Objective:

To report a case of rapid keratoconus progression in an older patient and the successful fitting of scleral lenses, highlighting the implications for treatment.

Key Findings:

• Rapid progression of keratoconus was noted, with K values changing significantly over 6 months.
• Despite the steepening, the sagittal depth of the cornea remained stable.
• Patient reported improved comfort and vision with the new scleral lenses, emphasizing the effectiveness of the fit.

Interpretation:

This case illustrates that keratoconus can progress rapidly even in older patients, and that scleral lens fitting can remain effective despite significant changes in corneal shape, underscoring the need for regular monitoring.

Limitations:

• The patient declined corneal crosslinking due to financial constraints, highlighting the need for accessible treatment options.
• Long-term outcomes of the scleral lens fit in the context of rapid keratoconus progression are not assessed, indicating a gap in knowledge.

Conclusion:

Regular follow-up is essential for patients with keratoconus to monitor progression and consider timely interventions, such as corneal crosslinking, to prevent further deterioration.