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New method of keratoconus grading helps plan treatment strategies
 Waleed Al-Tuwairqi |
ABU DHABI — A new method of keratoconus grading based on functional vision, presented here at the World Ophthalmology Congress, takes into account patients' subjective experience and might lead to better planning of treatment strategies.
"Gradual degradation of vision happens in a period of time that goes from puberty to the age of about 40. In this span of time, patients go from excellent spectacle vision to good spectacle vision to bad spectacle vision to impending corneal scarring and then terminal keratoconus, which is the stage of legal blindness," Waleed Al-Tuwairqi, MD, said.
The new classification takes into account the central stages, excluding excellent spectacle vision, in which minor changes might indicate some form of subclinical keratoconus but also no keratoconus at all, and the opposite extreme of terminal keratoconus.
"[Good spectacle vision] correlates with minor changes in visual function, but vision is still good enough to drive at night without particular problems, visual acuity is around 20/25 at distance and J2 at near, and coma is still below 1.5 µm. Later on, at the [bad spectacle vision] stage, the patient becomes very symptomatic, driving at night is difficult, coma increases to more than 1.5 µm. The disease continues. Adhesion between anterior and posterior cornea leads to the stage of [impending corneal scarring]," Dr. Al-Tuwairqi explained.
An appropriate procedure can be designed for each stage of disease. Combination cross-linking with PRK or STAAR Visian ICL implantation might be considered for good spectacle vision. Intracorneal ring implantation and eventually PRK and cross-linking are the best options for bad spectacle vision. MyoRing implantation (Dioptex) or stromal transplant might help at the stage of impending corneal scarring.
- Disclosure: Dr. Al-Tuwairqi has no relevant financial disclosures.