Keratoconus and quality of life: an updated comprehensive review

Keratoconus (KCN), a progressive ectatic corneal disorder, significantly impacts vision-related quality of life (VRQoL) beyond reduced visual acuity. This review aims to comprehensively examine the impact of keratoconus on patients' quality of life (QoL), considering its economic burden and the effectiveness of various treatment modalities in improving QoL outcomes. KCN profoundly impacts VRQoL, exceeding the effects of reduced visual acuity alone. Multiple factors contribute: refractive errors (leading to challenges with spectacle and contact lens correction, impacting comfort and convenience), decreased contrast sensitivity (hindering daily activities like driving and reading), ocular pain and discomfort (often stemming from the disease itself or treatment), and associated comorbidities (such as vernal keratoconjunctivitis, further compromising ocular health). Disease severity significantly influences VRQoL, with more advanced KCN generally linked to lower QoL scores, although this correlation is not consistently observed across studies. Demographic variations also play a role, with differences noted across genders and age groups in various studies. Nonsurgical options include spectacles (effective in early stages only), contact lenses (soft, rigid gas permeable, and scleral lenses offering varying degrees of visual correction and comfort), each impacting QoL differently based on visual improvement, comfort, and cost. Surgical interventions, such as corneal collagen crosslinking, indirectly improve QoL by stabilizing vision; however, they may not fully restore visual acuity and involve a period of postoperative discomfort. Intracorneal ring segments improve corneal shape and refractive errors, enhancing visual acuity and potentially QoL, but long-term effects and suitability depend on disease stability. Corneal transplantation, reserved for advanced cases, significantly improves vision and QoL for many patients, but it is an invasive procedure with potential complications and a recovery period that can impact QoL. Combined treatment approaches may optimize outcomes, but the optimal strategy remains individualized based on disease severity, patient preferences, and resource access. Ultimately, successful KCN management hinges on a balance of objective visual improvements and subjective QoL enhancements.