Wisse RPL, et al. - Through a prospective cohort study at 2 academic treatment centers of 504 eyes and 388 subjects between January 1, 2012, and June 30, 2014, the experts evaluated and verified a novel clinical scoring system as an easy-to-use assessment tool for crosslinking treatment in patients with keratoconus, as defining keratoconus progression is necessary for clinical decision making because crosslinking treatments are intimated when the disease is acknowledged as progressive. The Dutch Crosslinking for Keratoconus (DUCK) score which was based on alterations in 5 clinical parameters (age, visual acuity, refraction error, keratometry, and subjective patient experience) that were routinely evaluated, was used. Rather than opting for maximum keratometry, sticking to the DUCK score was correlated with a decrease in overall treatment rate by 23%, without raising the risk of disease progression. The DUCK score satisfactorily recognized eyes that were duly withheld treatment by 35%. Hence, in order to ascertain whether a crosslinking treatment could be assured, the findings provided verification of the DUCK score as a tool. The DUCK score may better select subjects who might profit from crosslinking treatment, in comparison with the conventional maximum keratometry criterion of more than 1.0 diopter. Moreover, it may potentially restrict undesirable treatments, diminish exposure to treatment risks, and enhance the cost-effectiveness of crosslinking.