Eyeworld

84 | EYEWORLD | MARCH 2021 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians Ken Beckman, MD Comprehensive EyeCare of Central Ohio Westerville, Ohio William Trattler, MD Center for Excellence in Eye Care Miami, Florida Relevant disclosures Beckman: Glaukos Trattler: Glaukos, CXLO, Oculus W hen considering keratoconus, one of the most important as- pects of the disease is screening and early diagnosis before being able to treat patients. William Trattler, MD, said young patients may begin to show signs of keratoconus. Even those under age 8 may show signs on topogra- phy, he said, noting that he's observed topo- graphic signs in patients as young as 5 years old. There's no hard rule as to when a screening topography should be performed, Dr. Trattler said, so the decision to perform topography is based on the eyecare provider's suspicion that keratoconus may be present. Dr. Trattler said you might want to consider performing a screening topography in anyone developing changes in his or her prescription. If you wait for patients to experience vision loss or show signs on the slit lamp exam, they likely will have advanced keratoconus at that point. Dr. Trattler evaluates the corneal shape with topography and tomography. Topography, which images the front surface of the cornea, is effective at identifying keratoconus. Tomogra- phy evaluates both the front and back surfaces of the cornea and in some cases may identify keratoconus earlier, he added. Dr. Trattler recommended an annual screen- ing for patients with borderline findings of keratoconus on topography to keep tabs on whether they have any signs of keratoconus and/or if they are progressing. Crosslinking is effective at stopping the progression of keratoconus, which if caught and treated early enough can prevent signifi- cant vision loss. Crosslinking is currently FDA approved for ages 14 and older, but Dr. Trattler said he has treated some younger patients with keratoconus. He said he thinks keratoconus screening as a whole could be significantly improved, as many patients get diagnosed with moderate to severe disease. Patients interested in refractive surgery including LASIK undergo topography screening, and a surprising number of patients with keratoconus are identified. If patients returning for their annual checkups for contact lenses were screened, it's likely many patients would be identified with keratoconus and at an earlier stage than is happening now. "Stud- ies looking at the incidence and prevalence of keratoconus have found a much higher percent- age of patients with keratoconus than people realize," he said. Ken Beckman, MD, agreed that early diagnosis for these patients is key. "While the incidence has been described as 1 in 2,000, it now appears to be much higher," he said. "The key to managing these patients is early Keratoconus screening in the U.S. Pre-treatment keratoconus in a 23-year-old male Post-treatment keratoconus in the same patient at 1 year

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