First presentation of keratoconus in a geriatric patient: Diagnosis and treatment of late progression

This case report presents an atypical, late presentation of keratoconus in a geriatric patient with successful management using a transepithelial corneal crosslinking (CXL) procedure. The treatment-naive 77-year old patient presented to the clinic after an assessment by an optometrist for recent onset of reduced vision that was initially thought to represent early cataract development. Corneal topography confirmed keratoconus, and subsequent review identified further progression. Crosslinking was performed using a transepithelial approach. The patient was followed for 3 years postoperatively. By the final visit, the uncorrected distance visual acuity had improved and the corrected distance visual acuity remained at 20/20 bilaterally. Corneal topographic parameters were considered stable. This case shows that keratoconus can present outside the previously established parameters and that CXL might be an effective option in older patients showing signs of progression. This might have additional benefits for future intraocular lens power calculations.