Follow-up of Patients with Keratoconus

Follow-up of Patients with Keratoconus: Protocol and Recommendations

Keratoconus is a progressive disease, so structured follow-up is essential to preserve vision and adjust treatments based on its progression. Below, we detail the recommended protocol based on the stage of the disease.

Checkup Frequency

Depends on the severity and stability of the keratoconus:

Keratoconus Stage

Mild (no progression)

Every 12-24 months

Moderate (stable)

Every 6-12 months

Advanced or progressing

Every 3-6 months

Post-Crosslinking (CXL)

At 1, 3, 6, and 12 months (then annually)

Post-ring implantation

At 1, 3, 6, and 12 months (then annually)

Key Follow-up Tests

Corneal Topography

Evaluates changes in corneal curvature.

Detects early progression (increasing asymmetry or elevation).

Corneal Tomography (Pentacam)

Analyzes corneal thickness (pachymetry) and 3D structure.

Identify areas of thinning or ectasia.

Visual Acuity (with and without correction)

Monitor the effectiveness of glasses/contact lenses.

Slit Lamp Examination

Look for Vogt's striae, scarring, or corneal hydrops (in advanced cases).

Management Based on Progression

Stable Case (No Change)

Continue with optical correction (glasses/contact lenses).

Continue follow-up according to initial severity.

Progression Detected

If Crosslinking (CXL) has not been performed:

Prescribe epi-off CXL (gold standard for stopping progression).

If CXL is already present but continues to progress:

Evaluate intracorneal rings (ICRS) or ICL (if high myopia is present).

Consider repeating Crosslinking (CXL).

In advanced cases with scarring:

Consider corneal transplantation (DALK or PKP).

Patient Recommendations

Avoid rubbing your eyes (it worsens corneal thinning).

Use specialized contact lenses (RPG, scleral) if tolerated.

Monitor eye allergies (antihistamines, lubricants).

UV protection (sunglasses with filters to prevent corneal damage).

Self-monitoring with an Amsler grid (to detect new distortions).

Warning Signs to Seek Urgent Care

Sudden vision loss.

Sudden increase in halos or distortions.

Eye pain + redness (possible corneal hydrops).

90% of cases are stabilized with crosslinking if detected early.

Rigid/scleral lenses improve vision in 80% of patients with advanced keratoconus.