Keratoconus is a gradual conical protrusion of the center of the cornea (transparent outer layer of the eyeball), without inflammation.

A cornea transplant is a surgical procedure to replace part of the cornea with corneal tissue from a deceased donor. The cornea is the transparent, dome-shaped surface of the eye that accounts for a large part of the eye's focusing power. A corneal transplant, called a keratoplasty can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea. Corneas used in corneal transplants come from deceased donors.

A corneal transplant is most often used to restore vision to a person who has a damaged cornea caused by a variety of diseases or injury. A corneal transplant may also relieve pain or other signs and symptoms associated with diseases of the cornea. A number of conditions result in the need for a corneal transplant such as:

• Thinning of the cornea

• Corneal scarring, caused by infection or injury

• Clouding of the The cornea

• Swelling of the cornea

• Corneal ulcers, including those caused by infection

• Complications caused by previous eye surgery

If the cornea becomes opaque, swollen, or scarred, vision is diminished. Medication to control the damage to the cornea is usually the first line of treatment, but once it is clear that medication will not halt or alter the damage, a corneal transplant is considered.

Before cornea transplant surgery, tests include

• A thorough eye exam that looks for conditions that may cause complications after surgery

• Measurements of the eye to determine what size donor cornea is needed.

• A review of all medications and supplements to identify those to stop before or after the corneal transplant.

In the early stages, rigid contact lenses will improve vision by correcting the corneal astigmatism. When contact lenses are no longer satisfactory, then a corneal transplant or penetrating keratoplasty surgery may be done.

Keratoconus is often a slowly progressive disease occurring between the ages of 20 to 60 years. If a corneal transplant is done before the cornea is extremely thinned, the prognosis for reading vision is excellent.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less (38 CFR 3.351(c)(1)).

• Consider entitlement to automobile allowance and/or automobile adaptive equipment if there is visual impairment to the degree specified in 38 CFR 3.808(b)(3).

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Review for entitlement to special monthly compensation under 38 CFR 3.350.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.