Originally approved for the correction for nearsightedness, Intacs or intracorneal ring segments (ICRS) received a humanitarian exemption by the FDA to be used as a treatment for keratoconus. ICRS are plastic inserts that theoretically have the potential to stabilize the keratoconic cornea and improve vision. From my perspective, most patients still require a rigid gas permeable lens in order to achieve functional vision. In some cases, ICRS can make contact lens fitting more difficult because they can create a mid-peripheral corneal ridge. Scleral contact lenses are ideal for the keratoconic patient who has ICRS because the lens is able to adequately vault over any induced ridges. ICRS can be surgically removed if necessary.