Battle of the bulge

28 February 2019
Winter 2019

Acuity looks at the importance of early diagnosis of keratoconus, and how you can help signpost towards effective treatment and manage the patient over the long term.

Progressively worsening vision, irregular astigmatism and glare have a huge impact, but early detection of keratoconus, new and promising treatments, and reassuring aftercare can significantly improve patients’ quality of life.


The incidence of keratoconus is around 1 in 450 to 1 in 10,000, depending on ethnicity and where in the world people live. While the precise reasons for the onset of the condition continue to be debated, the course of the disease is well understood. The central or paracentral corneal stroma undergoes progressive thinning and loss of structural integrity, leading to characteristic cone-like deformation and adverse impact on vision. Typically the disease afflicts both eyes, and patients present with irregular astigmatic changes resulting from the biomechanical warping of the cornea (Soiberman et al, 2017). Early diagnosis is critical, as prompt identification of the condition can lead to treatment that can help stabilise the cornea prior to visual changes.

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