Aim: This study aimed at assessing the therapeutic decisions made by an individual keratoconus specialist in the last 10 years, to treat patients with keratoconus. Materials and methods: We studied a case series and the descriptive analysis of individual cases treated by a single keratoconus specialist. Medical records of 636 patients totaling 1271 eyes were evaluated based on the therapeutic procedure used. Results: For the treatment of keratoconus, the specialist chose expectant (only spectacles) in 22.3% of the cases, contact lenses in 39.3%, implantation of intrastromal corneal ring segments (ICRS) in 27.7%, cross-linking in 0.9%, and penetrating keratoplasty in 8.5% of the cases. Conclusion: The keratoconus specialist preferred noninvasive therapeutic options to improve vision quality, such as spectacles and contact lenses. Clinical significance: Show the therapeutic preferences of a keratoconus specialist in order to compare with the daily practice.