BLOG: Bridge the gap between optometry, ophthalmology to better manage keratoconus

BySumit Garg, MD

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

Many ophthalmologists depend on optometrists in their referral network as a source of surgical patients and for postoperative care.

In the case of cataract and refractive surgery, that comanagement arrangement is often convenient for all but may not be necessary for patients to access care. But when it comes to keratoconus, primary care optometrists really hold the key to earlier diagnosis and treatment for the benefit of patients.

Sumit Garg

That’s because young patients with early-stage keratoconus don’t even know they have this disease. Typically, they present to an optometrist’s office thinking they just need an update to their (or their child’s) glasses or contact lenses. An optometrist who is suspicious of a rapidly changing refractive state, inability to correct to 20/20 or scissoring on retinoscopy can make a huge difference for that patient if they refer them for further topographic/tomographic evaluation while the patient still has good vision and minimal thinning/scarring or other slit lamp signs. If the patient is found to have progressive keratoconus, we can consider cross-linking them with the FDA-approved iLink system (Glaukos), which is a covered service under most commercial insurance plans.

As a cornea specialist, I often see patients for the first time not at this early stage, but when their disease is already quite advanced. Short of holding widespread keratoconus screenings among healthy young people — which isn’t likely to happen — our patients are absolutely dependent on their primary eye care providers to notice these changes and act on them before they become candidates for more invasive procedures such as corneal transplantation.

Figure 1. This patient was referred for further evaluation when the referring doctor saw red flags for keratoconus. Although the patient’s visual acuity was 20/20 with a refraction of –1.50 +1.00 × 45, tomography clearly indicates keratoconus.

Source: Sumit Garg, MD

Here’s how we can forge strong relationships with our colleagues in primary care:

1. Educate your network about new, evolving standards of care and the availability of treatment that can halt keratoconus progression.

2. Communicate well. Confirm the diagnosis and plan for treatment or additional follow-up. Be sure that comanaging doctors know what to expect after cross-linking.

Figure 2. Three months after epi-off iLink cross-linking, the patient’s vision is 20/20 and refraction is –1.25 +0.50 × 30e.

Source: Sumit Garg, MD

3. Send the patient back unless there is a stated transfer of care. Referring doctors need to feel confident that a referral for evaluation doesn’t mean losing their patient. Patients with keratoconus should still see their regular optometrist for annual exams and for vision correction, which will continue to be needed after cross-linking.

4. Seek out partners who excel in fitting specialty lenses. When a referring doctor demonstrates an interest in and aptitude for managing more difficult cases, they can be a wonderful partner in helping patients achieve optimal vision. It may take several months for patients to obtain preauthorization, get scheduled, have both eyes cross-linked and fully stabilize. During that time, their vision correction needs may change. In many cases, even after successful cross-linking, a specialty contact lens will allow for optimal vision. A contact lens expert who understands keratoconus and cross-linking can be an invaluable partner.

Published by: