Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
Highlights
In 2010, a comprehensive review of keratoconus was published in Contact Lens & Anterior Eye, which became the most cited article of the journal to date [1]
Various machine learning algo rithms have been developed using routinely collected clinical parame ters that can assist in the objective detection of early forms of the disease [2,155]
Corneal cross-linking is recommended to increase the biomechanical stability and rigidity of the cornea, with early intervention normally warranted, which highlights the importance of early diagnosis and close moni toring
Summary
In 2010, a comprehensive review of keratoconus was published in Contact Lens & Anterior Eye, which became the most cited article of the journal to date [1]. This article reviewed the definition, epidemiology, clinical features, classification, histopathology, aetiology and patho genesis, and management and treatment strategies for keratoconus. Improvements in corneal topography and the advent of corneal tomography has increased the ability of eye care practitioners to diagnose corneal ectasia at a much earlier stage than was previously possible. These imaging techniques, along with the increased use of wavefront aberrometry, have allowed better characterisation of the optical, anatomical, biomechanical and histopathological changes associated with keratoconus [2]. Together with recent developments of contact lens and surgical options for keratoconus, have lead to improved clinical management [3,4]. When several research papers reporting on similar findings appeared during the literature search, the most updated article(s) was typically used for review
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