Diagnosis and management of keratoconus in the paediatric age group: a review of current evidence

• Published in: Eye (London) Vol. 37; no. 18; pp. 3718 - 3724
• Main Authors: Price, Liam D., Larkin, Daniel F. P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2023; Nature Publishing Group
• Subjects: 692/699/3161/3163; 692/700/139; 692/700/565/545; Adolescent; Adolescents; Adult; Age groups; Child; Clinical trials; Collagen - therapeutic use; Cornea; Corneal Topography; Corneal transplantation; Cross-Linking Reagents - therapeutic use; Diagnosis; Follow-Up Studies; Humans; Keratoconus; Keratoconus - drug therapy; Keratoconus - therapy; Laboratory Medicine; Medicine; Medicine & Public Health; Ophthalmology; Pediatrics; Pharmaceutical Sciences/Technology; Photochemotherapy - methods; Photosensitizing Agents - therapeutic use; Review Article; Riboflavin - therapeutic use; Surgery; Surgical Oncology; Ultraviolet Rays
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-023-02600-1

The diagnosis and management of keratoconus in the paediatric age group presents additional challenges to those encountered in adults. The most significant of these, encountered in some young patients, are delayed presentation of unilateral disease, more advanced disease at diagnosis, difficulty in obtaining reliable corneal imaging, faster rates of disease progression and challenges in contact lens management. The stabilisation effect of corneal cross-linking (CXL), more extensively studied in adults with randomised trials and long-term follow-up, has been much less rigorously examined in children and adolescents. The high heterogeneity of published studies in younger patients, particularly in the choice of tomography parameters designated as primary outcome measures and the definitions of progression, indicates that improved standardisation for future studies on CXL will be necessary. There is no evidence that corneal transplant outcomes in young patients are poorer than those in adults. This review provides a current perspective on the optimal diagnosis and treatment of keratoconus in children and adolescents.