It's been almost 160 years since Nottingham (1854) published his landmark paper that defined keratoconus, or the conical cornea as it was frequently referred to, 'in the contemporary sense,' writes Charles McGhee in his editorial in a special edition of Clinical and Experimental Optometry that is fully devoted to keratoconus (with open access to anyone interested). The special edition, coordinated by Richard Lindsay, contains a series of 19 articles on the topic, ranging from etiology & genetics to treatment plans including surgery and refractive surgery. One of the papers is a report from Shneor et al, who studied 244 patients presenting to optometric services in Israel and identified a number of features for keratoconus including: male preponderance, the majority (79 percent) corrected by contact lenses, corneal transplantation in more than 20 percent, high prevalence of eye rubbing (66 percent) and moderate family history of keratoconus (28 percent). With regard to scleral lenses as an option: Adrian Bruce and Leanne Nguyen report on a case of acute red eye (non-ulcerative keratitis) in a patient wearing mini-scleral contact lenses for keratoconus. Successful prevention of further episodes of the acute red eye was achieved in this patient through improved patient compliance with lens cleaning, disinfection and lens case procedures. Lens hygiene may be particularly important for mini-scleral lenses with a sealed fitting, the authors state.