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Working with Keratoconus: Low-Cost Workplace Adjustments and Practical Support

/ Employment, Eye Health, Sight Loss Awareness / By

Consider an employee in their twenties who has had three prescription changes in eighteen months. Glasses no longer seem to help, lights at night have a smeared echo around them, and the monitor that was fine last spring is now tiring by lunchtime. Colleagues see someone who looks perfectly well. Line managers often see a performance dip with no obvious cause. Keratoconus is one of the conditions that can sit behind that picture.

The condition tends to appear early in a working life, when people are building careers and taking on screen-heavy roles. This article sets out what it is, where prevalence estimates differ, how it can affect work and which adjustments are practical, with referrers in mind. It is general information, not medical or legal advice.

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About keratoconus

Keratoconus is a non-inflammatory condition in which the cornea, the clear dome at the front of the eye, thins and gradually bulges into a cone-like shape, as Moorfields Eye Hospital describes it. Because the cornea does most of the eye’s focusing, the change in shape distorts the image. RNIB notes that it is usually present in both eyes, although one eye may be worse than the other.

Onset is typically in the teens or twenties. RNIB states that in most cases it becomes stable by the age of 40, while Moorfields says it usually stops getting worse by the mid-30s because of natural age-related stiffening of the cornea. The sources agree on the broad pattern but not on a single age, and the rate of change varies between individuals and between the two eyes. No prognosis can be drawn for any one employee from general information. Moorfields states that keratoconus does not cause complete blindness and that vision can usually be corrected with contact lenses, even in advanced cases.

How common is it?

Estimates differ widely. A 2020 systematic review of 29 studies covering more than seven million people in 15 countries (Hashemi and colleagues) found a pooled prevalence of 1.38 per 1,000, roughly 1 in 725. A nationwide Dutch study (Godefrooij and colleagues, 2017), using an insurance database of 4.4 million patients and modern diagnostics, estimated 1 in 375 and described this as 5 to 10 times higher than earlier population studies. A 2026 meta-analysis of 55 studies (Sriranganathan and colleagues) pooled 289.1 per 100,000, about 0.24 per cent, with a very wide confidence interval (124.2 to 671.1 per 100,000) and the highest prevalence in the 20 to 29 age group. Moorfields states that keratoconus is much more common than previously thought, although many cases are mild.

The variation reflects different diagnostic methods, populations and time periods. No UK-wide figure from a source of this standard was found, so these are international estimates. The studies also differ on sex: RNIB says men and women are affected equally, while the Dutch study found 60.6 per cent of diagnosed patients were male.

How keratoconus can affect work

Moorfields lists worsening vision with frequent prescription changes, blurring or clouding, and sensitivity and glare from bright lights. RNIB adds that dim light can be difficult and that sight can vary from day to day, even within the same day. That variability is often the hardest thing for colleagues to understand. An employee may read a report comfortably in the morning and struggle with the same text mid-afternoon, which can be misread as inconsistency. NHS Tayside also lists halos and difficulty seeing at night. Descriptions of a ghost image beside a light are recognised by ophthalmologists writing in the American Academy of Ophthalmology’s EyeNet magazine as a sign of irregular astigmatism, which keratoconus produces.

Specialist contact lenses are the usual route to good vision once glasses stop being enough. NHS trust leaflets describe rigid gas permeable lenses and, for some people, scleral or other custom designs. Lenses improve vision while worn but do not change the course of the condition, and comfort varies: a University Hospitals Coventry and Warwickshire leaflet notes that rigid lenses may be more uncomfortable than soft ones. In a US online survey of 197 lens-wearing people with keratoconus (Shorter and colleagues, 2021), 90 per cent reported symptoms suggestive of dry eye on a standard questionnaire. The sample was self-selected, so it is not a population figure, but it fits the dry, gritty or sore eyes many employees describe by the end of a long day. RNIB notes that dry eye can blur vision briefly, improving on blinking.

Screen work adds to this. The Health and Safety Executive states that display screen work does not cause permanent eye damage but can lead to tired eyes, discomfort and headaches.

Planned treatment adds another dimension. Corneal cross-linking, available on the NHS, uses riboflavin drops and ultraviolet light to aim to stabilise the cornea. NICE (guidance published 2013, now HealthTech guidance 319) found the evidence for the standard epithelium-off technique adequate for use with normal clinical governance. Moorfields advises at least one week off, or two weeks if the job involves a lot of computer work and the better eye is treated. Drops are needed hourly on the first day, then every four hours, eyes are light sensitive and vision is blurred at first. Cambridge University Hospitals describes a typical week off. Moorfields also notes that spectacle prescriptions can take around six months, and up to a year, to settle, so further adjustment may follow. Individual clinical advice governs.

Driving is a practical question for many. GOV.UK states that anyone who needs glasses or contact lenses to meet the standards of vision for driving must wear them every time, that a number plate must be readable at 20 metres, and that DVLA must be told of any eyesight problem affecting both eyes (short or long sight alone excepted). The DVLA guidance for medical professionals consulted does not name keratoconus, and its higher standards for bus and lorry drivers include no glare sensitivity, contrast sensitivity or twilight vision impairment. Moorfields checks vision at the follow-up appointment to confirm whether it is good enough to drive after treatment. Whether driving is affected is a matter for the individual, their eye clinic and DVLA, not for an employer to decide.

