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Surgeon advocates early referral for pediatric cross-linking

Issue: November 25, 2018

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Erin D. Stahl

CHICAGO — Corneal cross-linking should be considered in pediatric patients at diagnosis of clinically identifiable keratoconus, a speaker here said.

Even though FDA approval of the Avedro treatment system is indicated for progressive keratoconus in patients age 14 years or older, Erin D. Stahl, MD, said she treats children younger than 14 years at diagnosis.

Speaking at Pediatric Ophthalmology Subspecialty Day preceding the American Academy of Ophthalmology annual meeting, Stahl said, “When the diagnosis is made or considered, go on for the more sophisticated corneal analysis. And, at diagnosis, I and many other people who treat children outside of the United States advocate treating at diagnosis and not waiting for identifiable progression.”

Data show that pediatric keratoconus progresses more rapidly than in older counterparts and that it has been diagnosed in children younger than 14 years.

“There’s no reason, in my mind, to wait to stabilize that cornea,” she said.

Many children can be treated without sedation; however, the treatment lasts 75 minutes, with 35 minutes of speculum placement, so there are children who do need some form of anesthesia, she said.

Regardless, Stahl said she only treats one eye at a time.

“This is a surgical procedure. We want to make sure they heal well and everything is stable before going on to do the second eye,” she said.

The most important aspect to consider in pediatric cross-linking is rehabilitation, she said.

Often, even after cross-linking, scleral contact lenses are still necessary to rehabilitate vision, so referral to an optometrist who specializes in scleral contact lenses and challenging fits is needed. – by Patricia Nale, ELS

Reference:

Stahl ED. Mainstreaming corneal crosslinking in children. Presented at: AAO Subspecialty Day; Oct. 26-27, 2018; Chicago.

Disclosure: Stahl reports she is a consultant for Avedro.