{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:16:13Z","timestamp":1791483373078,"version":"4.3.4"},"reference-count":100,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Keratoconus is a progressive corneal ectatic disorder and a leading cause of corneal transplantation in developed countries. Early detection is critical for initiating timely interventions such as corneal cross-linking, which can halt disease progression and preserve long-term visual function. This review aims to synthesize current diagnostic approaches for early keratoconus detection and assess their clinical impact on visual outcomes. Materials and Methods: A comprehensive literature search was conducted across PubMed\/MEDLINE, Web of Science, Google Scholar, Scopus and the Cochrane Library through September 2025. Search terms included \u201cearly keratoconus,\u201d \u201csubclinical keratoconus,\u201d \u201cforme fruste keratoconus,\u201d \u201ckeratoconus detection,\u201d \u201ccorneal topography,\u201d \u201ccorneal tomography,\u201d \u201canterior segment optical coherence tomography (AS-OCT),\u201d \u201ccorneal biomechanics,\u201d \u201cartificial intelligence,\u201d \u201cgenetic risk, \u201cenvironmental factors\u201d, and \u201cmachine learning.\u201d Two independent reviewers analyzed the data. Studies were included if they investigated diagnostic modalities for early-stage keratoconus and discussed their relevance to visual outcomes. Results: One hundred and seven studies were included in the final review. Four diagnostic modalities demonstrated consistent clinical value: 1. corneal topography for assessing anterior surface irregularities; 2. corneal tomography, currently regarded as the gold standard due to its ability to detect early posterior elevation and pachymetric changes; 3. AS-OCT for epithelial and stromal profiling; and 4. biomechanical assessments, which evaluate corneal tissue stability prior to structural alterations. Artificial intelligence, when integrated with imaging data, enhances diagnostic sensitivity and standardizes interpretation across clinical settings. Conclusions: Early keratoconus detection is crucial for preserving vision; and integrating multimodal, AI-supported diagnostics into routine care\u2014especially for high-risk groups\u2014enhances accuracy, improves outcomes, and reduces progression rates of disease.<\/jats:p>","DOI":"10.3390\/medicina62010042","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T02:07:58Z","timestamp":1766714878000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Early Detection of Keratoconus: Diagnostic Advances and Their Impact on Visual Outcomes: A Systematic Review"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6676-0183","authenticated-orcid":false,"given":"Evangelos","family":"Magklaras","sequence":"first","affiliation":[{"name":"Ophthalmology Department, General Hospital of Volos, 38222 Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinia","family":"Karamitsou","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, General Hospital of Volos, 38222 Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios F.","family":"Diakonis","sequence":"additional","affiliation":[{"name":"2nd Ophthalmology Department, Metropolitan Hospital, 18547 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-4244","authenticated-orcid":false,"given":"Theodoros","family":"Mprotsis","sequence":"additional","affiliation":[{"name":"Department of Biomathematics, School of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos T.","family":"Tsaousis","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, General Hospital of Volos, 38222 Volos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.joco.2017.11.002","article-title":"Updates on managements for Keratoconus","volume":"30","author":"Mohammadpour","year":"2017","journal-title":"J. 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