Keratoconus Management: Navigating Patient Options


  • Amir R. Vosoughi, MD
  • Guillermo Rocha, MD, FRCSC, FACS



Keratoconus (KC) is a condition which results in progressive corneal thinning. It was first discovered by Dr. John Nottingham in 1854 who described it as “conical cornea” due to the outward bowing appearance caused by the condition. The prevalence of KC is between 0.2 and 4,790 per 100,000 people. KC does not have a gender predilection. It is believed to appear more commonly in South Asian and Middle Eastern populations.

Keratoconus typically begins in the second and third decades of life although it can develop at any time. The clinical symptoms of the condition include blurred and distorted vision. Patients may present with higher-order aberrations (HOA) ̶ the most characteristic of which is coma ̶ resulting in blurred and double vision. The common signs of KC include corneal protrusion and thinning, prominent corneal nerves, Fleischer ring, Vogt’s striae, and scissors reflex on retinoscopy. The most frequently encountered phenotype is oval cones in the central cornea. The primary diagnostic tool for KC is corneal topography, although pachymetry, including epithelial mapping and corneal tomography, are often performed in conjunction with each other as they aid with early detection and the monitoring of KC progression. 

Advancements in clinicians’ knowledge of KC and expertise in its treatment, have led to novel therapies. Stopping disease progression is now possible and improving patients’ quality of vision is feasible in many cases.

Preventive measures halting progression and management of mild and moderate forms of KC are reviewed. Treatment of severe KC will also be briefly reviewed.

Author Biographies

Amir R. Vosoughi, MD

Dr. Amir R. Vosoughi received his Bachelor of Science and Doctor of Medicine from the University of Manitoba. He is currently undertaking a Master of Science in Epidemiology from the London School of Hygiene and Tropical Medicine. He is interested in both basic and clinical research, with particular interest in neuro-ophthalmology and addressing sex and race disparities across clinical trials.

Guillermo Rocha, MD, FRCSC, FACS

Dr. Guillermo Rocha is originally from Mexico City, Mexico. He trained in ophthalmology at McGill University in Montreal and has completed subspecialty training in ocular immunology and inflammation, and cornea and external diseases. He completed the Physician CEO Executive Program at the Kellogg School of Management (2016) and the Foundations of Clinical Research Certificate Program, Harvard Medical School (2022). He is Professor of Ophthalmology at the University of Manitoba, President of the COS Foundation, Past President of the Canadian Ophthalmological Society (2016-2018), and past President of the Canadian Cornea, External Diseases and Refractive Surgery Society. In 1995, he was awarded the Canadian Society for Clinical Investigation & Medical Research Council of Canada Resident Research Award for his work on the causative factors of ocular inflammation. Dr. Rocha was the recipient of the Lieutenant Governor of Manitoba iCare Award for 2014. In 2015, he was recognized as one of the 10 Most Successful Mexicans in Canada, followed by an award as one of the 10 Most Influential Hispanic Canadians in 2016. Dr. Rocha performs anterior segment, refractive, and corneal surgeries.


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How to Cite

Vosoughi AR, Rocha G. Keratoconus Management: Navigating Patient Options. Can Eye Care Today [Internet]. 2023 Feb. 1 [cited 2023 Dec. 4];2(1):25–29. Available from:




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