Does the progressive increasing effect of radial keratotomy (hyperopic shift) correlate with undetected early keratoconus?

Keratoconus suspect is a new clinical entity revealed by videokeratography. We perform systematic videokeratography on all candidates for refractive surgery, and have identified a keratoconus suspect in more than 10% of eyes. A lot of patients with undetected early keratoconus have been operated on since 1980. We suggest a possible correlation between early keratoconus suspect and the hyperopic shift following radial keratotomy. Our arguments are based on clinical observations, knowledge about pathogenesis of keratoconus and the mechanism of action of radial keratotomy, and epidemiological considerations.