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Invited Commentary
March 28, 2019

A New Scoring System for Progressive Keratoconus

Author Affiliations
  • 1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
  • 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
  • 3Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  • 4Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  • 5Visual Science Academic Clinical Programme, Duke-NUS, Singapore
JAMA Ophthalmol. Published online March 28, 2019. doi:10.1001/jamaophthalmol.2019.0431

Keratoconus is the most common corneal dystrophy in the Western world, frequently leading to severely impaired vision, most commonly in late childhood to early adulthood. Up to 25% of individuals with keratoconus will progress to a disease stage in which sharp visual acuity cannot be achieved anymore with vision correction and surgery is required. In recent years, corneal crosslinking (CXL) has become an established treatment to reduce the progression of keratoconus, thus eventually avoiding the need for corneal transplant.1,2 This underlines the importance of an early identification of patients at risk. The current clinical paradigm states that the indication for CXL and its optimal moment within the disease process is mainly based on changes in keratometry over time.3 It is, however, well known that the progression rate of the disease is highly variable, and other risk factors, including age and sex, play an essential role. For example, younger patients with keratoconus are more likely to progress quicker than older individuals.4 Finding the right time for an intervention is therefore challenging.