Diagnosing Keratoconus and Treatment Options
The goal of treatment for iLink™ corneal cross-linking patients is to slow or halt the progression of keratoconus. For these patients, continued progression often results in loss of visual acuity or decreased tolerance to contact lens wear, caused by the ongoing changes in the cornea. This means early diagnosis is critical so that progressive keratoconus can be treated sooner.1
[Gelles2017/p1/col1/para2/lines6-9; col2/para1/lines5-8; p3/col1/para2/lines1-7]
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Left untreated, 1 in 5 patients with progressive keratoconus may require a corneal transplant. More than half of these patients could need multiple transplants within 20 years. 2, 3
Identifying keratoconus patients
Appropriate patients who have been diagnosed with progressive keratoconus or corneal ectasia following refractive surgery may be candidates for iLink™ corneal cross-linking.
- Keratoconus is a bilateral, progressive corneal ectasia resulting in irregular astigmatism and loss of visual function, with onset in teenage years.
- Corneal ectasia, a non-inflammatory condition marked by progressive corneal steepening and thinning, is a rare but serious complication of vision correction procedures.
What are the signs and symptoms of progressive keratoconus?
Early signs of keratoconus may include asymmetric refractive error, high or progressive astigmatism, or reduced best corrected visual acuity. The onset of keratoconus often occurs in the teenage years or early twenties but can start at any time.
Patient symptoms may include:
- Constantly and regularly changing refractive errors
- Blurry vision
- Increased light sensitivity
- Difficultly driving at night
- A halo around lights and ghosting (especially at night)
- Eye strain
- Headaches and general eye pain
- Eye irritation, excessive eye rubbing
Keratoconus, especially in the early stages, can be difficult to diagnose, and all of the above symptoms could be associated with other eye problems.
What tools do I need to observe the signs of keratoconus?
- Fleischer’s ring
- Vogt’s striae
- Apical scarring
Corneal topography or tomography
- Topography and corneal thinning
- Topography and corneal thinning
Patient with Keratoconus.
Patient with normal astigmatism.
The iDetect KC program
iDetect KC helps equip optometrists with advanced topography so they can begin integrating the 3 pillars of modern keratoconus care into their practice.
- Advanced topography enables earlier diagnosis and monitoring to help preserve patients’ vision by intervening sooner
- Optometrists can then refer patients to an ophthalmologist who can perform iLink™
- With topography, optometrists can provide long-term, continued medical care for patients while supporting the expansion of their contact lens service
Optometrist and ophthalmologist collaboration
iLink™ corneal cross-linking provides the opportunity for collaborative care between optometrists and ophthalmologists.
Optometrists are an essential part of the ongoing medical care keratoconus patients receive after they have been treated with iLink™ corneal cross-linking. It may be necessary for an optometrist to increase the frequency of a patient’s monitoring exams or fit them with contact lenses several times while their corneas stabilize.
Post-operative care management is up to the physician’s discretion. Although there is certainly some variation, corneal specialists will often see patients for the 1-day and 1-week visits and then, once the epithelium is intact, send them back to co-managing doctors for the remainder of the follow-up care. Patients should be monitored for resolution of epithelial defects.
Contact lens fitting
Scleral lenses or other vaulted designs are a good option for keratoconus patients as they do not rest on the corneal surface and avoid disrupting the epithelial healing. It is important to make patients aware that vision may change slightly during the first few months, and that the contact lens prescription may need to be updated.
For contact lens fitting purposes, one can expect that the corneal curvature may change after cross-linking, but not dramatically. It is not uncommon to notice an initial corneal steepening followed by flattening in the first months after an iLink™ procedure. More frequent contact lens evaluations may be required in the first year after the procedure while the cornea stabilizes.
“We report good visual results in patients who were fit in contact lenses after having undergone corneal cross-linking. Contact lens fits were as early as two weeks (soft lenses), but ranged depending on patient’s functioning needs and observed changes in corneal topography in the postoperative healing period. Gas permeable lenses were fit at the earliest 3 months postoperatively. Contact lens choice is a balance between patient’s needs and the lens able to achieve good comfort with optimal visual results.*”
-Clark Chang, OD, MS
*Results may vary
Resources for diagnosing keratoconus
Keratoconus: What You Need to Know – Diagnostics, Cross-Linking, and Scleral Lenses
John Gelles, OD, 2020 GSLS
Keratoconus and the Cross-Linking Story
Gloria Chiu, OD, FAAO, FSLS, Modern Optometry (October 2019)
Best Practices for Managing Keratoconus Patients
Scott Hauswirth, OD, FAAO, and Brooke Messer, OD, FAAO, FSLS, Optometry Times (July 2019)
Best Practices for Comanaging Keratoconus Patients
Mitch Ibach, O, FAAO, and Jeffery A. Sayler, OD, Optometry Times (April 2019)