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The natural history of corneal topographic progression of keratoconus after age 30 years in non-contact lens wearers
  1. Akilesh Gokul,
  2. Dipika V Patel,
  3. Grant A Watters,
  4. Charles N J McGhee
  1. Faculty of Medical and Health Sciences, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
  1. Correspondence to Professor Charles N J McGhee, Faculty of Medical and Health Sciences, Department of Ophthalmology, New Zealand National Eye Centre, Private Bag 92019, University of Auckland, Auckland, 1142, New Zealand; c.mcghee{at}


Background/aims To determine if significant progression of disease occurs in older, non-contact lens wearing, subjects with keratoconus and to identify potential predictive factors.

Methods Clinical and computerised corneal topography records of subjects with keratoconus attending a specialist optometry practice were retrospectively analysed to identify those aged ≥30 years, with ≥2 consultations ≥12 months apart, no contact lens wear and no corneal scarring, surgery or corneal hydrops. Topographic parameters assessed included: maximum keratometry (Kmax), steep keratometry (Ksteep), flat keratometry (Kflat), inferior-superior (I-S) ratio and the surface asymmetry and regularity (surface asymmetry index and surface regularity index) indices.

Results Of the 449 subjects with keratoconus assessed, 43 eyes of 27 patients (6.01%) met inclusion criteria, with median age 38.45 (12.86) years at baseline and median follow-up 4.36 (8.68) years. There was a significant increase in Kmax (0.30 (1.21) D), Ksteep (0.27 (0.90) D), Kflat (0.34 (1.12) D) and I-S (0.26 (0.82) D) between baseline and final review, p<0.05. Notably, 18.6%–25.6% of eyes demonstrated ≥1.00 D increase in one or more of four principal topographic parameters (Kmax, Ksteep, Kflat, I-S ratio), while 18.5%–37.0% of subjects had ≥1.00 D increase in the aforementioned parameters in at least one eye over the study period. However, <10% of eyes exhibited ≥1.00 D increase/year in all topographic parameters. The only significant predictor of progression was follow-up time.

Conclusions This study confirms that keratoconus may continue to progress beyond age 30. Older subjects with keratoconus should be monitored for progression, particularly with respect to possible corneal collagen cross-linking or astigmatic correction in cataract surgery.

  • Cornea
  • Imaging

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  • Contributors All the authors contributed to the design of the study. AG and GAW carried out the study, analysing patient records and collecting data. AG performed the statistical analysis of the data. All the authors contributed to writing the paper. AG produced the draft manuscript which was edited and critiqued by DVP, GAW and CNJM. All authors approved the final version.

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was obtained from the University of Auckland Human Participants Ethics Committee (approval number: 010547).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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