Keratoconus: Understanding, Managing, and Thriving" is to empower patients, eye care professionals, students, and families with practical knowledge, compassionate guidance, and the reassurance that keratoconus is manageable, treatable, and above all — not the end of your vision journey.

You’ll find here not only scientific explanations but also case stories, myths and facts, answers to real-life patient questions, mental health support, and the day-to-day challenges patients face — socially, financially, and emotionally. You’ll also meet patients who have succeeded — children who returned to school, adults who resumed work, and elderly patients who regained independence.

This book is written in a friendly, empathetic voice — the voice I’ve used with every patient who sat in front of me confused and scared. My hope is that by the time you close the last page, you’ll feel more confident, more informed, and more hopeful — whether you are living with keratoconus or helping someone who is.

To all my patients, colleagues, and students who inspired this journey — this book is for you.

With warmth,

Chandrashekhar Chawan PhD, FSLS, FAAO

Celebrity Optometrist & Ocularist
Founder, Shekhar Eye Research
Specialist in Keratoconus, HOA Optics, and Impression Scleral Lenses, Orthokeratology, Myopia Control and painted soft and scleral lenses.

Keratoconus: Understanding, Managing, and Thriving. 

Chapter 1: Introduction to Keratoconus   1

Chapter 2: Patient Stories – The First Signs   7

Chapter 3: Diagnosis and What It Really Means   

Chapter 4: The Emotional Journey   19

Chapter 5: Treatment Planning — When to Act and Why Timing Matters  

Chapter 6: Non-Surgical Treatments — The Power of Optical Precision   31

Chapter 7: Scleral Lenses — Vaulting the Cone, Restoring the Soul   

Chapter 8: High-Order Aberrations — When Clarity Still Isn’t Clear Enough 

Chapter 9: Corneal Cross-Linking — Stopping the Cone in Its Tracks   51

Chapter 10: Intracorneal Ring Segments — Bridging the Gap Between Lenses and Surgery   

Chapter 11: Topography-Guided PRK with CXL — Reshaping the Future   63

Chapter 12: Phakic IOLs — When the Cornea Is Irregular but the Lens Is Clear 69

Chapter 13: Keratoplasty (DALK/PK) — When the Cornea Needs Replacement 75

Chapter 14: Living with a Graft — Post-Keratoplasty Lens Options and Visual Rehab  79

Chapter 15: Pediatric Keratoconus — Seeing the Future Early   83

Chapter 16: Allergy and Eye Rubbing — The Hidden Fuel Behind the Fire  89

Chapter 17: Keratoconus in Pregnancy — Hormones, Hydration, and Caution 95

Chapter 18: Hydrops — When the Cornea Breaks   101

Chapter 19: Teenagers and Keratoconus — Self-Esteem, Social Life, and School 107

Chapter 20: The Cost of Clear Vision — Financial Challenges and Smart Planning 111

Chapter 21: Women with Keratoconus — Beyond the Diagnosis   115

Chapter 22: Emotional First Aid — Dealing with Anxiety, Shame, and the Fear of Blindness   121

Chapter 23: Work, Career, and Life Planning with Keratoconus   127

Chapter 24: Love, Relationships, and Social Confidence   133

Chapter 25: Daily Life Hacks — Making Vision Work for You   137

Chapter 26: Keratoconus Myths — Busting the Misconceptions   143

Chapter 27: The 7 Stages of the Keratoconus Journey — From Confusion to Confidence   145

Chapter 28: Contact Lens Hygiene — The Golden Rules of Eye Safety   151

Chapter 29: The Power of Routine Follow-ups — Staying One Step Ahead  157

Chapter 30: Kids and Teens — Helping Young Patients Stick to Their Plan  161

Chapter 31: Cross-Linking Revisited — FAQs, New Advances, and Lifetime Value 167

Chapter 32: Pregnancy, Hormones, and Vision — Special Considerations for Women 173

Chapter 33: Keratoconus in Aging Eyes — Wisdom, Adaptation, and Clarity After 50  179

Chapter 34: Post-LASIK Ectasia and Its Management   183

Chapter 35: Surgical Management of Keratoconus   189

Chapter 36: Reclaiming Life — The Psychological Triumph Over Keratoconus 194

Chapter 37: Thriving with Keratoconus — Life After Diagnosis and Beyond 199

Chapter 38: Hydra-PEG Coating on Scleral Lenses for Keratocnus .................... 203

Frequently Asked Questions (FAQ)   207

Reference    213

Comprehensive Index (A–Z)   215

About the Authors   218