Keratoconus is an ectatic corneal condition resulting in progressive myopia and/or astigmatism and higher-order aberrations. Its incidence is estimated at 1 in 2000. Onset is in the second decade, classically at puberty. Progression is possible until the condition stabilises in the third to fourth decades of life (Rabinowitz 1998). 

In the UK, high-street optometrists are usually the first to suspect or diagnose the condition. Once an individual with keratoconus is referred to the hospital eye service, optometric staff undertake assessment and refractive management; contact lens fitting is a very important and challenging facet of this management. When patients reach the stage where their visual acuity can no longer be improved to an acceptable level, or they become intolerant of contact lenses, penetrating keratoplasty has been the traditional mainstay of surgical correction. Whether the patient proceeds to penetrating keratoplasty or its lamellar variant, deep anterior lamellar keratoplasty, the optometrist will probably continue to be involved in patient monitoring and care, especially if postkeratoplasty contact lens fitting is required. Throughout this process, optometrists, as vital members of the care team for keratoconic patients, will be expected to be a reliable and realistic source of information for traditional as well as new treatment modalities.