title: Scalability and severity of keratoconus in children.
abstract: OBJECTIVE
  To assess the severity of keratoconus at diagnosis and its scalability over a period of 2 years in children compared to adults.
  
  
  METHODS
  A retrospective monocentric study was conducted in the National Reference Center for Keratoconus, Bordeaux (France), between October 1997 and November 2010.
  
  
  METHODS
  In total, 216 patients were studied, comprising 49 patients (22.7%) aged ≤ 15 and 167 patients (77.3%) aged ≥ 27 years at diagnosis, who were seen within 2 years of diagnosis. Severity at diagnosis was assessed using Krumeich's classification, and the scalability criteria of the US Food and Drug Administration (2010) were used. Student t tests and χ(2) tests were performed to compare the 2 groups.
  
  
  RESULTS
  Keratoconus in children was significantly more severe at diagnosis, with 27.8% being stage 4 vs 7.8% of adults (P < .0001). In addition, ophthalmoscopic signs were more frequent in children (42.9% vs 29.5%, P = .05), while mean values of maximum, average, and minimum keratometry as well as simulated keratometric astigmatism were higher (P < .0001, P = .0002, P = .0005, and P = .001, respectively). After diagnosis, keratoconus did not evolve more frequently in children. However, in the case of progression, keratoconus evolved faster in children, with significant differences in the spherical equivalent and maximum and minimum keratometry (P = .03, P = .02, P = .04, respectively).
  
  
  CONCLUSIONS
  At diagnosis, keratoconus is often more advanced in children than in adults, with faster disease progression. Early detection and close monitoring are therefore crucial in young patients.
authors.affiliation: Department of Ophthalmology, University Hospital Pellegrin, Bordeaux, France; University of Bordeaux, Bordeaux, France. sandy.leoni@chu-bordeaux.fr
authors.forename: Sandy
authors.initials: S
authors.lastname: Léoni-Mesplié
authors.forename: Bruno
authors.initials: B
authors.lastname: Mortemousque
authors.forename: David
authors.initials: D
authors.lastname: Touboul
authors.forename: Florence
authors.initials: F
authors.lastname: Malet
authors.forename: Delphine
authors.initials: D
authors.lastname: Praud
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mesplié
authors.forename: Joseph
authors.initials: J
authors.lastname: Colin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D002648:Child; D003315:Cornea / Q000503:physiopathology; D019781:Corneal Topography; D018450:Disease Progression; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity / Q000502:physiology