Yearly exams critical to identify keratoconus progression, even after cross-linking
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BOSTON — Annual exams with topography are key to identifying progression in patients with keratoconus regardless of whether they have undergone cross-linking, according to a speaker here.
At Cornea Day at the American Society of Cataract and Refractive Surgery meeting, William B. Trattler, MD, said that cross-linking is effective at stopping keratoconus progression, but there is still a risk for continued progression in about 2% to 4% of patients.
“There’s still a chance they can progress even with treatments,” he said. “That’s important to understand. They still need annual exams. Our goal is to figure out who has keratoconus and who has progression.”
To find these patients, Trattler said he uses serial topographies and tomographies over time to determine the changes in corneal shape. Worsening vision is also evidence of keratoconus progression, so he monitors visual acuity and worsening myopia or astigmatism.
There are several indications for which Trattler will perform cross-linking, including progressive keratoconus, post-LASIK ectasia and pellucid pattern keratoconus, in which earlier cross-linking is better. He said there are also a few off-label uses for cross-linking, such as in children younger than 14 years and in adults who are concerned about further progression.
“Keratoconus is a progressive disease,” Trattler said. “It’s important to continue to watch them at all ages. Even if they’ve had cross-linking, they can still progress, so we want to keep watching them year after year.”
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Trattler W. Keratoconus corner: What is progressive disease? When do I need to treat? Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
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