Eyeworld

Name of Ad Page number 10 10 Our message is simple: Send any patients who have KC, are suspected of having KC, or even have high astigmatism. It's my job to make the determination of whether a patient is progressing. — Br andon Ba artman, MD it is to visit practices and pro- vide updates on cross-link- ing and other referral servic- es for their patients. These staff members can be lev- eraged to educate referring doctors on specific types of patients or red flags that should prompt a referral. Information can be tailored to the diagnostic tools avail- able in each office. Glau- kos provides several useful detection and referral tools such as handy "cheat sheets" designed to be kept near the autorefractor or topographer. Visit www.idetectives.com/ resources to order these resources. The National Kera- toconus Foundation also pro- vides educational content to patients and to practices for their patients, including bro- chures, webinars, and a pod- cast; their website can be vis- ited at https://nkcf.org/. Among the points to con- vey in referral source educa- tion are reassurances that patients will be returned to referring doctors for post-treatment care, expect- ed healing and potential com- plications af ter cross-linking, pro- visions for annu- al topography, and alignment on the timing and expectations around shared care. Empower- ing primary care clinicians to rec- ognize warning signs for kerato- conus is critical to ensuring that patients are diagnosed earlier in the course of their disease. Personal phone calls or visits by the cornea special- ist can be very impactful in building trust. It is very impor- tant to follow up with refer- We strongly encourage collaborative management of KC patients with optometrists. Patients will need glasses, contact lenses and ongoing follow-up care that the surgeon doesn't have the time to provide. — Kathryn Hatch, MD Educate referral sources about these early KC clues: + Unusual autorefractor reading + Increasing or unusual astigmatism + Visual quality complaints + Unusual keratometry + Topographic irregularities + Contact lens considerations + Family history & genetics + Eye rubbing and ocular allergy + Down syndrome + Connective tissue disorders + Retinoscopy and ophthalmoscopy signals + Abnormal slit lamp examination Scan here for the idetectives toolkit ring doctors to provide notes about exam findings and cross-linking decisions. Pro- active and respectful com- munication will instill confi- dence that patients can be sent for consultations with- out being lost to the referring doctor. Inviting new referral sources to observe an iLink case or a corneal consult to learn more about the proce- dure and the patient experi- ence can also be helpful. A low threshold to refer should be encouraged, with the approach that, "When in doubt, refer out." Most experts now find that, rather than trying to provide a list of criteria for progression, it is more effective to ask referral sources to refer any patient with known or suspected KC for a corneal consult, even if they believe the KC is stable. Once the patient has permanently lost vision or has scarring, there is already a missed opportu- nity to achieve optimal out- comes. Referrals of young patients with high or changing astig- matism should be specifi- cally requested. About 90% of young corneas have with- the-rule (WTR) astigmatism, 15 so referrals of children with oblique astigmatism should also be encouraged. The iDe- tectives Toolkit (www.ide- tectives.com) can provide referring doctors with help- ful information about other common red flags (see side- bar). A broad-minded approach

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