Challenging the « No Rub, No Cone » Keratoconus Conjecture. D Gatinel. Int J Kerat Ect Cor Dis. 2018;7(1):;66-81
This paper (download: No rub No cone )aims to provide a comprehensive explanation for the physio pathogenesis of keratoconus and demonstrate why it is not corneal dystrophy of genetic origin, but primarily a warpage of the corneal dome of mechanical origin. Keratoconus is not a true ectasia. Rather, it results from the permanent corneal deformation caused by the buckling of the cornea, as a response to the repeated shearing forces inflicted by the patient’s hands.
While certain “keratotypes” (corneas with thinner and softer stroma) may be more exposed to the deleterious effects of excessive rubbing, it is necessary that a repeated trauma is exerted against the corneal wall for the typical keratoconus deformation to occur. Hence the title: “No Rub, No Cone”. This mechanical theory provides a much better explanatory framework than the putative “genetics and proteomics” theory and is compatible with most of what is observed in this condition. It appears more compatible to explaining the predominance of sporadic cases and the variability of KC expression between patients, eyes,
New theories in medicine can be supported by conjectural models relying on tangible evidence. The “No rub, no Cone” conjecture may be proven correct by existing logical data and evidence. The line of arguments developed here will hopefully receive enough consideration to be accepted as a viable theory and, if proven true, lead to new guidelines for managing and preventing KC.