Evaluating Natural Progression of Keratoconus in Relation to Age, Gender, and Disease Severity at Presentation
CORNEA, vol.45, no.8, pp.1019-1025, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 45 Issue: 8
- Publication Date: 2026
- Doi Number: 10.1097/ico.0000000000003979
- Journal Name: CORNEA
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Page Numbers: pp.1019-1025
- Istanbul University Affiliated: No
Abstract
Purpose: To investigate the natural progression of keratoconus (KC) with respect to age, gender, and disease severity at presentation. Methods: This study analyzed 949 eyes from 503 patients with KC followed at Eski & scedil;ehir Osmangazi University and Istanbul University-Cerrahpa & scedil;a between 2009 and 2023. Patients with >= 1 year of follow-up with >= 3 Pentacam (Oculus, Inc) scans spaced >= 3 months apart were eligible. Progression was identified using Belin ABCD Progression Display using 2 baseline visits. Progression rates were analyzed according to age groups (<= 18, >18 to <= 24, >24 to <= 30, >30 to <35, and >= 35 years), and KC severity was categorized based on the Topographic Keratoconus Classification (TKC) as subclinical, early-stage (TKC 1-2) and advanced-stage (TKC 3-4). Median time-to-progression (M-TTP) for progressive eyes was calculated with reference to the first presentation. Results: Keratoconus progression rates declined significantly with age ( P < 0.001); however, 44.3% of patients aged >= 35 years still showed progression, with the highest rate in those <= 18 years (86.4%). In patients >= 35 years, advanced-stage disease (TKC 3 and 4) markedly increased progression risk (OR: 10.5 [ P = 0.03], 20.0 [ P = 0.008], respectively). The shortest time-to-progression occurred in patients aged <= 18 years (M-TTP: 8.6 and 5.8 months in TKC 1-2 and 3-4, respectively), whereas in those >= 35 years, advanced-stage disease progressed significantly earlier than early-stage (M-TTP: 18.9 vs. 38.2 months). Conclusions: Although progression typically slows with age, 44% of patients >= 35 years still progressed. The shorter time-to-progression in younger individuals and in older patients with advanced disease at presentation highlight the need for close monitoring in both groups.