An interview with  Maria Walker, OD, PhD 

Houston, Texas, United States  

Assistant Professor · University of Houston College of Optometry 

What inspired you to specialize in keratoconus care? 

During my residency, I started seeing patients with keratoconus who needed scleral lenses. At first, my focus was on fitting specialty contact lenses, but over time, I became more interested in the condition itself. When I moved to Houston over a decade ago, I started doing more research on keratoconus, and I realized how much this condition impacts people’s lives. 

Many of my patients with keratoconus have unique challenges, and I’ve developed a deep appreciation for their resilience. The more I learned about the disease, the more I understood that it isn’t just a corneal condition—it can affect overall eye health and quality of life.  

How can patients advocate for themselves to get answers and an accurate diagnosis sooner? 

One of the most important things patients can do is share their family history. If a relative has keratoconus or has had a corneal transplant, mentioning this to an eye doctor can encourage earlier and more thorough screenings. 

Regular eye exams are also crucial. Many patients don’t realize they have keratoconus until their vision worsens significantly, so keeping up with routine checkups can help detect changes early. If vision keeps changing or glasses don’t seem to help as much as they should, asking for corneal topography can be an effective way to identify the condition sooner. 

Insurance coverage can also be a challenge for many patients, particularly when it comes to specialty contact lenses. It’s important for patients to educate themselves about their insurance plans, speak with their HR departments, and connect with others in the keratoconus community to find out what coverage options are available. 

Ultimately, the best way for patients to advocate for themselves is by being proactive—seeking second opinions if needed, asking their doctors about specialized testing, and staying informed about their options for treatment and vision correction. 

What advice would you give to someone newly diagnosed with keratoconus? 

The first thing I tell patients is to educate themselves about keratoconus, including treatment options and insurance coverage. Understanding the difference between regular contact lenses and medically necessary contact lenses is important, as insurance companies often have specific policies about coverage. 

It’s also essential to find an eye care provider with experience in keratoconus, particularly someone who fits scleral lenses. These specialists are well-versed in the full range of contact lens options and can help determine the best choice for each patient. The goal is twofold: slowing or stopping progression with treatments like corneal cross-linking and restoring vision with specialty contact lenses. 

Beyond medical care, I encourage patients to connect with a supportive community. The National Keratoconus Foundation (NKCF) is an incredible resource, offering education, advocacy, and a network of over 20,000 members who share experiences and advice. Many patients feel overwhelmed by their diagnosis, but knowing there’s a community that understands what they’re going through can make a huge difference. Whether patients want to be actively involved in support groups or just access reliable information, NKCF provides a trusted platform to help navigate their journey with keratoconus.  

How do you approach determining the best treatment option for an individual patient? 

My first priority is to determine whether a patient’s keratoconus is progressing. If there is any suspicion of progression, I refer them for corneal cross-linking. Right now, cross-linking is the only FDA-approved treatment shown to slow or stop progression, so I strongly advocate for it in eligible patients. 

That said, like any procedure, cross-linking works well for most patients but isn’t always 100% effective. That’s why I’m excited about future advancements that could further improve outcomes. Just five to ten years ago, we had no treatment options to halt keratoconus progression—we could only watch and wait as the condition worsened. Today, we have cross-linking, and I believe ongoing research will continue to improve both the procedure itself and other potential therapies. My ultimate goal is to maximize treatment effectiveness for each individual patient, ensuring they get the best possible outcome for their vision and quality of life. 

What steps can patients take to actively manage their condition and improve outcomes? 

The most important thing you can do is stop rubbing your eyes—immediately. Eye rubbing is the only known behavioral factor that worsens keratoconus. Many patients with keratoconus experience eye irritation, possibly due to allergies or an underlying inflammatory response. However, rubbing your eyes can release inflammatory molecules that weaken the cornea, accelerating the progression of keratoconus. If your eyes feel itchy, try over-the-counter antihistamine eye drops to help manage the itchiness. If over-the-counter options aren’t effective, talk to your doctor about prescription treatments to control your symptoms. 

Beyond avoiding eye rubbing, regular follow-up appointments are essential. Keratoconus is a progressive disease, and ongoing monitoring allows your doctor to track changes and adjust treatment as needed. Staying consistent with your eye care visits ensures that any worsening of your condition is detected early. 

Finally, don’t be skeptical of corneal cross-linking. Some patients hesitate to pursue this treatment, but it is the only FDA-approved procedure that can slow or stop keratoconus progression. It’s a straightforward procedure with the potential to protect your vision long-term. If your doctor recommends cross-linking, consider it seriously—it can be life-changing. 

Taking these steps—avoiding eye rubbing, managing itchiness, attending regular check-ups, and considering cross-linking—can help protect your vision and improve your overall eye health. 

How can patients get involved to make a difference in raising awareness and improving care for keratoconus? 

One of the best ways to make a difference is by getting involved with organizations like the National Keratoconus Foundation (NKCF). Whether you’re newly diagnosed or have been managing keratoconus for years, being part of this community can be incredibly valuable. 

There are many ways to contribute, depending on your interests and abilities. If you’re a patient or family member, sharing your story can be powerful—whether that’s through social media, blogs, or support groups. You can also make a difference by donating time or financial support. These contributions help fund educational programs, research initiatives, and advocacy efforts that drive progress in keratoconus care. 

Finally, simply being vocal about your condition can have a meaningful impact. Talking to your community, sharing experiences, and spreading awareness can help ensure more people receive early diagnosis and better treatment options. The more people engage in the conversation, the more progress we can make together.