My 5-year-old kid has keratoconus stage 1 with high cylindrical powers. Will it lead to vision loss?

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I am sorry to hear that she has been diagnosed as Keratoconus stage 1. However, I am surprised as the age is too low. It generally sets in adolescents with onset in early to mid-teens. I guess it is difficult for me to comment without seeing her topography pictures. However, she seems to have early signs in topography and if you can keep her away from rubbing her eyes too much (hence Olopatadine is given), the chance of progression and vision loss is less. Even if it progresses later in life, there are many treatment modalities like collagen-cross linking which cures it to much extent. I suggest repast the topography every 6 months and use the drops.

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I have seen all the topography scans (attachment removed to protect patient identity). I myself being a pediatric ophthalmologist, I am seeing many children with high astigmatism and your child seems to be having around 4.0 to 4.50 cylindrical errors in both eyes. While it is absolutely fine to get the topography done for such high cylindrical powers. I order the scans only when there is a change in cylindrical powers over time (ideally it does not change over time). From the scans, to be honest, I see no abnormalities. It is a normal symmetric bow tie in both eyes. If she was my patient I would have assured you that everything is fine. She has no keratoconus changes as far as I am concerned. You have to remember such high cylindrical power is generally present since birth and she can see a bit less than 6/6 even with glasses and then we have to advise patching therapy if vision is 6/12 or worse with glasses. The red flag for keratoconus is when cylindrical power changes over time and in some cases long term itching of eyes and hence rubbing can lead to keratoconus changes but it is not until mid teens. If she has itching continue Olopatadine. Check power every 6 months. Tell her to avoid rubbing. Apply a cool compress. Her eyes are fine and definitely she is not having keratoconus.

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