Screening for Keratoconus and Related Ectatic Corneal Disorders

To the Editor: We read with great interest, but ultimately great concern, the recent article ambitiously titled “Global consensus on keratoconus and ectatic corneal diseases.” Undoubtedly, this process was a significant undertaking, and we commend the leadership of the representative Cornea Societies for their efforts. We, however, have serious concerns about the “take-home” messages from the Definition/Diagnosis Section and believe that these represent opinions that are unsupported by scientific data, potentially misleading, and not representative of the current standard of care with respect to keratoconus detection and refractive surgery screening. How is keratoconus (and related ectatic corneal disorders) best identified at its earliest stage? What constitutes the most accurate screening protocol? Many solid screening protocols exist already using Placido-based corneal topography to evaluate anterior surface changes. Beyond these, additional screening metrics are being investigated, including epithelial thickness mapping, and posterior corneal surface and relative corneal thickness metrics as highlighted by the authors. Unfortunately, the consensus statements do not reflect the ongoing controversies and scientific pursuits to answer these fundamental questions. Specifically, we take issue with the following statements, which are abstracted, word for word, from the article’s Table 2: