In this case, the corneal strength is adequate and there is no scar, and therefore no need for lamellar keratoplasty. Continuing with this example, I would perform laser advanced surface ablation (ASA) surgery, because astigmatic treatments remove the least tissue and correct the astigmatism to bring the VA close to 20/20. From a medicolegal standpoint, I would explain to the patient that, with this technique, I should be able to reshape the cornea to provide predictable vision. I would remind them that the outcome would not be like that of a virgin eye with 20/20 VA. I would also inform the patient that I have Intacs as a backup option if their keratoconus progresses naturally or because of the laser.