Collagen crosslinking (CXL) has emerged as the standard intervention to arrest progression of corneal ectasia [1,2,3,4,5]. Since 2015, young patients with keratoconus in NHS Greater Glasgow and Clyde (NHSGGC), Scotland, have been monitored every 4–6 months in a dedicated optometrist-led early keratoconus clinic. Those with documented evidence of progression are offered CXL, a cost-effective procedure intended to stabilise the cornea and avoid future corneal transplantation [6, 7]. CXL has been shown to be effective in arresting the progression of corneal ectasia in this younger age group at 2 and 5 years follow up [1, 8,9,10]. Progression of keratoconus is known to be more aggressive in the younger age group, so CXL services were protected and prioritised in many corneal units during the COVID-19 pandemic [11]. These measures were necessary as rapid topographic changes may occur and result in corneal thinning progressing beyond standard treatment protocols (corneal thickness <400 μm). [12] In light of this, the advocacy for early intervention with CXL at presentation rather than ‘wait for documented progression’ is growing for the younger age group. We wished to identify our younger patients with keratoconus and model the real-world clinical, financial costs, and service capacity implications of ‘waiting for documented progression’ prior to CXL.

Electronic records of patients <21 years of age at referral attending our early keratoconus clinic in NHSGGC between January 2015 and September 2019 with a minimum of 1 year follow up were retrospectively reviewed. Demographic, topography, visual acuity, clinic attendance, and intervention data were analysed.

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