Hi Gerald!
Its interesting that you brought this thread "back to life"
I am no medical or eye specialist here, so please don't take my feedback instead of expert medical advice, it's just my personal experience as someone who has had quite a bit of experience with this...however what I do know for sure is that in many places (the FAA system included) Keratoconus is NOT a disqualifying factor as long as you are able to achieve and maintain proper eye correction that meets the licencing standards and use it while excercising the priveleges of the licence, and that there are no other eye problems that may jeopardize safety of flight. So if anyone tells you otherwise, make sure you do your homework and understand it the rules. Now I don't know how this applies to your situation because you didn't give us details, however it all depends on factors like how much your Keratoncuns has progressed and how it has affected your visual acuity so far, what your visual acuity is like at the moment, your age (usually Keratoconus stops progressing at around the age of 40, so once past this point it is not supposed to get worse) etc. Many Keratoconus patients are still able to achieve acceptable (and even better than acceptable) vision with proper treatment and using glasses or contacts (either soft or hard, that are epsecially designed for Keratoconus, there are so many options out there) and continue to fly safely and lead normal lives. And with new techniques like collagen crosslinking now available, patients whose keratoconus is detected early enough and qualify for the procedure, may be able to stop the progress of the keratoconus once and for all. ( I belive I have touched upon all this in previous posts). A corneal transplant is usually only required in roughly 20% to 25% of Keratoconus cases, and these are normally cases where functional vision can no longer be attained using glasses nor contacts and the corneas have become extremely thin and irregular, so it is normally seen as a "last resort" kind of thing for the more extreme cases. Reaching the point of needing a transplant doesn't just happen right away. Bear in mind that corneal transplants or grafts do not necesarily mean that a person will have perfect vision or near perfect vision! Even post-graft patients might still need some kind of vision correction (usually in the form of contacts), it's just that it won't be as bad as if someone didn't have the graft/transplant altoghether.
So going back to what you said about what that eye specialist told you, I think he/she was right to suggest that you see a corneal specialist. It has nothing to do with "reputation" or "liablibility", it's just the right thing to do. Any professional doctor is expected to do that, otherwise it would be bad practice, that's just usually how it works and its for your own good. However about what the specialist told you about needing a transplant, I must say it sounds rather strange. It's not something that an eye specialist would say, no offense to him/her. As I said I am no doctor, but this sounds rather odd to me. Having a transplant without reaching the point of actually needing it, is not reccommended as far I know and it certainly doens't make you "more medically fit to fly" if you are able to meet licencing requirements using other forms of correction and treatment that are out there. Your cornea specialst should be able to advise you better on this.
Having said that, I must say the biggest lesson I have personally leanred is that it is important to see a corneal specialist who has a very good understadning of keratoconus and the medical developments surrounding it. I cannot emphasize enough how important it is! In the fight against keratoconus, your best friends are going to be a cornea specialist (i.e. an opthalmologist who secilaized in corneal and refractive surgery) and an optometrist who both have the knowledge and the patience and genuine desire to work with you. Unfortunately such people are far and few (especially optometrists who are familiar with keratoconus patients), so make sure you do your homework. Going into this at 1st, I thought all corneal specialsits should be the same at least in terms of understanding keratoconus. I was very surprised at how much difference there was. Bear in mind that keratoconus is a condtion for which there have been no new developemts for an extedned period of time, and only recently have new developements for treatment and correction began to appear. Therefore many doctors aren't aware of what's out there and the tendency is to steer patients in one direction without giving it much thought. Some specialsits I saw had knowledge that was so outdated it's almost scary to think that had I just followed their advice wihtout getting another opinion, that I would be regretting it right now. So take your time to find a specialist that understands keratoconus very well and the various treatment and correctionm modalities that are out there.
I am sorry for the long message! but I hope this helps. I know when I was 1st diagnosed finding 1st hand experience from others was helped me most. Just one last word of advice though, I wouldn't say its good to think of oneself as "liability", its not such a positive or healthy way of seeing things. The only "liability" in avaiation is an airman who exhbits poor airmanship and poor judgement and lack of repsonsibility!