Progressive Keratoconus Prevalence Relatively High in Adults

Though corneal ectasias can range in severity, keratoconus (KC) often progresses to debilitating levels that compromise quality of life. It’s particularly important to get younger patients evaluated and promptly treated. In a new study published in Cornea, researchers based in Turkey analyzed KC patients to determine how various factors affect the condition. One previous report found that a steep cornea and a thin minimum radius at initial examination were risk factors for needing corneal crosslinking later on, stressing the point that advanced topographic indices, like steeper, thinner corneas, strongly predict future progression. Photo: Thomas Wong, OD. Click image to enlarge. Included were a total of 949 eyes from 503 patients, all of whom had one year or more of follow-up and three or more Pentacam scans spaced at intervals of three or more months apart. Progression was analyzed in five age groups: under 18, 18-24, 25-30, 31-35 and over 35. Severity was determined by the Topographic KC Classification (TKC) system: subclinical, early-stage or advanced stages (TKC 1, 2, 3 and 4, respectively.)Progression rates of KC were found to decline significantly with age. Interestingly, though, 44.3% of those aged 35 or older still experienced progression of at least one eye, with the highest rate seen in those ≤18 years old (86.4%). Also in the oldest age group, advanced-stage disease (TKC 3 and 4) markedly increased risk of progression, with rates of 10- to 20-fold increased risk. Of those in the ≥35 group who had progression, the majority (74.2%) only had it in one eye. Shortest time-to-progression was seen once again in those ≤18 years old, with median time being 8.6 and 5.8 months in TKC 1-2 and 3-4, respectively. In those ≥35, advanced-stage disease progressed earlier than early-stage, with median time-to-progression being 18.9 vs. 38.2 months.In total, 55.3% of cases progressed. Men and women had comparable rates—56.1% and 54.3%, respectively—and bilateral progression was most common in those under 18 (50%), but with no significant distribution across age groups. Among all TKC stages, highest progression was seen in the bracket of ≤18 and in advanced disease at 91.7%.Due to the relatively high rate of progression seen in older KC patients, the study authors recommend that “advanced stage KC should be considered a risk factor for disease progression” and that “these findings are consistent with prior literature emphasizing the impact of age on the clinical course of KC and highlight the need for age-tailored risk stratification in both disease monitoring and treatment planning.”  More generally, they communicate that “understanding progression rates in KC by age, gender, and initial severity at presentation is essential for identifying cases requiring intervention (i.e., corneal crosslinking) while avoiding overtreatment in cases that would otherwise remain stable.” Click here for the journal source. Ozalp O, Ozaslan MK, Apaydin F, et al. Evaluating natural progression of keratoconus in relation to age, gender, and disease severity at presentation. Cornea. September 2, 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.