<p>Optimal management of pediatric keratoconus: challenges and solutions</p>

Abstract

Keratoconus (KC) shows several distinctive features in clinical appearance, disease progression, and treatment in children compared with adults. Therefore, diagnostic, clinical care, and therapeutic approaches are different. However, pediatric keratoconus is often undiagnosed and thus untreated in many cases. Once diagnosis has been made, compliance with treatment recommendations is often poor. Pediatric keratoconus also tends to have more rapid progression than in adults; therefore, early detection and treatment are paramount to prevent serious vision impairment, which can affect the child’s development. This review of pediatric keratoconus discusses important issues such as worldwide epidemiology, clinical features in children compared to adults, and challenges in diagnosis and treatment and focuses on the most appropriate management strategies based on the best available current evidence.

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

“…Corneal cross-linking is recommended to apply to halt progression of the disease in mild-to-moderate corneal extasia. 3 Conventional epithelium-off CXL, usually referred to as 'Dresden' protocol, was applied in the majority of keratoconus. However, recently increasing attention is being paid to the faster alternate, the accelerated protocols.…”

“…2 In pediatric population, the prevalence of pediatric keratoconus is reported to be higher from 1/375 to 1/2000. 3 Keratoconus commonly presents in the second decade and progresses until the third or fourth decade of life; compared with adults, pediatric keratoconus is more severe with higher risk of deterioration and faster progression. 4,5 The clinical characteristics of keratoconus include progressive loss of vision and increasing irregular astigmatism, resulting from a more conical shape in thinning and steepening cornea.…”

“…These factors may contribute to a late seeking in medical care and more deterioated visual function in pediatric patients. 3 Visual impairment in keratoconus severely affects educational, economical, and social development, which may decrease patients' quality of life. Thus early and prompt intervention to halt the progression and improve visual quality is very important.…”

Baseline factors predicting the need for corneal crosslinking in patients with keratoconus

“…Keratoconus is well known to progress in younger patients. Early onset keratoconus tends to progress at a faster rate, and is more likely to require corneal transplant, compared with late onset cases [10,11]. Therefore, many clinicians recommend that CXL be performed immediately in younger keratoconus patients [12][13][14], which accords with our finding of an association of younger age with the requirement for CXL.…”

<p>Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective</p>

“…The age of presentation in our study is similar to studies conducted in Nepal, 2 Kenya, 9 Iran 33 and Malaysia 34 and slightly lower than studies in Ghana 7 and South Africa. 35 The concern with the widespread late presentation is that recent studies indicate that the onset of KC may be as young as 4 years of age 36 with rapid progression during puberty. 37 Despite the expected negative impact on education and daily living functions experienced by these young individuals, they continue to endure reduced visual morbidity challenges for many years before seeking care.…”