Preferred practice patterns in the management of keratoconus: a national survey of cornea specialists in Saudi Arabia

Keratoconus is a progressive corneal disorder that often affects young individuals and can significantly impair visual function. Over the past two decades, diagnostic and therapeutic options have evolved rapidly, yet little is known about the current practice patterns of cornea specialists in Saudi Arabia. This study aimed to assess the availability of diagnostic tools, treatment modalities, and preferred clinical practices in keratoconus management nationwide. A cross-sectional nationwide survey was conducted between April and May 2025 among cornea specialists in Saudi Arabia. A structured 26-item questionnaire was distributed electronically and included items related to demographics, diagnostic tools, surgical and nonsurgical treatment practices, and clinical decision-making. Descriptive statistics were used to summarize findings, and chi-square tests were applied to explore associations between selected variables. A total of 102 cornea specialists responded to the survey. The majority (93.1%) had completed a cornea subspecialty fellowship, and most (63.7%) practiced in governmental hospitals. Access to corneal cross-linking (CXL) was reported by 96.1% of participants. Scheimpflug-based imaging devices, particularly the Pentacam, were the most commonly used diagnostic tools (74.5%). Epi-off, accelerated CXL was the most preferred treatment protocol. DALK was the preferred surgical option for keratoplasty, with most surgeons favoring a hybrid technique starting with the big bubble approach. Scleral and RGP lenses were widely used, and indications for CXL extended beyond documented progression. No statistically significant associations were found between region, years of experience, or practice setting and the use of key treatment modalities. Cornea specialists in Saudi Arabia demonstrate high adherence to advanced and evidence-based practices in keratoconus management. Nonetheless, regional variations and lack of standardized protocols highlight the need for national guidelines to ensure consistent care across all settings.