**7. Conclusion**

The two most important goals of management of keratoconus are stopping disease progression and visual rehabilitation. An ocular allergy should be treated. Care providers should instruct the patients to avoid eye rubbing to halt disease progression. A careful follow up is needed to document disease progression and provide prompt treatment. A nonsurgical treatment of keratoconus includes spectacles or contact lens. Contact lens use does not slow or halt progression but can provide satisfactory vision in early stages of keratoconus. A contact lens type is selected based on the manifest refraction and the degree of keratoconus.

The five operations (CXL, ICRS, PK, DALK and BL transplantation) currently represent the available surgical treatment options for advanced KC. Treatment for advanced KC has trended away from invasive procedures such as PK and even DALK toward minimally invasive procedures such as CXL, ICRS or BL transplantation. CXL and ICRS were once regarded only for mild to moderate keratoconus, their roles are now expanding in advanced diseases as well.

PK and DALK provide long term good vision but has slow visual rehabilitation and may be disrupted by complications such as suture-related problems and graft rejection. BL transplantation was introduced for advanced KC with extreme thinning/steepening. This novel procedure may postpone penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) and potentially allow long term contact lens wear. Since genetic factors play significant roles in KC, advances in gene therapy may soon yield innovative treatments of this disease.
