Eyeworld

Name of Ad Page number 3 3 K eratoconus (KC) is a progressive corne- al ectatic disease that alters the corne- al collagen structure, leading to irregu- lar astigmatism, corneal thinning, and vision loss. The prevalence of KC has generally been accepted to be approximate- ly 1 in 2,000. 1 Recent evidence suggests that KC prevalence in certain populations could be higher if screening with advanced diag- nostic tools like tomography were routinely performed. 2 The onset of KC typically occurs during puberty, but the disease can mani- fest earlier in childhood or, conversely, may be detected much later in life. Untreated, keratoconus progresses over time, particu- larly during the first four decades of life, but the rate of progression is variable. Histori- cally, up to 20% of cases have progressed to the point of needing a corneal transplant. 3 Young patients with KC tend to experience the most rapid progression. 4-6 Sustainable results of cross-linking in kera- toconus has been shown through 10 years of follow-up of a single cohort of the pivot- al trial, with 81.8% having stable topography 10 years after cross-linking with iLink. 7 The iLink Cross-Linking System (Photrexa Vis- cous [riboflavin 5'-phosphate in 20% dextran ophthalmic solution], Photrexa [riboflavin 5'-phosphate ophthalmic solution] and the KXL system) [Glaukos]) is the only FDA-ap- proved treatment to slow or halt the pro- gression of progressive KC; 8 thus, it is the only corneal collagen cross-linking proce- dure that is covered by patient's insurance. Cross-linking with iLink can result in signif- icant savings for patients of nearly $44,000 over their lifetime, including direct costs and lost productivity. 9 By reducing the number of years patients spend in the advanced stag- es of KC and reducing the rate of penetrat- ing keratoplasty, this translates into a nation- al cost savings of between $150 million and $736 million. 9 Early diagnosis and treatment of progres- sive KC is critical to preserve vision and cor- neal stability. Research suggests that treat- ing patients younger than 18 within 6 weeks of diagnosis and adults (18 years and older) within 12 weeks is ideal. 4 This white paper reviews 10 best practic- es in the management of KC and provision of cross-linking, reflecting the wisdom of dozens of successful cross-linking providers who have shared their experiences with the authors. When implemented, these strat- egies will help to ensure diagnosis early in the disease course, facilitate timely treat- ment, instill confidence in referring clinicians, and, ultimately, result in better patient out- comes. Shared learnings suggest first opti- mizing your internal practice patterns prior to expanding your referral efforts. Introduction

• Cover