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Diagnostic Patterns in Keratoconus
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
To investigate the current patterns of diagnosis and referral in keratoconus.
Methods
A retrospective chart review was performed of patients who had recently been diagnosed with keratoconus and attended dedicated clinics at Antwerp University Hospital, Belgium and Maria Middelares General Hospital, Ghent, Belgium between June 2013 and February 2018. Exclusion criteria included longstanding keratoconus diagnosis, reduced cognitive capabilities and prior surgical procedures (corneal crosslinking, penetrating keratoplasty or any type of refractive surgery).
Results
Three-hundred and ninety-nine patients (722 eyes) were included in this study. The mean age was 24.7±6.5 years and the average maximal keratometry was 51±5.2 D for the better eye and 58.4±9.6 D for the worse eye. Upon diagnosis, 233 eyes (32.2 %) and 51 eyes (7.1 %) had a thinnest pachymetry<450 and<400 μm, respectively. At 6-month follow-up, 58 % of patients had been fitted with specialty contact lenses. During follow-up, 199 eyes (27.6 %) underwent corneal crosslinking. One patient underwent corneal graft surgery of his worse eye due to contact lens intolerance and insufficient visual acuity.
Conclusion
Despite advances in diagnostic tools, keratoconus is often diagnosed at a relatively late stage. Earlier detection of keratoconus would increase the overall clinical benefit of corneal crosslinking. Further research into screening strategies is required to develop cost-effective screening programs.
Kreps and colleagues, in their review of nearly 400 patients with newly diagnosed keratoconus, make the notable finding that these patients, in general, are diagnosed well into their disease course. This has important clinical implications now that we have a treatment to hold or slow the progression of keratoconus. Corneal cross-linking (CXL), now FDA-approved, can indeed improve the prognosis of the disease.1 Therefore, early diagnosis and treatment of keratoconus is ever more important.
Given the importance of CXL to the young patient with early keratoconus, it is essential for the general eye care community to diagnose keratoconus in its earlier stages. Optimally, this is done with computer-assisted corneal topography. Realizing, however, that this technology is not yet universally adopted in general practice, there are other findings that should motivate further work-up or referral of the putative keratoconus patient. These include younger patients who cannot refract to 20/20, subtle abnormality of the mires on manual keratometry, any irregularity of the retinoscopic or dilated red reflex, and anisometropia of astigmatism between the two eyes, especially against the rule and oblique cylinder. The importance of early diagnosis, especially in younger patients, cannot be overstated because expedited crosslink treatment can prevent future progression and vision problems in patients with keratoconus.
References