Over years, studies on the relationship between ECM and KC have been more and more conducted, and many ECM-related genes and corresponding proteins have been found to be potentially involved in the pathogenesis of KC, such as glycoprotein fibronectin (FN1)15, integrin15, metalloproteinase (MMP9)15,16, tissue inhibitor of metalloproteinase (TIMP1, TIMP2)15,16, thrombospondin1 (THBS1)15,17, transforming growth factor beta-induced gene (TGFBI)15,18,19, et al. LOX, COL5A1 and TIMP3 were three ECM-related genes identified in this study. Here, ART4 is linked to keratoconus.