Learn more about Keratoconus - Day 2

What a great event the Keratoconus Symposium was! We had over 2600 doctors registered who all had the opportunity to learn from the top experts in the field!

Let’s review day 2 of our Keratoconus Symposium:

Dr. Steven Greenstein - “Keratoconus Surgical Options - Where Do They Fit In?“

If you have patients with keratoconus, you are likely asked I there are any surgeries available for them. Dr. Greenstein reviewed refractive procedures available for our keratoconus patients, including topography guided PRK, Intacs – both traditional intacs as well as innovative corneal tissue inlays, cross-linking, and implantable collamer lenses. He discussed how some of these techniques can be used in conjunction to optimize visual outcomes.

In fact, with just topography guided PRK, subjects in Dr. Greenstein’s retrospective review gained 3.5 lines of improved uncorrected vision.

Drs. Melissa Barnett and Barry Eiden - “Incorporating Technology into Today’s Keratoconus Practice“

In this presentation, Drs. Barnett and Eiden reviewed all the technology that is available to take the best care of our keratoconus patients, including topography, tomography, anterior segment OCT, scleral topography, aberration control technology, and genetic testing. They did an amazing job deep diving into each of these types of technologies, what their advantages and disadvantages may be, and how to interpret and use the data provided.

Drs. Clark Chang and William Tullo - “The Most Updated Keratoconus Management Guide”

Did you know that true unilateral keratoconus does not exist and central pachymetry is the least reliable indicator for diagnosing keratoconus? Drs. Chang and Tullo reviewed specialty testing to diagnose keratoconus early, such as in subclinical stages and how to define progression to indicate the need for crosslinking.

Dr. Tullo reviewed crosslinking in depth, how it is performed, and how to answer tough questions from patients regarding crosslinking. One particular question may be, “Why do I need crosslinking?”

Here are a few responses: 

·       Crosslinking can improve lifetime outcomes and economic burdens by helping prevent or delay corneal scarring and ultimately, the need for corneal transplantation

·       Crosslinking may help patients have a better quality of life

·       Crosslinking provides synergy with optical rehabilitation, such as ease of fitting specialty contact lenses

Another question may be, how long does CXL last?

According to a study by Dr. Greenstein, patients had stable BCVA 10 years following the procedure.

Christine Sindt, OD and Clark Chang, OD - “What would you do? How to select an appropriate contact lens option for your keratoconus patient.”

Dr. Sindt and Chang reviewed real life examples on addressing patient concerns with troubleshooting specialty contact lenses and considering various modalities pending slit lamp appearance and patient complaints. They walked us through multiple examples in which various modalities of specialty contact lenses were used and why they chose to go that route.

Drs. Sindt and Chang’s lecture was chalk full of expert tips, such as the importance of adaptation following new optics/new lens modalities. What the patient experiences in your exam chair after initially placing lenses on their eyes, may completely change following a few weeks of wear.

In some cases, we may be inverting the blur the patient is accustomed to. For example, if they’re accustomed to a smearing appearance off to the left side of their field. A scleral lens could actual create an opposite effect. So, patients experience a different type of blur they’re unaccustomed to and may not provide that initial “WOW” response you were hoping for.

Some other tips to consider are that size makes a huge difference on patient comfort, along with ensuring that the peripheral Q-values of the cornea are taken into account to best align lenses on irregular corneas.

All of these presentations are available at WooU.org, under the title “Keratoconus Symposium”. Be sure to check them out to learn the most up to date research and clinical pearls from all of the leaders in the field of keratoconus!