BLOG: Set a goal to learn more about keratoconus in 2024
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Although we all learned about corneal disease in optometry school, both the understanding of keratoconus and expanding protocols for its treatment have changed dramatically since many practicing optometrists graduated.
In sharp contrast to how keratoconus was once managed with a watch-and-wait approach, cross-linking is now considered the first-line treatment to slow or halt progression of keratoconus. As a result, corneal transplants are becoming much less common.
Specialty contact lenses can be utilized to improve vision either before or shortly after cross-linking. A variety of procedures for keratoconus, such as topography-guided PRK and corneal tissue addition keratoplasty, can be used to improve corneal contour and to improve vision with and without glasses, as well as expand contact lens options. All of this has made corneal transplantation for keratoconus nearly extinct; however, when necessary, new techniques are making for more repeatable procedures and better outcomes.
We know that keratoconus and myopia overlap in the pediatric population. As more optometrists branch out into myopia management, it is important to ensure that young patients’ myopia is due to axial length elongation and not corneal steeping — both for the sake of early intervention and to better guide myopia management decisions. It is prudent to screen young myopes with corneal tomography, which is capable of detecting the disease at its earliest manifestation. When tomographic screening was performed routinely in a Chicago-based pediatric population, keratoconus was found to be more common than classically reported, according to research published by Harthan and colleagues.
Continuing education events
Fortunately, there are many print, online and in-person resources for optometrists who want to deepen their understanding of keratoconus. The archives for this blog series, for example, cover a wide range of topics related to keratoconus.
To get all the latest information, I’m a fan of attending focused, in-person events. Perhaps the best of these may be the International Keratoconus Academy annual meeting, a 2-day conference entirely devoted to all things keratoconus, for both optometrists and ophthalmologists. This year’s meeting takes place May 18-19, 2024, in Bethesda, Maryland.
My colleagues and I at the Cornea and Laser Eye Institute Center for Keratoconus chair the upcoming Collaborative Care Symposium, a free virtual symposium that focuses on various aspects of refractive surgery and collaborative OD-MD patient care, including a 2-hour lecture on modern management of keratoconus. This conference takes place March 22-23, 2024.
Beyond getting a solid foundation on the disease itself, there is much to learn about fitting specialty lenses to manage vision in patients with keratoconus. Several live conferences in the next year offer a deep dive into this topic. First, the International Congress of Scleral Contacts will be held May 10-11, 2024, in San Diego. From disease to practice management, this meeting is dedicated exclusively to the topic of scleral lenses.
The Cornea & Contact Lens Advancing Skills Symposium will be held Sept. 5-7, 2024, in Dallas. This meeting differentiates itself by being the “how to” and “hands on” cornea and contact lens meeting. Attendees can learn about the full gamut of contact lenses, from soft and cosmetic lenses to complex management of irregular corneas with specialty lenses. Additionally, management of corneal disease, ocular surface disease and myopia will be covered, along with hands-on skills transfer courses and workshops.
It’s also not too early to plan ahead for the Global Specialty Lens Symposium taking place in Las Vegas in January 2025. This meeting is classic and completely focused on specialty lenses and the research around them.
Other resources
Getting involved in focused societies can also aid in learning more about keratoconus and contact lens management of the keratoconus patient. The Gas Permeable Lens Institute website has a large library of online resources, including lots of content related to lenses for keratoconus. And of course each specialty contact lens manufacturer offers training related to their specific lenses. This is often a great place to start before adding more types of specialty lenses to your practice.
For scleral lens-specific education, the Scleral Lens Education Society is another great resource. Become a member of the International Keratoconus Academy to stay updated on keratoconus care. Additionally, the National Keratoconus Foundation offers doctor and patient resources, as well as an excellent comprehensive document on keratoconus that can be found at the National Keratoconus Foundation website.
A quick, new keratoconus-focused collection of resources can be found on the Glaukos iDetective page, which takes a fun approach to reviewing oft-missed clues that can point to keratoconus. The site also offers cheat sheet-style cards for the autorefractor or topographer with reminders for you and your staff about clues to watch for during diagnostic testing.
In fact, this is a great time to go back to basics and make sure you are familiar with the diagnostic tools available in your office. There are many resources available for learning how to interpret topography and tomography; an excellent but often overlooked resource is the device manual. So many of today’s devices have various device-specific metrics that aid in identifying keratoconus or simply flag an abnormal cornea.
Many device manufacturers will even offer user webinars or meetings that can aid in use and interpretation. I also recommend an excellent article written by our former fellow, Becky Su, OD, FAAO, FSLS, which gives the quintessential primer for everything you would want to know about corneal topography.
This is a great year to be intentional about keratoconus education.
References:
- 2nd Annual IKA Keratoconus Symposium. https://events.keratoconusacademy.com/event/0547cdcb-a90d-410b-a721-39365e4c77c9/websitePage:645d57e4-75eb-4769-b2c0-f201a0bfc6ce. Accessed March 22, 2024.
- Class: The Cornea & Contact Lens Advancing Skills Symposium. https://www.classsymposium.com/. Accessed March 22, 2024.
- Collaborative Care Symposium. https://collaborativecaresymposium.com/. Accessed March 22, 2024.
- Doctor resources for treating keratoconus. https://nkcf.org/doctor-resources-for-treating-keratoconus/. Accessed March 22, 2024.
- Global Specialty Lens Symposium. https://na.eventscloud.com/website/53661/future-symposiums/. Accessed March 22, 2024.
- GPLI: keratoconus/post-surgical. https://gpli.info/keratoconus-post-surgical/. Accessed March 22, 2024.
- Harthan JS, et al. Eye Contact Lens. 2024;doi:10.1097/ICL.0000000000001072
- iDetective. https://www.idetectives.com/resources/. Accessed March 22, 2024.
- International Congress of Scleral Contacts 2024. https://icscmeeting.com/. Accessed March 22, 2024.
- International Keratoconus Academy of Eye Care Professionals. https://www.keratoconusacademy.com/. Accessed March 22, 2024.
- Scleral Lens Education Society. https://sclerallens.org/. Accessed March 22, 2024.
- The definitive guide to corneal topography. https://www.revieweducationgroup.com/ce/the-definitive-guide-to-corneal-topography. Published Sep. 15, 2023. Accessed March 22, 2024.
For more information:
John Gelles, OD, FAAO, FIAOMC, FCLSA, FSLS, FBCLA, is director of the specialty contact lens division at the Cornea and Laser Eye Institute-Hersh Vision Group and the CLEI Center for Keratoconus in Teaneck, New Jersey. He also is clinical assistant professor in the department of ophthalmology at Rutgers New Jersey Medical School.
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