Although a “gene for keratoconus” (or a gene that at lease predisposes people to develop keratoconus) has not yet been found, the disease is likely to occur in a person who has family members who also have the disease. It is therefore very important to make sure that if one family member has keratoconus, all family members are screened for the disease.
Many keratoconi go undetected for years and – the disease can lay relatively dormant for years. However, the cones can become active at any time and this will affect people’s vision. Time and time again, we examine the children of our adult keratoconus patients and find that they have an incipient keratoconus – despite the fact that the child is not (yet) wearing glasses and their vision is still good. In such a case, regular monitoring and early cross-linking are important to maintain good eyesight.
A 56-year-old family man with bilateral keratoconus. His three children do not wear glasses and have good eyesight (according to their parents). During the screening, the 17-year-old son showed a previously undiscovered grade I keratoconus in the left eye. The right eye was suspicious, but not yet obviously ill.
If keratoconus is discovered in children, it should be treated directly with CXL. Cross-linking in children and adolescents has been established for years and we have one of the longest experiences worldwide. So if we find the disease in children, we will not hesitate to treat them.