Keratoconus presents a particular challenge for eye-care systems across the Middle East.
It often begins when patients are young, can progress at very different rates, and may affect quality of life long before the patient reaches advanced disease. At the same time, the modern keratoconus pathway has become increasingly sophisticated: corneal tomography can identify early structural changes, cross-linking can be considered when progression is documented, and advanced contact lens technology can restore functional vision even in highly irregular corneas.
The challenge is no longer simply detecting keratoconus.
It is creating a care pathway that connects early diagnosis, disease stabilization and visual rehabilitation rather than treating them as separate problems.
This is particularly relevant in the Middle East, where several epidemiological studies have reported substantial keratoconus prevalence in selected regional populations. A 2022 epidemiological review noted that some of the highest reported prevalence rates have been found in Middle Eastern populations, although rates vary considerably according to population and diagnostic methodology.
Why keratoconus deserves particular attention in the Middle East
Keratoconus is a progressive corneal ectasia in which the cornea becomes thinner and increasingly irregular. As the corneal shape changes, patients can develop irregular astigmatism, blurred vision, glare, ghosting and reduced visual quality.
The condition is found worldwide, but regional studies suggest that keratoconus deserves particular attention across the Middle East.
A prospective study of adolescents and young adults in eastern Saudi Arabia identified keratoconus in 2.75% of the restricted study population and suspected keratoconus in a further 11.93%. The authors stressed that larger population studies are needed, but also highlighted the potential value of regional screening programmes.
Research involving Emirati adolescents similarly estimated keratoconus prevalence at 2.7%, with a considerably larger group classified as keratoconus suspects. The investigators concluded that screening secondary-school populations could be feasible in a high-risk setting.
These figures should not be interpreted as universal prevalence estimates for every Middle Eastern country. They do, however, reinforce an important clinical message: keratoconus can affect young people in the region at meaningful rates, and delayed detection can allow structural progression before patients enter an appropriate care pathway.
Early diagnosis changes the conversation
In the past, many patients first received a keratoconus diagnosis only after their vision had deteriorated significantly.
Modern corneal imaging has changed that.
Topography and tomography can reveal patterns of corneal curvature, elevation and thickness that may not be obvious from a conventional refraction alone.
This is why a young patient who repeatedly develops increasing astigmatism, changing prescriptions or unexplained reductions in visual quality may require more than another pair of glasses.
Family history, persistent eye rubbing, allergies and unexplained changes in corneal shape can also increase the clinical rationale for further assessment. Contemporary reviews describe keratoconus as a multifactorial condition involving genetic and environmental influences rather than a disease with one single cause.
Earlier identification gives clinicians something particularly valuable: time.
It creates an opportunity to determine whether the cornea is stable or progressing before the disease becomes significantly more difficult to manage.
Stabilizing keratoconus and improving vision are not the same treatment goal
This distinction is one of the most important concepts in modern keratoconus care.
When progression is documented, corneal collagen cross-linking may be considered by a corneal ophthalmologist to increase biomechanical stability and reduce the risk of further ectatic progression.
But stabilizing the cornea does not automatically restore normal optics.
A patient can have a successfully stabilized cornea and still experience substantial irregular astigmatism, ghost images, glare or poor night vision.
Conversely, a specialty contact lens may provide excellent functional vision without changing the biological progression of the disease.
Effective keratoconus management therefore requires clinicians and patients to answer two different questions:
Is the cornea progressing?
and
What does the patient need in order to see and function well?
Treating only one side of this equation can leave an important clinical gap.
Visual rehabilitation is the next part of the pathway
Glasses and conventional soft contact lenses may provide satisfactory vision in mild disease.
As corneal irregularity increases, however, conventional refractive correction becomes less effective because the problem is no longer simply sphere and cylinder.
Rigid gas-permeable, hybrid and scleral lenses can help create a more regular optical surface.
Scleral lenses have become particularly important for patients with moderate or advanced irregular corneas. Rather than resting on the central cornea, they vault over it and rest on the scleral surface, with a fluid reservoir between the lens and the cornea.
A 2025 systematic review examining 463 eyes found consistent improvements in best-corrected visual acuity and vision-related quality-of-life measures among keratoconus patients using scleral lenses, although the authors also emphasized limitations in the available long-term evidence.
The implication is important: successful keratoconus care should not end when progression has been addressed.
Functional vision matters too.
Not every scleral lens fitting is the same
As scleral lens use has expanded, fitting technology has also become considerably more sophisticated.
Traditional diagnostic fitting remains effective for many patients, but highly irregular eyes may require more customized approaches.
Recent ophthalmic literature describes developments including customized scleral haptics, topography- and profilometry-based fitting, impression-based designs and wavefront-guided optical correction. These developments can be particularly valuable in difficult ectasia, post-transplant corneas and eyes with significant corneal scarring.
