Keratoconus

A 22-year-old male presents with progressive blurring of vision and frequent changes in spectacle prescription over the past 18 months. He reports a family history of keratoconus in his father. On examination, visual acuity is 6/18 in both eyes that does not improve with pinhole. Slit-lamp examination reveals a cone-shaped protrusion of the cornea with Vogt's striae and Fleischer ring. Retinoscopy shows irregular astigmatism. What is the most appropriate initial management for this patient?

Which genetic syndrome is most commonly associated with keratoconus?

A 22-year-old male presents to the ophthalmology clinic with progressive blurring of vision and frequent changes in spectacle prescription over the past 18 months. He reports rubbing his eyes vigorously due to chronic allergic conjunctivitis. On examination, visual acuity is 6/36 in both eyes. Slit-lamp examination reveals a conical protrusion of the cornea with stromal thinning at the apex. Keratometry shows irregular astigmatism with a difference of >1.5 D between the two meridians. What is the most appropriate next step in management?

A 28-year-old woman with Down syndrome presents with a 3-year history of progressive visual deterioration. She complains of blurred vision and frequent changes in her glasses prescription. Her mother reports that the patient rubs her eyes constantly. On slit-lamp examination, there is a characteristic conical protrusion of the cornea with Vogt's striae and Fleischer ring visible. Corneal topography confirms irregular astigmatism with a central corneal power of 52 D. The patient has tried spectacles and soft contact lenses without satisfactory visual improvement. What is the most appropriate management to halt disease progression?

A 22-year-old male presents with progressive blurring of vision and frequent changes in spectacle prescription over the past 18 months. He reports rubbing his eyes vigorously due to chronic allergic conjunctivitis. On examination, visual acuity is 6/18 in both eyes that does not improve significantly with refraction. Slit-lamp examination reveals a cone-shaped corneal protrusion with stromal thinning at the apex. Keratometry shows marked astigmatism with against-the-rule pattern. What is the most appropriate next step in management?