Diagnosis and management of paediatric keratoconus
Reviewed by Ivan Yip

This article reviews the current literature on paediatric keratoconus diagnosis and management. Paediatric cases pose challenges as they may not vocalise unilateral changes, difficulty in obtaining reliable imaging, faster rates of progression, difficultly with contact lenses and presumed worse outcomes for corneal grafting. In terms of diagnosis and monitoring, corneal topography is the mainstay and similar to adults, and more work is needed to evaluate if the children have different corneal parameters. Efficacy of crosslinking studies is hampered by heterogenous outcomes where studies have different definitions of progression. Although not always statistically significant, the trend is that corneal cross-linking (CXL) has an impact. In terms of corneal transplant new evidence suggests children have comparable outcomes to adults and further studies on deep anterior lamellar keratoplasty (DALK) compared to penetrating keratoplasty (PK) may increase survival rates further. The review highlighted the need for keratoconus literature to adopt standardised definitions, outcomes and further research into the natural course of keratoconus.

Diagnosis and management of keratoconus in the paediatric age group: a review of current evidence.
Price LD, Larkin DFP.
EYE
2023;37(18):3718–24.