This retrospective study compared keratoconus severity at diagnosis and scalability during a two-year period in children versus adults. The study's authors found that the disease is often more advanced at diagnosis in children, with faster progression. They conclude that early detection and close monitoring are crucial in young patients, particularly because of the new therapeutic options available in recent years.
The study included 216 patients seen within two years of diagnosis. At diagnosis, 49 (22.7 percent) were younger than 15 years and 167 (77.3 percent) were older than age 27 years. Severity at diagnosis was assessed using Krumeich's classification and scalability using U.S. Food and Drug Administration 2010 criteria.
The authors found that 27.8 percent of children in the study were diagnosed at stage 4 compared with 7.8 percent of adults (P < 0.0001). Ophthalmoscopic signs were more frequent in children (42.9 vs. 29.5 percent, P = 0.05), and mean values of maximum, average and minimum keratometry, as well as simulated keratometric astigmatism were higher (P < 0.0001, P = 0.0002, P = 0.0005, and P = 0.001, respectively).
While keratoconus was observed to evolve faster in children, with significant differences in the spherical equivalent and maximum and minimum keratometry compared with adults (P = 0.03, P = 0.02, P = 0.04, respectively), it did not evolve more frequently in them.
The authors note that recent technologies, such as topography, aberrometry and the Ocular Response Analyzer, allow for an earlier diagnosis prior to the onset of functional or clinical signs of the disease. They say, therefore, that corneal topography should be systematically performed in children with corneal astigmatism of recent onset.