No-cost and low-cost workplace adjustments

Area Suggested adjustment Why it helps
Glare and lighting Seat away from windows or use blinds; set the monitor side-on to light; reduce overhead glare RNIB distinguishes discomfort glare from disability glare, which reduces contrast and detail
Screen set-up Larger text, higher contrast and a display mode the person chooses Distorted vision may be easier with bigger, bolder content
Breaks Short, regular screen breaks, with flexibility to step away for lens comfort or eye drops HSE recommends regular breaks, and dry or tired eyes build up over a day
Variable days Move fine-detail tasks to the better time of day where possible; avoid judging performance on a single day RNIB notes sight can vary within the day
Documents Provide key documents digitally so size and contrast can be changed; allow extra proofreading time Small or low-contrast print is harder with blur or ghosting
Eye tests Offer a DSE eye test on request and time for specialist appointments HSE requires employers to provide a test on request
Planned treatment Agree leave for cross-linking early, with a phased return and lighter screen load Moorfields advises one to two weeks off and a blurred start
Travel Discuss lifts, public transport or flexible hours when driving is not possible or comfortable, such as at night Glare and night vision can be harder, and clinic clearance may be needed after treatment

What this means for occupational health, HR and case managers

A workplace plan works best when it is based on function, meaning what the person can comfortably do on a given task, rather than on diagnosis alone. Referral questions about glare, fluctuation and screen tolerance may be more useful than a visual acuity figure alone, because acuity measured in a clinic at one point in the day may say little about the last hour of an afternoon shift.

Fluctuation is the second point. A single assessment captures one moment, so reports should say plainly that vision varies, and recommendations should hold on a poor day. Planned treatment is the third: cross-linking has a known timetable, so adjustments can be agreed in advance. Absence around treatment can be recorded as planned treatment leave rather than handled through attendance procedures.

A visual impairment workplace assessment is a specialist, practical, non-clinical review of how someone works in their actual environment. It sits alongside occupational health, optometry and ophthalmology rather than replacing them, and gives HR and line managers recommendations on lighting, screen set-up and task design that they can act on. Nothing about keratoconus makes someone unsafe or incapable. The aim is to remove avoidable barriers so that an experienced employee can keep doing their job well.

Hints and tips for the individual

  • Keep a short note of when vision is best and worst, and share it with your manager and assessor.

  • Avoid rubbing your eyes, and ask your eye clinic about managing itchy allergy symptoms.

  • Follow lens care advice and keep regular clinic appointments.

  • Request an eye test through your employer if you use a screen for much of the day.

  • Tell your employer in good time about planned cross-linking.

  • Seek urgent help from your eye clinic or urgent care for a sudden, painful drop in vision, which can indicate a rare complication called hydrops.

Building awareness and communication

Keratoconus is largely invisible. A person may look at a screen without apparent difficulty. Teams benefit from simple, specific information: vision can change from hour to hour, bright light may be uncomfortable, and someone may step away to rest their eyes or look after their lenses. None of this reflects effort or attitude.

Managers can ask what works rather than guess, and agree in advance how a poor day will be handled. Sharing documents before meetings, avoiding small, low-contrast slides and letting the person choose where to sit cost nothing. Given the age at which the condition tends to appear, early-career staff may not yet know what to ask for.

Legal rights and support

Under the Equality Act 2010, a person is disabled where they have an impairment with a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. Schedule 1, paragraph 5 generally ignores the effect of treatment, but not to the extent that an impairment of sight is correctable by spectacles or contact lenses, so vision with ordinary correction is taken into account. Paragraph 8 may be relevant to progressive conditions where the effect is not yet substantial. Anyone certified as sight impaired or severely sight impaired by a consultant ophthalmologist is deemed disabled under regulation 7 of the Equality Act 2010 (Disability) Regulations 2010. Where the definition is met, the employer must make reasonable adjustments. Whether the definition is met for a particular person depends on their circumstances, and this article is general information rather than legal advice.

Access to Work can help with specialist equipment, support workers and travel costs for eligible people in England, Scotland and Wales; GOV.UK states that Northern Ireland has a different system. Employers also have DSE duties, including eye tests on request.

Summary

Keratoconus affects people early in their working lives, varies from day to day and is easy to overlook. Most useful adjustments are inexpensive: control glare, make screens easy to read, allow breaks and plan around treatment. Referrers will get better outcomes by asking for functional recommendations that allow for fluctuation, and by agreeing support before cross-linking leave rather than after it.

Frequently Asked Questions

Moorfields and NHS trust leaflets state that keratoconus does not cause complete blindness. Vision can usually be corrected with glasses or specialist contact lenses, though severity varies between people.

Moorfields advises at least one week, or two weeks if the job involves a lot of computer work and the better eye is being treated. A Cambridge University Hospitals leaflet describes a typical week. The treating clinic gives individual advice.

It can be, but it depends on the individual. The test is whether there is a substantial and long-term adverse effect on normal day-to-day activities, taking ordinary glasses and contact lenses into account. This is general information, not legal advice.

That depends on whether the person meets the standards of vision for driving with their glasses or lenses. DVLA must be told of an eyesight problem affecting both eyes, other than short or long sight. Individual questions should go to the eye clinic and DVLA.

If you or someone in your team is visually impaired and would like expert, tailored support to stay productive and comfortable at work, visit https://visualisetrainingandconsultancy.com/workplace-assessments/visual-impairment-workplace-assessments/ to arrange a visual impairment workplace assessment.

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