Accordingly, it can be speculated that abnormal collagen synthesis due to hormonal influence (McKay et al., 2022; Zhao et al., 2022), disruption of corneal extracellular matrix homeostasis or intracellular protein trafficking plausibly through miRNA due to rs2371597 polymorphism in STON2 gene (Hosoda et al., 2020; Zhang et al., 2022) combined with age factor may help explain why the young males in our KC cohort are more susceptible to KC, highlighting the complex interplay of different biological and genetic factors may work together to affect the risk of KC. Here, STON2 is linked to keratoconus.