This also explains why previous contact lens failure should not always be interpreted as proof that specialty lenses cannot work.
Sometimes the issue is not the concept of a scleral lens itself, but the geometry, landing zone, optical design or fitting method used for that particular eye.
Beyond visual acuity: the importance of visual quality
A conventional eye chart tells clinicians how small a letter a patient can identify.
It does not necessarily tell them how the patient sees headlights at night.
Patients with irregular corneas may achieve relatively good visual acuity while continuing to experience halos, glare, starbursts, reduced contrast or ghost images.
Higher-order aberrations can be an important part of this problem.
Recent research into contact lens correction for keratoconus highlights the role of residual wavefront error and the potential for more sophisticated lens modifications, including wavefront-guided correction, in selected cases.
For these patients, the clinical endpoint should not simply be “Can the patient read 20/20?”
A more useful question is:
Is the vision stable, comfortable and usable in real life?
An integrated eye-care pathway matters
The broader principle extends beyond keratoconus.
Middle East Health has previously highlighted the importance of integrated eye healthcare services rather than treating individual eye-care interventions in isolation.
Keratoconus is a particularly clear example of why such integration matters.
The ophthalmologist may need to evaluate progression and determine whether a medical or surgical intervention is indicated.
The optometrist specializing in irregular corneas may then focus on functional visual rehabilitation and specialty lens fitting.
Corneal imaging provides objective structural information.
Wavefront evaluation may help explain residual visual-quality complaints.
Long-term follow-up connects these pieces over time.
The goal is not to make every patient undergo every technology. It is to make sure that each stage answers the correct clinical question.
Regional access to advanced corneal rehabilitation
As healthcare systems across the Gulf and wider Middle East continue to invest in increasingly sophisticated diagnostic and specialty services, patients are also becoming more mobile in their search for complex care.
M’Eye Clinic in Jerusalem, Israel, is one example of a regional centre focused on advanced optometric management of irregular corneas and complex visual rehabilitation. The clinic works with keratoconus, post-corneal-transplant cases, severe ocular surface conditions and difficult specialty lens fittings, including customized scleral lens technologies. It also receives international patients from countries including the UAE, Saudi Arabia, Qatar, Bahrain and Kuwait.
The relevance of centres such as this is not that every keratoconus patient needs highly advanced technology.
Most do not.
Their role becomes important when standard correction no longer explains or solves the patient’s functional visual problem.
What should an effective keratoconus pathway include?
For healthcare providers and patients across the region, a practical care pathway can be built around several distinct stages.
Early recognition
Repeated changes in astigmatism, declining visual quality or relevant risk factors should trigger consideration of corneal imaging.
Structural assessment
Topography and tomography help determine whether an ectatic pattern is present and provide a baseline for future comparison.
Progression monitoring
A diagnosis alone does not establish whether the cornea is actively changing.
Medical stabilization when indicated
Patients with documented progression should be evaluated by a corneal ophthalmologist for appropriate management.
Visual rehabilitation
Glasses, RGP, hybrid or scleral lenses can be selected according to disease severity and optical requirements.
Advanced optical evaluation when necessary
Persistent glare, halos or poor visual quality despite an apparently successful fitting may justify deeper assessment of residual optical aberrations.
Frequently asked questions
Is keratoconus more common in the Middle East?
Several regional studies and epidemiological reviews have reported comparatively high keratoconus prevalence in selected Middle Eastern populations. However, prevalence varies considerably between studies, countries, age groups and diagnostic methods, so one figure should not be applied to the entire region.
Can keratoconus be stopped?
Progressive keratoconus can often be managed with corneal cross-linking, which is intended to stabilize the cornea. Whether the procedure is appropriate depends on progression, corneal characteristics and ophthalmic assessment.
Does cross-linking restore normal vision?
Not necessarily. Its main goal is structural stabilization. Patients may still require glasses or specialty contact lenses for visual rehabilitation.
Why are scleral lenses used for keratoconus?
They vault over the irregular cornea and create a new optical surface, which can substantially improve functional vision in suitable patients.
What happens when a standard scleral lens still does not provide good visual quality?
The fitting should first be reassessed. In selected complex cases, customized geometry, impression-based fitting or advanced wavefront-guided optics may provide additional options.
Looking beyond the diagnosis
The future of keratoconus care in the Middle East is not simply about diagnosing more patients.
It is about diagnosing them earlier, identifying progression accurately, stabilizing the cornea when required and ensuring that patients are not left with preventable functional vision problems after the disease itself has been addressed.
Modern care provides more tools than ever before.
The real opportunity is to connect them into one coherent pathway – from the first suspicious corneal map to stable, usable vision in everyday life.
