Diagnosing Keratoconus and Treatment Options

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
• Difficulty 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?

Keratometry

• Fleischer’s ring
• Vogt’s striae
• Apical scarring

Corneal topography or tomography

• Topography and corneal thinning

Corneal OCT

• Topography and corneal thinning

Topography Examples

Collaborating with surgeons and post-op care

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.

Epithelial healing

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.