Global Consensus on Keratoconus and Ectatic Diseases—Edition 2

PURPOSE: Ten years after the first Global Consensus on Keratoconus and Ectatic Diseases, this updated edition revisits key issues, incorporates advances in new technologies, and integrates the expertise of corneal and refractive surgeons from 12 international societies. This initiative aimed to establish a consensus among global ophthalmology experts, including corneal and refractive specialists from 6 continents, on the definition, diagnosis, staging, clinical management, and surgical treatment of keratoconus and ectatic corneal diseases. METHODS: The Delphi method consisted of 4 rounds of questionnaires, supplemented by a face-to-face meeting. A total of 128 ophthalmologists participated, with 3 main coordinators and 125 keratoconus experts distributed across 7 panels: definition/diagnosis/staging, clinical treatment and noninvasive visual rehabilitation, cross-linking for progression, and invasive visual rehabilitation (including therapeutic approaches, improved corrected distance visual acuity, keratoplasty techniques, and cataract surgery in keratoconus). The consensus threshold was defined as at least two-thirds agreement. RESULTS: A significant consensus was reached on topics such as definitions, diagnostic and progression criteria, and management strategies for keratoconus and other ectatic corneal disorders. A comprehensive approach was outlined, encompassing both nonsurgical and surgical treatments, organized in a group-based approach. In addition, major agreements and disagreements across the 7 subcommittees are outlined in individual tables. CONCLUSIONS: This updated Global Consensus provides revised definitions, expert statements, and recommendations for diagnosing and managing keratoconus and other ectatic corneal diseases. It benefits from broader participation, with more refractive surgeons and greater representation from major ophthalmic societies across 6 continents, capturing a wider range of global clinical perspectives than the prior report.