PEDIATRIC KERATOCONUS: A SCOPING REVIEW OF ITS EPIDEMIOLOGY, DIAGNOSTIC APPROACHES, THERAPEUTIC STRATEGIES, AND PSYCHOSOCIAL CONSEQUENCES

Background: Pediatric keratoconus is a progressive corneal ectatic disorder affecting children and adolescents, with earlier onset, faster progression, and greater disease severity than adult-onset keratoconus. Advances in corneal imaging have improved detection of subclinical disease and revealed a higher disease burden than previously recognized. Although corneal collagen cross-linking has changed clinical management, evidence remains scattered across epidemiology, diagnosis, treatment, psychosocial outcomes, and economic impact. Objective: This scoping review aimed to map the available evidence on pediatric keratoconus and identify major research themes, knowledge gaps, and future priorities related to epidemiology, diagnostic approaches, therapeutic strategies, and psychosocial consequences. Methods: This review was conducted according to the PRISMA-ScR framework and guided by the Joanna Briggs Institute methodology for scoping reviews. Eligible studies included children and adolescents aged 18 years or younger diagnosed with keratoconus. English-language publications from January 1998 to December 2025 were searched in PubMed/MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. Studies of any design were considered if they reported epidemiological data, diagnostic methods, treatment outcomes, psychosocial findings, economic burden, or quality-of-life outcomes. Data were charted using a standardized extraction framework and synthesized narratively. Results: The search identified 1,802 records. After removal of duplicates, 777 articles were screened, 97 full-text articles were assessed for eligibility, and 76 studies were included. Reported prevalence varied widely, with estimates reaching 1 in 251 confirmed cases and 1 in 72 when suspected cases were included. School-based studies reported prevalence values of 626 per 100,000 children and 3.6% in selected populations. Corneal cross-linking demonstrated disease stabilization in more than 80% of treated pediatric cases, including evidence from 2,186 eyes across 35 studies. However, progression criteria, imaging parameters, follow-up duration, and outcome measures varied substantially. Psychosocial, educational, caregiver-related, and economic outcomes were limited. Conclusion: Pediatric keratoconus is an important childhood eye condition requiring early detection, standardized monitoring, timely treatment, and broader patient-centered assessment. Future research should strengthen population-based screening, harmonize progression criteria, and evaluate long-term clinical, psychosocial, and economic outcomes. Keywords: Adolescent; Child; Corneal Cross-Linking; Corneal Topography; Epidemiology; Keratoconus; Quality of Life.