AIM: To evaluate the visual, refractive and corneal asphericity changes after intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation of keratoconus. METHODS: A total of 42 eyes of 32 patients were included. After creation of intrastromal tunnels of 5.01±0.03 mm inner diameter, 5.71±0.03 mm outer diameter and at 384.21±34.12 μm depth, 1 or 2 ICRS of 150-300 μm thickness and 90°-210° arc length were implanted. Changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive errors, mean simulated keratometry readings (SimKavg), anterior and posterior corneal asphericity values (Qant and Qpost, respectively) measured with Scheimpflug topography were evaluated retrospectively. RESULTS: There was a significant improvement in UDVA and CDVA, along with a significant decrease in refractive spherical equivalent (SE), cylinder and SimKavg postoperatively (P<0.001 for all). Mean Qant increased from -1.06±0.48 to -0.57±0.58 postoperatively (P<0.001). Change in mean Qpost was insignificant (P=0.92). Postoperative changes in UDVA and CDVA were not correlated with the postoperative changes in SE and cylinder (P>0.05 for all); but were correlated with the preoperative SimKavg and Qant values (P<0.001 for all). CONCLUSION: ICRS implantation seems to approximate the anterior corneal asphericity of “advanced prolate” shape to “optimal prolate” shape and an “ideal Q value” of -0.46; which may have a role in improved UDVA and CDVA postoperatively, besides decreased refractive cylinder values.