The Second Global Consensus on Keratoconus is close to publication, and has been presented at several international congresses during 2025.
A long-awaited update defining international standards for keratoconus care
The Consensus was organised by José Álvaro Gomes MD, PhD; Renato Ambrósio Jr MD, PhD; and Farhad Hafezi MD, PhD, FARVO, and brought together experts from 12 international societies spanning six continents. Its aim was to distil collective expert judgement into practical, internationally applicable guidance for keratoconus care.
How the Consensus was developed
As outlined in the EuroTimes report, the document was produced using a modified Delphi methodology. Only statements achieving a minimum agreement threshold of 66% were accepted, ensuring that recommendations reflected broad expert consensus rather than individual opinion. The organisers emphasised that the resulting document represents a structured snapshot of current international practice rather than a static or prescriptive endpoint.
Clinical relevance beyond academia
The Second Global Consensus is intended to function as a practical clinical framework. In addition to supporting day-to-day decision-making, it is designed to help professional societies, training programmes, and healthcare systems harmonise standards of care across regions. By consolidating evidence-based recommendations, the Consensus also informs policy discussions related to corneal disease management.
Key updates presented at ESCRS 2025
Several core updates were presented during a Cornea Day session at the 2025 ESCRS Annual Congress in Copenhagen. These included immediate treatment of children at diagnosis, adoption of the Belin ABCD system for staging and monitoring, and updated guidance on cross-linking strategies for thin corneas, including protocols such as ELZA-sub400.
The programme also addressed newer techniques and technologies—such as ELZA-PACE, CAIRS, and SLAK—and discussed their role within a broader treatment pathway that extends beyond disease stabilisation toward functional visual rehabilitation.
A structured overview of the Consensus was delivered, with sessions covering diagnostic definitions, staging, and cross-linking strategies. The organisers noted that the final publication draws on the work of seven expert panels addressing definition and staging, non-invasive treatment, cross-linking, invasive visual rehabilitation, keratoplasty, refractive surgery, and cataract surgery in keratoconus.
Read the EuroTimes coverage of the Second Global Consensus on Keratoconus
From stabilisation to visual rehabilitation
If the First Global Consensus helped establish corneal cross-linking as the standard of care, the 2025 update reflects a broader ambition. The Second Consensus integrates advances in multimodal diagnostics, individualised treatment planning, ectasia prevention, and visual rehabilitation. For many patients, this shift means moving beyond progression control toward meaningful improvements in visual function and quality of life.
