Clinical Scorecard: The Anatomy of Disagreement
At a Glance
| Category | Detail |
|---|---|
| Condition | Keratoconus and Ectatic Diseases |
| Key Mechanisms | Consensus on diagnosis, staging, and treatment options including cross-linking and keratoplasty. |
| Target Population | Patients with keratoconus and ectatic diseases. |
| Care Setting | Ophthalmology clinics and surgical centers. |
Key Highlights
- New staging system for keratoconus based on Belin ABCD grading.
- CXL confirmed as standard of care for stabilization at all stages.
- DALK recommended as preferred keratoplasty method.
- First consensus guidance on cataract surgery in keratoconus.
- Disagreement on definitions and metrics for progression.
Guideline-Based Recommendations
Diagnosis
- Use abnormal steepening of anterior and/or posterior surface as major criterion for diagnosis.
Management
- CXL is a valid option for thin corneas below 400 µm stromal thickness.
Monitoring & Follow-up
- Close monitoring for eyes with findings justifying suspicion of keratoconus.
Risks
- Current evidence for adjuvant therapies insufficient; should not replace CXL.
Patient & Prescribing Data
Individuals diagnosed with keratoconus or suspected keratoconus.
CXL remains the primary treatment; adjunct therapies are not recommended as replacements.
Clinical Best Practices
- Display zonal keratometry and anterior/posterior radii of curvature on diagnostic devices.
- Utilize biomechanical assessment as an adjunct in refractive surgery screening.
Related Resources & Content
- Global Consensus on Keratoconus and Ectatic Diseases
- Belin ABCD Grading System
- Randleman et al. Review on Metrics
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