Eyeworld

FALL 2026 | EYEWORLD | 25 EYEWORLD JOURNAL CLUB by the John A. Moran Eye Center ophthalmology residents and Rachel Simpson, MD, Vice Chair of Education central corneal thickness (CCTmin), and total root mean square wavefront aberration. Patients were evaluated at several early postoperative visits, then approximately annually through a maximum of 60 months. The statistical approach deserves particular attention. Because outcome distributions were nonparametric and sample sizes became smaller at later intervals, the investigators used paired Wilcoxon signed-rank tests to compare each postoperative timepoint with baseline. Impor- tantly, the baseline comparator at each interval consisted only of eyes that actually contributed data at that particular postoperative timepoint. Thus, the 60-month comparison was between the 45 eyes returning at 60 months and those same 45 eyes at baseline—not between the full baseline cohort and the 60-month cohort. The authors appropriately emphasize that these analyses should not be interpreted as a conven- tional fixed-cohort repeated-measures trajectory. Results The study included 243 eyes from 193 patients; 50 patients underwent bilateral CXL. Mean age at intervention was 24.2 years, and 80 eyes were from pediatric patients. Follow-up de- clined sharply over time: 202 eyes remained at 12 months, 139 at 24 months, 76 at 36 months, 52 at 48 months, and only 45 at 60 months. Thus, while the study technically contains "5- year data," only 18.5% of the original cohort contributed to the 5-year analysis. Overall CDVA improved from a baseline mean of approximately 0.31 logMAR and re- mained statistically better than baseline through 60 months. CCTmin decreased substantially during the first 2 postoperative years, followed by partial rethickening, although values re- mained below baseline at 5 years. Kmax showed its greatest flattening during the first 2 years. The reduction remained statis- tically significant through 48 months but was no longer statistically different from baseline at 60 months. At 12 months, 79.7% of eyes had a lower Kmax than baseline, 18.8% had an in- crease, and 1.5% were unchanged. Twenty-one eyes, or 10.3%, demonstrated worsening of Kmax by more than 1 D at 12 months. Review of "Long-term outcomes of corneal crosslinking for keratoconus across pediatric, adolescent, and adult populations in a diverse U.S. population" 1 C orneal crosslinking (CXL) has funda- mentally changed the management of progressive keratoconus by provid- ing a treatment intended to alter the natural history of disease rather than simply rehabilitate vision. The clinical rationale for treatment may be particularly compelling in children and adolescents, who tend to present with more aggressive disease and may expe- rience faster progression than adults. Howev- er, the long-term evidence base in pediatric patients remains less robust than that in adults, particularly in North American populations. The authors therefore sought to evaluate visual and tomographic outcomes following epithelium-off CXL across pediatric, young adult, and adult age groups in a racially and ethnically diverse U.S. population. This retrospective cohort study included 243 eyes from 193 patients treated at a single tertiary academic center. Eighty eyes, or ap- proximately one-third of the cohort, were from patients younger than 18 years. The primary clinical value of the study is its relatively large pediatric cohort and availability of follow-up extending as long as 5 years, although—as becomes important statistically—only a small minority of the original cohort remained under observation at the final timepoint. Methods The authors retrospectively reviewed patients undergoing standard epithelium-off CXL using the Dresden protocol between January 2017 and May 2023. Progressive keratoconus was defined as at least a 1.0 D increase in maximum keratometry (Kmax) over 12 months. Patients with severe scarring or advanced disease were excluded. A minimum of 12 months of postoper- ative follow-up was required for inclusion. Outcomes included corrected distance visual acuity (CDVA), keratometry, minimum EyeWorld Journal Club review continued on page 26 Reference 1. Chen KM, et al. Long-term outcomes of corneal crosslinking for keratoconus across pediatric, adolescent, and adult popula- tions in a diverse U.S. population. J Cataract Refract Surg. 2026. Online ahead of print.

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